Data collection on health indicators at sub-national level


In health monitoring, the exchange of health indicators at regional level across Europe allows health professionals and decision-makers to place their own region within the wider context of all other regions across the EU.

A set of regional (or sub-national) health indicators for the EU have been developed by the ISARE project and by Eurostat in order to fix objectives in health. These regional health indicators should adhere to standard definitions and methodologies in order to be comparable.

Socio-health regions are defined in very different ways from one regional, provincial or local government to another, and from one Member State to another. With regional governments becoming more important, the regions are also increasingly important in Europe as units for the political and administrative management of health issues. In Spain, for example, regional governments manage the whole of their health budget themselves. The situation is very similar in Belgium.  France's healthcare reform in 1996, introduced to put healthcare planning on a regional footing, allowed hospitals to be responsible for allocating these budgets. Healthcare management is also being drastically reorganised in the United Kingdom, with NHS trusts having varying levels of responsibility. In other Member States, such as the Netherlands and Sweden, the municipalities are responsible for healthcare.

The difficulty with statistics on health at regional level stems from the fact that regional, provincial or local government statistics or the breakdown by region which is of interest to health authorities in the Member States sometimes do not tally with the NUTS (Nomenclature des Unités Territoriales Statistiques) classification, use of which is compulsory in the EU, and problems may arise with cross-referencing to compare regional statistics.

The ISARE project

The ISARE ( Indicateurs de Santé pour les Régions de l'Europe) project made a recommendation on appropriate "health regions" for 13 of the EU Member States. These are shown in the table, together with the corresponding NUTS level (or its nearest equivalent).

Table 3: Selected Isare Health region and NUTS level
Recommended Health Region
NUTS level
Government office regions
Hospital Distcricts
Health regions (regroupées)
Health Board
National Level
Health Care Region
Autonomous Communities

The recommended levels comprise of 300 health regions across 13 countries. The average  population size is around 1.2 million, with considerable variations. All recommended levels have responsibilities in the field of health promotion and all but one carry out  the function of public-health reporting.

The availability of key data at regional level was examined by means of a questionnaire based on the European Community Health Indicators (ECHI) project. The ISARE suggested that despite disparities between the recommended "health regions", the exchange of health indicators is feasible. Virtually all recommended levels are already involved in public-health reporting. The ISARE project's approach consisted in identifying one level in each country according to a set of criteria. These "health regions" appear to be the best compromise for ensuring an effective exchange of health information at sub-national level within the EU.

On the ISARE short listpdf(2 MB) Choose translations of the previous link français (fr) , the 17 variables surveyed for all the regions of a given country were grouped into eight subject-area. The ISARE long listpdf(2 MB) Choose translations of the previous link français (fr) of the data collected for the selected region in each country includes the 17 variables above, plus a further 21 variables.

ISARE project made a useful contribution towards understanding the role of "health regions", and fostering their use as units for the exchange of health indicators.

See ISARE-1 Final Report
See ISARE-2 Final Report
See ISARE-3 Project

Regional health data in Eurostat

Regional health statistics for the EU are drawn up by Eurostat to help to fix objectives in the field of health. They are based on standardised definitions and methods which aim to make comparisons possible. If they are to yield high-quality comparable information on the general health of the population, the data will have to be comparable from one region to another and reflect changes over time. In addition, the main non-medical factors governing the health of the population at regional level must be taken into account.

Currently, Eurostat regional-level health statistics cover three major areas at Nuts 2 level. On the one hand, there are data on mortality (Standardised death rate per 100 000 inhabitants, 3 years average) by underlying causes, where the illnesses or diseases in question are defined according to an international classification and where data are collected using comparable methods:

            - All causes of death
            - Death due to cancer
            - Death due to ischaemic heart diseases
            - Death due to accidents
            - Death due to transport accidents.

Eurostat also collects health-sector data on infrastructure (e.g. available beds in hospitals per 100 000 inhabitants), on staffing in the health sector (e.g. number of physicians or doctors per 100 000 inhabitants and dentists).

See Eurostat 'Regions: Statistical Yearbook 2006' Chapter on health pages 120-129

See Eurostat 'Atlas of Mortality in the European Union' 2009

The Regions for Health Network (RHN)

The Regions for Health Network (RHN) is organised through the WHO Regional Office for Europe. Networks are one of the main resources and strongest WHO assets for promoting and protecting health, and for reducing the widening gaps in states of health both between and within countries.

Important preparatory work towards a joint dataset has already been achieved by the Network through the development of a Common Minimum Indicator Setpdf, a project led by the Landesinstitut für den Öffentlichen Gesundheitsdienst NRW.

This joint information project aimed at a geographical information system with an integrated tool for analysis. The "Health for All (HFA) Database" developed by the WHO Regional Office for Europe, was  used as a basis. With the HFA database interfaces for data integration established, it would be possible for the regions to integrate their data in a standardized way into the database. The data/indicators of other regional database projects, e.g. ISARE, should be compatible with the system.