Use of the Health Survey for England in policy making and monitoring

Abstract

BackgroundInformation is needed at all stages of the policymaking process, but data from routine sources for objective measures of health and risk factors are scarce. The Health Survey for England (HSE) is an annual, cross-sectional health examination survey of the free-living general population in England. It was originally set up to inform national policy making and monitoring by the Department of Health. The aim of this project was to identify specific examples of when the use of the measurements and samples, gathered as part of the survey examination, have been useful or essential in: identification of a health issue amenable to policy intervention; initiation, development, or implementation of a strategy; choice and monitoring of targets; or assessment and review of policies. MethodsSpecific examples of use of HSE data were identified through interviews with senior members of staff at the Department of Health and at the Health and Social Care Information Centre, and through systematic searches of Chief Medical Office reports, Government White Papers, and clinical guidance documents. Interviewees were recruited through advertising, and snowballing was used to reach additional staff. Policy documents referred to by interviewees were retrieved for review, and reference lists of associated policy documents were checked. FindingsReports and publications of HSE data have informed policy for tobacco control, obesity, respiratory disease, chronic kidney disease, diabetes, and other issues. HSE data have been used in all stages of policy making and monitoring. For identification of an issue, measurement of serum creatinine and ratio of urine albumin to creatinine were used to assess the national general population prevalence of chronic kidney disease for the first time, and showed underdiagnosis of this disease. This issue, highlighted to government, inspired action to tackle this problem. HSE provided measured height and weight data used to forecast future trajectories of obesity and quantify the magnitude of this problem in the Foresight report. In strategy development, height and weight measures were the basis for calculation of excess calorie intake by the population, used to set a target in the so-called Responsibility Deal. Risk factors for cardiovascular disease were used in economic modelling for the vascular risk checks. For monitoring, government targets for a population fall in systolic blood pressure of 5 mm Hg by 2005, were based on HSE data, and subsequently monitored through HSE data that showed achievement of this target. For assessment, HSE salivary cotinine data were used to assess the effect of the smoke free legislation on passive smoking in the children of smokers, showing that the then minister's concerns that smokers who were unable to smoke at work would expose children to more smoke at home were unfounded. Other specific examples will be presented. InterpretationThis work presents how academic public health can affect the health of the national population through provision of the evidence-base for policy making and monitoring. Collation of these examples emphasises the usefulness of a health examination survey and shows to policy makers ways in which they can use such data sources to bring the evidence base into their work. FundingNone.