A review of the use of health examination data from the Health Survey for England in government policy development and implementation

Abstract

BackgroundInformation is needed at all stages of the policy making process. The Health Survey for England (HSE) is an annual cross-sectional health examination survey of the non-institutionalised general population in England. It was originally set up to inform national policy making and monitoring by the Department of Health. This paper examines how the nurse collected physical and biological measurement data from the HSE have been essential or useful for identification of a health issue amenable to policy intervention; initiation, development or implementation of a strategy; choice and monitoring of targets; or assessment and evaluation of policies.MethodsSpecific examples of use of HSE data were identified through interviews with senior members of staff at the Department of Health and the Health and Social Care Information Centre. Policy documents mentioned by interviewees were retrieved for review, and reference lists of associated policy documents checked. Systematic searches of Chief Medical Officer Reports, Government ‘Command Papers’, and clinical guidance documents were also undertaken.ResultsHSE examination data have been used at all stages of the policy making process. Data have been used to identify an issue amenable to policy-intervention (e.g. quantifying prevalence of undiagnosed chronic kidney disease), in strategy development (in models to inform chronic respiratory disease policy), for target setting and monitoring (the 1992 blood pressure target) and in evaluation of health policy (the effect of the smoking ban on second hand smoke exposure).ConclusionsA health examination survey is a useful part of a national health information system.

European health examination surveys – a tool for collecting objective information about the health of the population

“…Decision-making on health-related policies, including setting up new legislation and regulations, requires strong evidence-based support. For example in Finland and the UK [ 48 ], information about exposure to second-hand cigarette smoke obtained from national HESs was used to support smoking legislation and also to monitor the effects after the legislation was in force. HES data have also been used to evaluate the potential to reach goals set in the WHO Global Action Plan for Prevention and Monitoring on noncommunicable diseases [ 49 – 52 ].…”

Chronic obstructive pulmonary disease: missed diagnosis versus misdiagnosis:

“…The health survey has been undertaken annually since 1991, 26 and its data are used to help design appropriate healthcare programmes for the UK. 27 The triangular area in the right of both plots represents people with airflow obstruction diagnosed by GOLD criteria but not by LLN (false positives). This triangle is larger in men than women.…”

The first Portuguese National Health Examination Survey (2015): design, planning and implementation

“…Health examination surveys, in which the information collected by a detailed questionnaire is complemented with objective information measured by physical examination and laboratory tests on biological samples, provide accurate and better quality information. 4,5 In Portugal, none of the population-based epidemiological studies already performed [6][7][8] have followed the standardized methods of the European Health Examination Survey (EHES), [9][10][11] ensuring international comparability. The only previous experience conducted in Portugal was the EHES pilot project in 2009-10 developed in Algarve, which comprised a sample of 221 individuals aged 25 years or more.…”