Proposal for the future operationalisation of GALI in social surveys

Transcription

1 EUROPEAN COMMISSION EUROSTAT Directorate F: Social statistics Unit F-5: Education, health and social protection DOC 05-PH-03 Proposal for the future operationalisation of GALI in social surveys Meeting of the Public Health Statistics Working Group Luxembourg, 6-7 November 05 Bech Building Room Quetelet

2 Proposal for the future operationalisation of GALI in social surveys. INTRODUCTION The purpose of the paper is to give an overview of recent activities and their results related to the Global Activity Limitation Indicator (GALI) variable and efforts on its improvement in the context of modernisation of EU social statistics. The document briefly introduces in section activities on the improvement of GALI and standardisation of social variables. It presents in section 3 the discussion and Eurostat proposal on future operationalisation of GALI in social surveys. The members of the Public Health Statistics Working Group are expected to: Take note and comment on the activities on the improvement of GALI including the GALI Task Force and Eurostat study on testing GALI. Comment on the methodological guidelines (standard sheets) for GALI and Selfperceived health (SPH) as proposed by Eurostat after the consultation of TG HIS in October 05 (see Annex and Annex ).. GALI IN THE CONTEXT OF THE MODERNISATION OF SOCIAL STATISTICS.. Activities on the improvement of GALI The current data availability at European level clearly does not allow for a regular, comprehensive and harmonised monitoring of the situation of the persons with disabilities. The need for such regular analysis of the situation of disabled people, regarding for instance the Europe 00 targets, calls for the introduction of an identifier of people with disabilities in all ESS surveys. Therefore, in the context of the modernisation of social statistics and because of this need for more EU-harmonized data on health and disability, Eurostat recommended two improvements in this area: the introduction of GALI and self-perceived health (SPH) as core social variables (with the focus on the Labour Force Survey), and further harmonisation and improvement of GALI. DSS agreed in November 03 that Eurostat initiates further methodological work to improve GALI with the help of a dedicated Task-Force. The objective of the Task-Force on GALI was to propose ways to improve the acceptance and robustness of GALI, and to harmonise it further. The Task-Force met twice in September 04 and in May 05 and the results of its work are summarized in the final report which reviews the state of art of the implementation of GALI at national level, reviews the quality of GALI from a general methodological and implementation point of view and from specific country experience, and finally provides recommendations for the improvement of GALI and disability measurement. In addition, and based on a recommendation of the Task-Force to facilitate its work, Eurostat conducted a qualitative study on cognitive testing of different split (routed) That is variables included in all social surveys. Annex of Document DSS/05/Sept/04.3: Final report of the Task-Force on the Global Activity Limitation Indicator

3 versions of GALI in three languages (English, German and French). The objectives of the study were: to evaluate the quality of different versions of GALI in three languages, to evaluate the quality of different versions of GALI in different modes of data collection, to assess the impact of proxy on GALI results, and to formulate recommendations on how the current GALI could be improved and how the possible impact of different survey arrangements could be minimised. Main results of the study helped the formulation of recommendations by the Task-Force and were presented in its final report. Results of the Task-Force were presented to the Labour Market Statistics Working Group (LAMAS WG) in June 05, to the DSS in September and to the Technical Group HIS in October 05. These groups welcomed both activities, even though not all recommendations were supported by all Member States. DSS recognised that comparable data on disability is a priority. It also concluded that the inclusion of GALI together with self-perceived health in the Labour Force Survey would be a possible compromise and supported the discussion of the results of activities on the improvement of GALI in the relevant Working Groups, including the recommendation on technical implementation of GALI and SPH... Standardisation of social variables The project on standardisation of social variables is part of the process of the modernisation of social statistics and is closely linked to the work on the IESS Framework Regulation. It aims at providing common definitions and descriptions for variables which would be collected in at least two social micro-data collections concerning households or persons. GALI and SPH are among these variables for which detailed methodological guidelines (called standard sheets) are to be prepared. Standard sheets will complement IESS framework regulation and the subordinate legislation but will serve only as guidance without any legal obligation for Member States. Standard sheets have common structure and include: variable name and definition, category concept, implementation guidelines and reference (or model) question. Standard sheets for GALI and SPH were compiled by Eurostat and approved by majority of GALI Task Force members. They were presented to and discussed with the TG HIS in September 05 and sent for internal consultation in Eurostat. The revised version of standard sheets is presented to WG PHS (see Annex and Annex ). It will be sent for comments to all Working Groups concerned with the standardisation of social variables in the first half of 06. 3

4 3. PROPOSAL FOR FUTURE OPERATIONALISATION OF GALI IN SOCIAL SURVEYS Currently used model question for collecting data on GALI was originally developed as a single-question instrument by the Euro-REVES project 3. This single question was recommended for being implemented in SILC and EHIS since 003. However, following concerns about the length and complexity of the single-question version (four concepts in one question) and experience with its implementation, several studies aiming at simplifying and improving GALI were carried out. The Eurostat study tested and recommended a routed, two-question version. This routed version aims at making GALI better and easier to understand for respondents, in particular in telephone interviews and self-administered questionnaires. The wording of the routed version is as follows: Q: Are you limited because of a health problem in activities people usually do? Would you say you are. severely limited. limited but not severely, or 3. not limited at all? Q: Have you been limited for at least the past 6 months?. Yes. No GALI Task Force considered pros and cons 4 of the current single-question instrument and of the routed version and recommended continuing using single-question instrument, i.e. not introducing any change in the operationalisation of GALI in SILC and EHIS. However, it also stated that a routed version could facilitate the implementation of the variable in the LFS and other ESS surveys. Eurostat discussed the recommendations of GALI Task-Force with TG HIS in September 05. Concern was expressed about having different operationalisation of GALI in different surveys (EHIS, SILC and LFS). Several Member States supported a routed GALI version for future EHIS, and more generally for EU surveys where GALI is implemented. Based on the results of this discussion, Eurostat launched a written consultation of TG HIS on the preferred option for GALI in future. The proposal listed two options: Option : Implement the current single-question version of GALI in all relevant social surveys The main advantage of this option is that it ensures the stability of GALI within SILC and EHIS and avoids in particular breaks in time series. The single-question GALI was validated in a number of studies and surveys in several Member States. On the other hand, there are persisting concerns on the length and complexity of this GALI version, particularly for telephone interviews. Option : Implement a routed, two-questions version of GALI in all relevant social surveys The main advantage of this option, which was a result of the recent GALI study and task-force, is that a two-question version is considerably easier to understand 3 4 The wording of the question and the answer categories are: For at least the past 6 months, to what extent have you been limited because of a health problem in activities people usually do? Would you say you have been. severely limited,. limited but not severely or 3. not limited at all? For more details see Annex of Document DSS/05/Sept/04.3: Final report of the Task-Force on the Global Activity Limitation Indicator, pages

5 for respondents, in particular during telephone interviews and for selfadministered questionnaires, as each of the two questions is shorter and less complex. However it could potentially introduce a break in series for GALI as well as for the main related indicators in EHIS and SILC. The options were accompanied by important explanations about the timing of the implementation of future GALI and actions which would take place before such implementation. The standardization of the variables is intended to be implemented together with the IESS Regulation and is therefore only a mid- to longer-term perspective, from 09 onwards at the earliest. It would also mean that, should the second option is agreed on: Quantitative testing of the routed GALI would be necessary, in different surveys and for different modes and other survey conditions; A study on the relation between relevant versions of GALI (including option and ) would be desirable to develop methods for adjusting for changes in GALI versions in order to minimise effects of breaks in time series. Overview of the results of the consultation is provided in the following table 5 : Option Votes of Member States? 8 MS (BE, BG, HR, HU, NL, SE, SK, UK) other country (CH) MS (AT, CY, DE, EL, FI, IT, LT, LU, PL, PT, RO, SI) 3 other countries (NO, TR, XK) 6 MS (DK, EE, ES, IE, LV, MT) without response; MS (CZ, FR) with no clear preference other countries (IS, RS) without response. The results show a slightly prevailing preference of TG HIS for the routed version of GALI. This provided a new perspective in the debate on the operationalisation of GALI by health surveys experts. Eurostat considered the results of the consultation and revised the standard sheet for GALI and proposes option (routed version) to be implemented in all relevant EU social surveys within the IESS framework regulation (see Annex ). The revised proposal would be better aligned with the efforts for high level of harmonisation among surveys and also facilitate the implementation of GALI in all social surveys. It should be noted that: Standard sheets serves as methodological guidelines to ensure high level of harmonisation; but are not binding for Member States; Standard sheets will be finalized and provided for implementation only in midterm, that is in 09 at earliest; Further methodological work will precede finalization of standard sheets. In case of GALI, quantitative testing of the routed GALI and developing methods for adjusting for changes in GALI version are envisaged in different surveys and for different modes and other survey conditions; EHIS wave 3 (09) could be used for performing tests in order to assess the impact of using option. 5 Answers received from countries as of 6//05 are provided in Annex 3. 5

6 ANNEX : STANDARD SHEET FOR LIMITATION IN ACTIVITIES BECAUSE OF HEALTH PROBLEMS VARIABLE Name of the variable Limitation in activities because of health problem (Global Activity Limitation Indicator - GALI) Scope The social micro-data collections concerned are EU-SILC, EHIS and EU-LFS Variable definition Reporting unit Individuals Filter None Concept Participation restriction through long-standing limitation (and its severity) in activities that people usually do because of health problems It measures the respondent s self-assessment of whether he/she is limited (in "activities people usually do") by any on-going physical, mental or emotional health problem, including disease or impairment, and old age. Consequences of injuries/accidents, congenital conditions and birth defects, etc., are all included. Only the limitations directly caused by or related to one or more health problems are considered. Limitations due to financial, cultural or other none health-related causes should not be taken into account. An activity is defined as: the performance of a task or action by an individual and thus activity limitations are defined as the difficulties the individual experience in performing an activity'. People with longstanding limitations due to health problems have passed through a process of adaptation which may have resulted in a reduction of their activities. To identify existing limitations a reference is necessary and therefore the activity limitations are assessed against a generally accepted population standard, relative to cultural and social expectations by referring only to activities people usually do. Usual activities cover all spectrums of activities: work or school, home and leisure activities; self-care (bathing, dressing, etc.), communication (speaking, hearing, talking, etc.), walking or using transportation are also to be included. The purpose of the variable is to measure the presence of long-standing limitations, as the consequences of such long-standing limitations (e.g. care, dependency) are more serious. Temporary or short-term limitations are excluded. The period of at least the past 6 months is strictly related to the duration of the activity limitation and not to the duration of the health problem. The limitations must have started at least six months ago and still exist at the moment of the interview. This means that a positive answer ("severely limited" or "limited but not severely") should be recorded only if the person is currently limited and has been limited in activities for at least the past 6 months. 6

7 New limitations which have not yet lasted 6 months but are expected to continue for more than 6 months shall not be taken into consideration, even if usual medical knowledge would suggest that the health problem behind a new limitation is very likely to continue for a long time or for the rest of the life of the respondent (such as for diabetes type ). One reason is that in terms of activity limitation it may be possible to counteract at some point negative consequences for activity limitations by using assisting devices or personal assistance. The activity limitations of the same health problem may also depend on the individual person and circumstances, and only past experience can provide a safe answer. Sources:. Eurostat. European Health Interview Survey (EHIS wave ) - Methodological manual, 03 edition. Eurostat. Methodological guidelines and description of EU-SILC target variables, 05 operation (version November 04) Category concept The response categories include 3 levels to better differentiate severity of activity limitations: severely limited (severe limitations), limited but not severely (moderate limitations), not limited at all (no limitations). Severely limited means that performing or accomplishing an activity cannot be done or only done with extreme difficulty. Persons in this category usually cannot do the activity alone and would need further help. Limited but not severely means that performing or accomplishing a usual activity can be done but only with some difficulties. Person in this category usually do not need help from other persons. When help is provided it is usually less often than daily. People with recurring or fluctuating health conditions should refer to the most common (frequent) situation impacting their usual activities. People with conditions where several activity domains are affected but to different extent (less impact in some domains but more impact in some other domains) should make an overall evaluation of their situation and prioritize more common activities. Categories for the variable The following standard categories are recommended for data transmission. Limitation in activities because of health problems Severely limited Limited but not severely Not limited at all Not stated 7

8 Implementation guidelines The question corresponding to the variable should not be filtered by any preceding question. A proxy interview for the variable should be limited but is possible (it should always be indicated if the question was answered by the respondent or proxy respondent). Proxy interviews should be restricted to persons living together or being in daily contact with the originally selected respondent. This variable is part of the Minimum European Health Module (MEHM). MEHM consists of two more variables on health status: 'Self-perceived general health' and 'Longstanding health problem'. If the MEHM is implemented, all the questions should be asked in the recommended order (Self-perceived general health, Long-standing health problem, Limitation in activities because of health problems) and with no inclusion of any other health status related questions before or between MEHM questions as it could have impact on results. MEHM, or a part of it, could be introduced to respondents using a short introduction: I would now like to talk to you about your health. The question should clearly show that the reference is to the activities people usually do and not to respondent s own activities. Neither a list with examples of activities nor a reference to the age group of the subject is included in the question. As such it gives no restrictions by culture, age, gender or the subjects own ambition. Specification of health concepts (e.g. physical and mental health) should be avoided. In an interview mode, all possible answer categories should systematically be read to respondents. Reference question The model question was originally developed as a single-question instrument by the Euro-REVES project. This single-question version was implemented in SILC and EHIS. However, following concerns about the length and complexity of the single-question version (four concepts in one question) and experience with its implementation, several studies aiming at simplifying and improving GALI were carried out. This led to the development of a routed, two-question version. This routed version aims at making GALI better and easier to understand for respondents, in particular in telephone interviews and self-administered questionnaires. The routed version is to be implemented in all EU social surveys, when relevant. The exact wording of the routed version of GALI is as follows: Q: Are you limited because of a health problem in activities people usually do? Would you say you are. severely limited. limited but not severely, or 3. not limited at all? Q: Have you been limited for at least the past 6 months?. Yes. No 8

9 ANNEX : STANDARD SHEET FOR SELF-PERCEIVED GENERAL HEALTH VARIABLE Name of variable Self-perceived general health Scope The social micro-data collections concerned are EU-SILC, EHIS and EU-LFS Variable concept Reporting unit Individuals Filter None Concept General health state The concept of self-perceived health is, by its very nature, subjective. The notion is restricted to an assessment coming from the individual and as far as possible not from anyone else, whether an interviewer, healthcare professional or relative. Self-perceived health might be influenced by impressions or opinions from others, but is the result after these impressions have been processed by the individual relative to his/her own beliefs and attitudes. The reference is to health in general rather than the present state of health, as the question is not intended to measure temporary health problems. It is expected to include the different dimensions of health, i.e. physical and emotional functioning, mental health (covering psychological well-being and mental disorders) and biomedical signs and symptoms. It omits any reference to age as respondents are not specifically asked to compare their health with others of the same age or with their own previous or future health state. Sources:. Eurostat. European Health Interview Survey (EHIS wave ) - Methodological manual, 03 edition. Eurostat. Methodological guidelines and description of EU-SILC target variables, 05 operation (version November 04) 3. World Health Organization, Statistics Netherlands. Health interview surveys: Towards international harmonization of methods and instruments. Copenhagen: WHO Regional Office for Europe. WHO Regional Publications, European, Series, n 58), 996. Category concept Five answers categories are proposed. Two (very good and good) are at the upper end of the scale and two (bad and very bad) are at the lower. It is also important to note that the intermediate category fair should be translated into an appropriately neutral term (neither good, nor bad), as far as possible keeping in mind cultural interpretations, in the various languages. 9

10 Categories for the variable Standard answer categories for the variable are defined as follows: Self-perceived general health Very good Good Fair Bad Very bad Not stated Implementation guidelines The variable is intended to be collected from individuals aged 5 years and more. The model question for the variable should not to be filtered by any preceding question. A proxy interview for the variable should be limited but is possible (it should always be indicated if the question was answered by the respondent or proxy respondent). Proxy interviews should be restricted to persons living together or being in daily contact with the originally selected respondent. This variable is part of the Minimum European Health Module (MEHM). MEHM consists of two more variables on health status: Long-standing health problem and Limitation in activities because of health problems) (also known as Global Activity Limitation Indicator). If the MEHM is implemented, all the questions should be asked in the recommended order (Self-perceived general health, Long-standing health problem, Limitation in activities because of health problems) and with no inclusion of any other health status related questions before or between MEHM questions as it could have impact on results. MEHM could be introduced to respondents using a short introduction: I would now like to talk to you about your health. Reference question The model question is recommended by the World Health Organization and the wording is as follows: How is your health in general? Is it very good, good, fair, bad, very bad. 0

11 ANNEX 3: OVERVIEW OF ANSWERS RECEIVED FROM TG HIS ON OPTIONS FOR FUTURE IMPLEMENTATION OF GALI Code Country Comments AT BE Austria Belgium Concerning GALI, Statistics Austria prefers option (routed question) of the standard indicator sheet. We agree on the standard indicator sheet for self-perceived health. Belgium (WIV-ISP) agrees on the need to collect disability-related information in all ESS social surveys and to include GALI as a core variable in LFS and in all other ESS surveys for that purpose. For what concerns the report of the GALI Task-force, Belgium has the following position: The report is too vague and leaving to many options open ; it will thus be diversely interpreted in the member states and this might be counterproductive as far as the standardisation throughout of Europe is concerned About recommendation (3): Belgium strongly advocates the use of a single-question instrument as the operationalization of GALI and to use this single-question instrument in all ESS surveys. Preferred option About recommendation (5): Belgium pleas for an inputharmonisation not only for the GALI question but also for all health related variables in EHIS, SILC and other ESS surveys. For what concerns your question to the EHIS technical group : Belgium is for the Option : Single-question GALI as currently included in EHIS and SILC BG Bulgaria Bulgarian NSI supports the Option : Implement the current singlequestion version of GALI in all relevant social surveys. We agree on the standard indicator sheet for self-perceived health. With reference on the above mentioned subject I would like to inform you on the following:. We agree on the standard indicator sheet for self-perceived health. As regards GALI, we support the second option for a routed, twoquestion variable. It has been identified that the existing single question is very complicated for the respondent to understand since many concepts are included in one question. Therefore, since the suggestion is to use the routed version for LFS in order to simplify the question, we suggest moving to the routed question for EHIS and SILC as well. CY Cyprus

12 Code Country Comments CZ DE DK EE EL ES FI FR HR HU IE IT Czech Republic Germany Denmark Estonia Greece Spain Finland France Croatia Hungary Ireland Italy As regards the GALI question, we agree that current concept (one question) is not the best one especially for some types of survey (telephone interview), but currently we do not have better one, I think. In the long-term perspective we would agree with Option - implementation of routed version, but this one should be based on appropriate study, which would investigate the best concept and wording of the questions (I am not sure that the routed version currently proposed in the sheet is the best one) and will perform the quantitative testing of the question. Before this I think that we cannot agree with change of the current concept of GALI. As regards SPH - why do we allow this question to be answered by proxy? Do we have clear idea for what types of proxy it should be allowed? I think at least minimum set of requirements should be mentioned (as for GALI at least) here as regards proxy. Thank you for the opportunity to comment on the future of the GALI question in EHIS. The German position still is that we prefer the routed instead of the single-item GALI question (option ). We agree with: - the proposal option : the single question of the GALI variable to be splitted into two more simplified questions for better understanding - on the standard indicator sheet for self-perceived health. For EHIS we support the option, routed version of GALI and agree on the SPH standard sheet As it is a mid- to longer-term perspective, we feel that there is no reason to decide this point in haste and that additional time should be given for consultation. Concerning GALI, Croatia prefers Option : Implement the current singlequestion version of GALI as currently included in EHIS and SILC. Croatia agree on the standard indicator sheet for self-perceived health. We support that GALI question(s) should be the same in all questionnaires, so if in LFS, Time Use Survey, etc. there will be a routed version for GALI variable, the same solution would be useful for EHIS and SILC as well. If you insist on the comparability in time regarding EHIS, you should use the question-model (although it is really complicated) in all relevant other surveys too. For me, the first version seems to be more reasonable. As for SPH, we agree on the standard indicator sheet. Istat supports the implementation of two health variables in all Social Surveys as Core variables, using input harmonization (the same questions in all surveys). It's also relevant to assure comparability across the countries. We agree on option : Implement a routed, two-questions version of GALI in all relevant social surveys (such as Silc and Ehis), after testing this new formulation including "bridge tests" to save time series. We agree on the standard indicator sheet for self-perceived health. Standard indicator sheet for GALI could be probably improved after tests, in particular in the implementation guidelines. Preferred option??

13 Code Country Comments LT LU LV MT NL PL PT RO SE Lithuania Luxembourg Latvia Malta Netherlands Poland Portugal Romania Sweden Statistics Lithuania supports option, to implement a routed version of GALI in all relevant social surveys. We agree on the standard indicator sheet for self-perceived health. As already mentioned during the TG HIS meeting on 8 9 October, Luxembourg will support the routed, two-questions version of GALI for upcoming EU social surveys. With regard to your question for TG HIS, Statistics Netherlands would like to express her strong preference for option, the single-question variant of GALI. Although Statistics Netherlands currently uses the single-question version of GALI for her national HIS and SILC, until 05 the two-question version was employed. This change was issued in order to align GALI to other member states. We would therefore preferably not introduce a second break in our series. In addition, it is our view that the difference in complexity between the alternatives should not be overrated, because only the specification of the 6-month time period of GALI is moved to a separate question in option. This leaves option as just slightly less complex than option. More importantly, option has been validated in several studies and surveys, which suggests that it is in fact not too complicated respondents. As Statistics Netherlands changed the GALI question from option (until 05) to option (from 05) in HIS and SILC, data from these surveys might be used to examine the effect of changing GALI on the series. We choose and support Option : Implement a routed, two-questions version of GALI in all relevant social surveys. In our opinion, it is more friendly and understandable for respondents. At the same time we believe, that the question/ questions on GALI should be absolutely the same in all the surveys which it/ they will be implemented in, regardless of ultimately chosen form. We are opposed to use of GALI in its present form in EHIS and SILC only and in the different form in other surveys. It is the only and best solution, which allow for full harmonization and comparability of GALI in all social surveys. Moreover, this solution will reconcile the interests of all surveys experts and stakeholders. PT supports option (GALI two-questions routed version). In what concerns integration of the two health variables (GALI and SPH) in more social surveys it should be analyzed in a higher level. Statistics Romania supports option, to implement a routed version of GALI in all relevant social surveys. Also, we agree on the standard indicator sheet for self-perceived health. We support the suggested Option, using the current used EHIS item - ensuring the stability of GALI within SILC and EHIS and to avoid breaks in the time series. Preferred option 3

14 Code Country Comments SI SK UK Slovenia Slovakia United Kingdom We agree with the proposed standard indicator sheets. Regarding the use of st or nd option of the GALI question in social surveys we support the implementation of the routed, two-questions version of GALI - but only in case that the same version of question is implemented in all social surveys and that quantitative pilots of different versions of questions in different modes of interviews are implemented prior to national implementations. If these two conditions are not fulfilled it will be better to use the st option of the GALI question as it is used now. We had an unpleasant experience in change of the GALI question in SILC in year 00 as we 'only' changed the wording in the part of the question concerning the time reference and there was then a large difference in data compared to previous years. So we believe we have to be conservative in changing the key questions, but we understand the need to make it more simple, so more quantitative pilots in different survey settings should be done. Of two proposed Gali options, which is to be implemented after the adoption of the IESS regulation from 009 onwards as a standard model question for ESS social survey, Slovakia supports option as this version ensures stability of Gali within SILC and EHIS and avoids breaks in time series. However in this connection we again emphasis the statement of Slovakia related to introduction of SPH and Gali into other ESS social survey, which presented at DSS meeting: Slovakia does not support introduction of health variables into ESS social surveys other than EHIS and EU SILC by reason that we are afraid of low data reliability as health is out of scope of these surveys and secondly implementation could have negative impact on increase of respondent s burden due to high sensitivity of health questions. In case of necessity to introduce them into other ESS social surveys, we are only for introduction into LFS (with planned -years periodicity), we strongly do not support their implementation into rest of social surveys (e.g. ICT, HBS...). For LFS it is important to emphasize the need of testing module of health questions in terms of location in the questionnaire. We would favour option - to maintain consistency with the current GALI approach adopted on EU-SILC and EHIS. I should reiterate that: we understand the continuing desire of Eurostat to improve the comparability of disability statistics, primarily on a voluntary basis. Your understanding towards the UK concern to maintain our existing time series and links to national legislation is appreciated. we would like to emphasise the willingness of the UK to engage with further efforts of the Task Force GALI or other research and development activities to improve the GALI question formulation and/or to explore alternative data sources for disability statistics, subject of course to the availability of resources. As for your regarding Self Perceived Health, our only comment is that we would collect this for adults aged 6 and over (as this is our model of data collection for EHIS, SILC and LFS). Preferred option 4

15 Code Country Comments CH IS NO RS TR XK Switzerland Iceland Norway Serbia Turkey Kosovo. Standardization of social variables Switzerland supports to keep the option for GALI. Even when a routed version seems to be better understood by respondent s we want to avoid break in time series. The studies have shown that the question is valid despite the length and the complexity of the question. Furthermore, the cost (financial and psychological for survey which are not concerned directly by the theme) of option has never been relayed. We think, it is important to have the same variable in all the social survey, including LFS.. Self perceived health In Switzerland we used the same language version as France and Germany. Unfortunately we found some incoherencies between the French and German version for the modality fair in our results, which led to big differences inbetween language groups. It seems that the French and German translation doesn t mean the same ( assez bon / mittelmässig ). So there will be probably the same differences by comparing results between France, Germany, Belgium and Luxembourg. Maybe we need some more recommendations for translating the answer categories. Many countries don t use fair but neither good nor bad. In Norway we support option, to implement a routed version of GALI in all relevant social surveys, including Silc and EHIS. We agree on the standard indicator sheet for self-perceived health, and have no further comments to the proposal. -We agree on the standard indicator sheet for self-perceived health. -We suggest changing to the routed question for all social survey including EHIS and SILC. With my reference in the above mentioned subjects I would like to inform you that we have the following because we have examined with care questions (proposals) to your set like this:. We agree on standard indicator sheet for self-perceived health, because we think that is closer to the population.. As regards Gaul, we support the second option for a rout, variable with two questions. It has been identified that existing single issue is very complicated for the respondent to understand that many concepts are included in a query. Therefore, since the suggestion is to use the version of routed AFP in order to simplify the question, we suggest moving the question and SILC Ehis routed to like Preferred option 5