Good Practice in Health Reporting – Guidelines and Recommendations 2.0

Health reporting provides a description of the health of the population, analyses problems and demonstrates areas in which action needs to be taken in health care provision, health promotion and disease prevention. Accordingly, it offers a rational basis for participatory processes and health policy decision-making.

This edition of Good Practice in Health Reporting resulted from a revision of the first edition, which was first published in March 2017. It incorporates contributions from experts, and various institutions and associations from the German federal-state and national levels. This revised edition rose out of the need for continual development in health reporting. In some cases, a number of changes were made so that certain aspects could be defined more clearly; in other cases, changes were made to methodology, for example, in order to accommodate participatory and qualitative approaches.

This publication is aimed at providing people working in health reporting with professional direction and guidance. We welcome your feedback.

1. Preface

We are very happy to be able to publish this second edition of Good Practice in Health Reporting. Once again, it has been included as a special issue of the Journal of Health Monitoring. Numerous contributions from experts from the German local, state and national levels as well as from institutions and associations have been incorporated into this publication. We would like to take this opportunity to thank everyone who has been able to contribute. We view the extensive discussions surrounding these contributions and the debate that accompanied the publication of the first edition as continued recognition of the importance of our work.

The significant changes that this edition includes were chiefly implemented to accommodate participatory approaches and qualitative methods. However, we continue to view established nationwide, national and international indicators as the foundation for health reporting as they enable the study of temporal trends and regional/inter-municipal comparisons. Nevertheless, qualitative methods can still be used in health reporting as part of mixed method approaches. We believe that they are particularly suitable for developing questions for study and revealing the complexity of certain problem areas.

This edition of Good Practice in Health Reporting provides an expanded list of criteria. The changes made to the criteria on gender, for example, involve issues such as the importance of conducting comparisons within gender-based groups and of accounting for the societal framework behind gender-based differences.

Good Practice in Health Reporting aims to provide guidance to health officials working at the local, state and national levels and to people working in health reporting in other institutions. It underscores the fact that health reporting is not an end in itself, but that it has a social function that follows the old, yet still relevant, principle of providing ‘data for action’.

Health reporting has been tasked with identifying problem areas and fields in which action needs to be taken. Consequently, it helps promote and safeguard the population’s psychological, social and physical health.

The contributions that we received principally concerned legislation, staffing and financing. Although we understand the request for more details about these topics and would certainly welcome the development of the best possible data pools and facilities, formulating such standards would go beyond the reach of a publication on good practice in health reporting.

Finally, we would like to take this opportunity to wish everyone who uses Good Practice in Health Reporting every success. We hope that this publication provides a positive contribution to further research. Although we will not be opening another formal commenting procedure, we continue to look forward to receiving feedback, and, if necessary, the contributions we receive could result in further revisions of Good Practice in Health Reporting.

2. Preamble

Health reporting provides an interpretive description of the population’s health, analyses problems, and highlights areas in need of action.

Due to the misuse of medical statistics and social medicine during National Socialism, health reporting was established relatively recently as a steering instrument in Germany. Importantly, the Ottawa Charter for Health Promotion provides an essential foundation for the development of health reporting. In addition to calls for better integration of different policy fields in order to reduce social inequalities in health, the Ottawa Charter particularly underscores the importance of providing information about the population’s health. In 1987, the Advisory Council for Concerted Action in Health Care (now the Advisory Council on the Assessment of Developments in the Health Care Sector) published a report calling for the establishment of health reporting in Germany with the aim of providing data that could be used for targeted resource allocation. In 2012, the World Health Organization’s Regional Committee for Europe also identified the surveillance of population health and wellbeing as one of ten essential public health operations (EPHOs).

Health reporting has been successfully established in many German federal states and municipalities since the 1980s. This process was strengthened by legislation anchoring health reporting as an official undertaking of the public health service. Since the end of the 1990s, the Robert Koch Institute has conducted health reporting at the federal level in close cooperation with the German Federal Statistical Office.

2.1 The aims and tasks of health reporting

Health reporting provides information to politicians and the public about the health, illnesses, health risks and mortality of a spatially and temporally defined population. One of its main tasks is interpreting data from different data sources. As a steering instrument in health policy, health reporting acts as an empirical basis with which to make rationally justifiable policy decisions. Furthermore, it accompanies health policy processes and enables public participation. As such, it is embedded within a particular political discourse. Reporting systems at the local, state and national level are subject to the respective legal and political frameworks.

This means that health reporting:

▶ provides a description of the health of the population. It takes into account the unequal social and regional distribution of health risks and potentials for disease prevention, and demonstrates areas at the national, state and local level where action needs to be taken

▶ accounts for gender, migration and any other living conditions that influence the health of the population or selected population groups

▶ acts as a foundation for the cross-departmental planning of disease prevention, health promotion and care provision, and can be used to evaluate health policy measures

▶ involves the continuous collection of data about the health of a population and identifying possible changes in health at an early stage. Therefore, it can be used to make timely health policy decisions

▶ is not only aimed at experts and decision makers from politics and administration but also at the general public

▶ promotes the process of forming public opinion by providing information and enabling people to participate in drawing up health policy objectives supports the civil society concern of participation

2.2 The methodological and theoretical foundations of health reporting

Health reporting requires a broad range of data. Although participative and qualitative methods can also be used to identify relevant topics and issues if they are methodologically justifiable, health reporting should be based on valid and, ideally, uniform standardised data. Moreover, data should be sourced from surveys that have been purposely conducted by the public health service, official statistics and process-generated data from other health system institutions (secondary data). Health reporting should rely on purposely undertaken analyses of these data as well as (international/national/nationwide) coordinated, standardised and routinely prepared indicators. The data holder’s expertise in data collection should be included in the interpretation of results, and, where appropriate, in the formulation of recommendations. Finally, it is essential that the work involved in data collection and the willingness to make these data available for health reporting are appropriately recognised.

In some areas, health reporting needs more data than can be provided by the public health service and secondary data sources alone. In these cases, epidemiological studies and representative health surveys should also be used as they offer additional information about the population’s health, health-related behaviour and health care provision.

Health reporting is typically based on an interdisciplinary approach with epidemiology providing its primary methodological and scientific basis. However, health reporting also incorporates theoretical concepts and empirical findings from the social sciences, medicine, social medicine, medical sociology, health economics, health care research, health system research and health evaluation research as well as other disciplines.

The substantive integration of health reporting into diverse reporting systems, such as social, environmental and educational reporting, is becoming increasingly important. Since there are strong correlations between health and disease and socio-structural factors, health reporting also needs to include data from these reporting systems. Due to significant overlaps and interdependencies that exist between health and social reporting, it is impossible to distinguish strictly between these two fields. As such they can achieve synergy effects in most cases. Nevertheless, the objectives and tasks of health reporting mean that it is essential that this field continues to develop independently and that the work conducted in health reporting is undertaken with the appropriate level of expertise.

Finally, as integrated health reporting is carried out interdisciplinarily, intersectorally and under the involvement of various stakeholders, the field requires specific guidelines to be laid out and the development of good practices.

2.3 The foundations, framework and resources needed for health reporting

Health reporting is a complex task that requires detailed knowledge and adequate human, temporal, financial and infrastructural resources. Staff involved in health reporting must be adequately qualified and undergo regular training. The provision of appropriate resources enables high quality, practice-relevant health reporting to be carried out, but also provides staff with an appropriate level of recognition.

2.4 Good Practice in Health Reporting

Good Practice in Health Reporting is aimed at providing professional guidance for the production of health reports and highlighting the importance of health reporting as a basis for rational policy-making. One of its focuses is the interpretation of results with regard to their relevance for public health and the basis they provide for health policy decision-making.

In some situations it may be necessary, if not essential, to make exceptions to these guidelines. However, in keeping with good practices, wherever this is done, it needs to be clearly mentioned in the report.

Good Practice in Health Reporting complements Guidelines and Recommendations for Ensuring Good Epidemiological Practice [1] and Good Practice in Secondary Data Analysis [2] by providing additional, albeit central, recommendations for health reporting. However, it also highlights sections of these two documents that contain information that is relevant to planning, preparing and conducting empirical studies and processing, analysing and interpreting the resulting data.

Good Cartographic Practice in Health Care [3] should be referred to for more information about the use of cartography in health reporting. If reports contain findings that can be understood as health-related information (for example, if they contain references to health-promoting behaviour or approaches to tackling health-related risks), the guidelines set out in Good Practice Guidelines for Health Information [4] should also be followed.

3. Guidelines and Recommendations

Guideline 1 (Ethics)

Health reporting must be carried out in accordance with ethical principles and preserve human dignity and human rights.

The objectives of public health ethics should be taken into account in health reporting.

Recommendation 1.1

Results that highlight specific problems among individual population groups should be published with the differentiation and objectivity that is expected of scientific studies.

Recommendation 1.2

Health reporting should consider the lives and needs of different social groups and should not be discriminative. This applies to all phases of health reporting.

Recommendation 1.3

The indicators used to analyse health-related issues should meet ethical standards. Parameters and indices need to be reviewed to ensure that they are not based on normative assumptions or implicit value judgements.

Recommendation 1.4

Health reporting should maintain academic distance and must not provide a voice for interest groups. By providing objective, verifiable information, health reporting creates transparency.

Guideline 2 (Framework)

Health reporting requires a defined political and organisational framework and should be anchored in legislation at all policy levels.

The legislative basis extended to health reporting should set out the requirements needed to meet scientific quality standards and specify the conditions and framework needed to ensure a good standard of health reporting.

Recommendation 2.1

In addition to sufficient time, financial and infrastructural resources, staff involved in health reporting need appropriate methodological and technical qualifications.

Recommendation 2.2

In the case of externally commissioned health reporting, legally binding arrangements should be made for drawing up health reports, accessing and using data, and for supplementary analyses and expertise. This also applies when working together with scientific institutions.

Guideline 3 (Public Health)

Health reporting should provide an empirical foundation for health policy decision-making.

Health reporting identifies areas from which professionally-based recommendations can be derived. The aim is to improve the health of the population and to take equal opportunities into account.

Recommendation 3.1

Health reporting should focus on and analyse issues that are relevant to public health (such as issues that concern certain population groups or that are related to specific illnesses and clusters of illnesses).

Guideline 4 (Subject of the Report)

Health reporting must use data to support its descriptions of current aspects of the health status of the population or population groups. It should provide information and analyse health determinants, frameworks and other health-related aspects.

Health reporting involves the study of explicit, operationalisable issues. This provides the basis of a particular design that takes into account the study population, the underlying data, as well as data collection and analysis. As such, estimates can be made of the time and costs associated with reporting and of the scope in which the results can be applied.

Recommendation 4.1

The topicality, public health and policy relevance of an issue should be considered when selecting the topics of health reporting. The aim of a selection, the reason why it was made, and the relevant target groups should all be stated.

Recommendation 4.2

When dealing with the issues at the focus of a particular health report, the latest scientific research should be consulted in order to avoid redundancies and outdated hypotheses.

Recommendation 4.3

Health reporting should integrate findings from other reporting systems such as social, educational and environmental reporting. This provides an appropriate basis with which to interpret the results and to position them within the literature.

Recommendation 4.4

The selection of the population under study and the indicators chosen to represent it should be supported with reference to the issue at hand.

Guideline 5 (Working Basis)

Health reporting should be based on the best available data, indicators that have been accepted at different policy levels, as well as the latest research.

Health reporting needs access to socio-demographic, socio-structural and regionally differentiated data. Data collection should always be subject to quality assurance.

Recommendation 5.1

A review should be conducted of the relevance, representativeness and informative value of any data that is used. The data owner should be clearly stated.

Recommendation 5.2

The selection of the indicators and the literature used to interpret the results should reflect the latest research and consider the entire range of the issue at hand.

Recommendation 5.3

Data for the indicators should be collected continuously so that temporal developments can be observed. Regional comparisons of health-related issues should be undertaken using standardised indicators.

Recommendation 5.4

Health reporting should highlight any gaps in the data and review new data sources as needed.

Guideline 6 (Data Processing)

A detailed plan should be drawn up for the acquisition and storage of all data used in health reporting, for data processing, plausibility testing, coding and data provision.

The Guidelines and Recommendations for Ensuring Good Epidemiological Practice, Good Practice in Secondary Data Analysis and Good Cartographic Practice in Health Care apply here.

Recommendation 6.1

The choice of primary data and the rules governing data collection should be documented. It is important to ensure continuity in terms of the rules that apply to data collection, the study population and legal requirements.

Recommendation 6.2

If the data have already been prepared, evaluated or published elsewhere, the primary reason for their collection, as well as the regulations that governed data collection and evaluation, should be made clear.

Guideline 7 (Data Analysis)

Data analysis needs to be carried out promptly using scientific methods. The raw data that provide the basis of the results should be stored in a fully reproducible manner in accordance with freedom of information laws.

The Guidelines and Recommendations for Ensuring Good Epidmiological Practice and Good Practice in Secondary Data Analysis apply here. They particularly apply to the documentation requirements associated with calculating complex indicators and indices.

Recommendation 7.1

Established epidemiological indicators and procedures should be used for data analysis in health reporting.

Recommendation 7.2

Analyses should be repeatable; results should be replicable.

Recommendation 7.3

Qualitative methods from empirical social research are particularly used in health reporting as part of participatory approaches. Decisions to use qualitative approaches should have a methodological justification; data evaluation should be based on established scientific techniques, such as qualitative content analysis.

Guideline 8 (Interpretation)

Health reporting should provide an interpretation of the results.

A critical discussion of the methods, data and results in the context of the available evidence should form the basis of any interpretation.

Recommendation 8.1

One of the primary tasks of health reporting is to evaluate the results. This process should not be influenced by personal, political or financial interests.

Recommendation 8.2

Results should be described against the background of the latest scientific research. This includes considering health determinants that are essential to the issue in question and illustrating their importance for the development of public health. Alternative interpretations of the results, where relevant, should also be discussed.

Recommendation 8.3

Any limitations to the transferability of results to other populations or periods must be set out in the report. If a lack of data prevents certain conclusions from being made, this also needs to be stated. When interpreting temporal developments or trends, it is important to note that the significance of the variables under study and the way in which they are defined are liable to change.

Recommendation 8.4

Data interpretation and the formulation of recommendations for action are essential aspects of health reporting. Recommendations for action should be drawn up together with stakeholders from other relevant fields.

Guideline 9 (Data Protection)

The applicable data protection regulations should be observed when using data for health reporting.

Health data are sensitive, and ethical and legal requirements mean that particular data safeguards must be put in place.

Recommendation 9.1

The responsible data protection officer should be involved in the application of the relevant data protection regulations.

Guideline 10 (Communications)

Health reporting is not an end in itself. It competes with other socially relevant issues for the attention of the public.

Health reporting should rouse people’s interests. Appropriate media, forms of representation and stylistic elements should be used to achieve this aim.

Recommendation 10.1

Health reporting should use clear, non-discriminatory language that the general population can understand and address target groups appropriately.

Recommendation 10.2

Health reporting should use various reporting formats and media that are tailored to the interests and informational habits of the target groups. In addition to print media, the results should be distributed digitally using new media formats; accessibility should be taken into account while doing so.

Recommendation 10.3

Health reporting should use attractive and appealing designs to present results. Graphics and illustrations should be used to support any claims. Core results should be highlighted.

Recommendation 10.4

Health reporting should use the opportunity to present the results proactively to target groups, expert audiences, relevant stakeholders and the interested public.

Guideline 11 (Quality Assurance)

Quality control of all relevant instruments and procedures is essential in health reporting.

The most important asset in health reporting is probity, and, subsequently, the trustworthiness of the results. Therefore, quality assurance is an indispensable component of health reporting. The scope of the quality assurance undertaken must be in reasonable relation to the overall costs incurred by health reporting.

Recommendation 11.1

Quality assurance should be conducted during all stages of health reporting. It applies to all of the instruments and procedures employed, ranging from data collection (and the choice of data), data preparation and the use of calculations and interpretations to using data to draw up recommendations.

Recommendation 11.2

If secondary data are used, they should be checked for plausibility. Any anomalies and/or systematic errors should be reported to the data-collecting authority.

Recommendation 11.3

Specially qualified third parties that were not involved in reporting should participate in quality assurance.

List of Criteria

Preliminary Note

The following list identifies the criteria that usually need to be taken into account when producing health reports. The relevance of each criterion, however, depends on the aim, the issue and, therefore, the complexity of a particular report. As such, authors should assess the relevance of these criteria for their particular case. Points that do not appear to be relevant can be ticked as ‘Not applicable’.

1. Scientific Work

› the scope of the report is suitable considering the available material and the focus (there are no redundancies, and unnecessary data have been omitted)

› the report is structured logically and each section builds upon the last (the second step results from the first)

› the data and results are scientifically accurate and supported by scientific evidence. Observations and findings are reproduced truthfully

2. Reporting System

3. Style, Layout, Printing and Distribution

4. Subject of the Report

› a reappraisal of a current situation that endangers (or has endangered) the health of the population

› a particular theme as well as an analysis of a specific issue (such as with regard to a specific disease, a specific population group or a cluster of illnesses)