Health examination surveys (HESs), carried out in Europe since the 1950’s, provide valuable information about the general population’s health for health monitoring, policy making, and research. Survey participation rates, important for representativeness, have been falling. International comparisons are hampered by differing exclusion criteria and definitions for non-response. Information was collected about seven national HESs in Europe conducted in 2007–2012. These surveys can be classified into household and individual-based surveys, depending on the sampling frames used. Participation rates of randomly selected adult samples were calculated for four survey modules using standardised definitions and compared by sex, age-group, geographical areas within countries, and over time, where possible. All surveys covered residents not just citizens; three countries excluded those in institutions. In two surveys, physical examinations and blood sample collection were conducted at the participants’ home; the others occurred at examination clinics. Recruitment processes varied considerably between surveys. Monetary incentives were used in four surveys. Initial participation rates aged 35–64 were 45 % in the Netherlands (phase II), 54 % in Germany (new and previous participants combined), 55 % in Italy, and 65 % in Finland. In Ireland, England and Scotland, household participation rates were 66 %, 66 % and 63 % respectively. Participation rates were generally higher in women and increased with age. Almost all participants attending an examination centre agreed to all modules but surveys conducted in the participants’ home had falling responses to each stage. Participation rates in most primate cities were substantially lower than the national average. Age-standardized response rates to blood pressure measurement among those aged 35–64 in Finland, Germany and England fell by 0.7-1.5 percentage points p.a. between 1998–2002 and 2010–2012. Longer trends in some countries show a more marked fall. The coverage of the general population in these seven national HESs was good, based on the sampling frames used and the sample sizes. Pre-notification and reminders were used effectively in those with highest participation rates. Participation rates varied by age, sex, geographical area, and survey design. They have fallen in most countries; the Netherlands data shows that they can be maintained at higher levels but at much higher cost.

Background: The consistent finding of higher prevalence of hypertension in US blacks compared to whites has led to speculation that African-origin populations are particularly susceptible to this condition. Large surveys now provide new information on this issue. Methods: Using a standardized analysis strategy we examined prevalence estimates for 8 white and 3 black populations (N = 85,000 participants). Results: The range in hypertension prevalence was from 27 to 55% for whites and 14 to 44% for blacks. Conclusions: These data demonstrate that not only is there a wide variation in hypertension prevalence among both racial groups, the rates among blacks are not unusually high when viewed internationally. These data suggest that the impact of environmental factors among both populations may have been under-appreciated.

Surveillance of and monitoring trends for cardiovascular diseases and risk factors are relevant when we consider that these diseases and conditions are largely preventable. The aim of this paper is to assess time trends of cardiovascular diseases, lifestyles, risk factors and high risk conditions in different socioeconomic levels. Paired but independent population samples of men and women aged 35–74 years located in all 20 Italian regions were examined in 1998–2002 (n = 9612) and in 2008–2012 (n = 8141). Time trends of lifestyles, cardiovascular risk factors, prevalence of high-risk conditions and cardiovascular diseases are shown for two different socioeconomic levels, as assessed by educational level. Over 10 years, in both genders and socioeconomic classes, the prevalence of smoking decreased (from 32% to 23% in men) as well as mean levels of blood pressure (systolic from 136 mmHg to 133 mmHg in men and from 132 mmHg to 127 mmHg in women), while the prevalence of dyslipidemia and obesity increased reaching 35% and 25% of the population respectively; the prevalence of myocardial infarction remained stable (1.6% in men; about 0.5% in women), that of stroke decreased in men (from 1.2% to 0.7%); the prevalence of diabetes did not change (12% in men; 8% in women). In the low educational class, cardiovascular risk factors and diseases remained unfavourable compared with the high educational class. The burden of cardiovascular diseases and their risk factors remain high and require continuous appropriate action at the community and individual levels, as suggested by the European Guidelines for Cardiovascular Prevention.

Representative and reliable data on health and health determinants of the population and population sub-groups are needed for evidence-informed policy making; planning and evaluation of prevention programmes; and research. Health examination surveys (HESs) including questionnaires, objective health measurements and analysis of biological samples, provide information on many health indicators that are available not at all or less reliably or completely through administrative registers or health interview surveys. Standardized cross-sectional HESs were already conducted in the 1980’s and 1990’s, in the framework of the WHO MONICA Project. The methodology was developed and finally, in 2010–2012, a European Health Examination Survey (EHES) Pilot Project was conducted. During this pilot phase, an EHES Coordinating Centre (EHES CC, formerly EHES Reference Centre) was established. Standardized protocols, guidelines and quality control procedures were prepared and tested in 12 countries which conducted pilot surveys, demonstrating the feasibility of standardized HES data collection in the European Union (EU). Currently, the EHES CC operates at the National Institute for Health and Welfare (THL), Finland. Its activities include maintaining and developing the standardized protocols, guidelines and training programme; maintaining the EHES network; providing professional support for countries planning and organizing their national HESs; external quality assessment for surveys organized in the EU Member States; and development of a centralized database and joint reporting system for HES data. An increasing number of EU Member States are conducting national HESs, demonstrating a strong need for such surveys as part of the national health monitoring systems. Standardization of the data collection is essential to ensure that HES data are comparable across countries and over time. The work of the EHES CC helps to ensure the quality and comparability of HES data across the EU. HES data have been used for health monitoring and identifying public health problems; to develop health and prevention programmes; to support health policies and preparation of health-related legislation and regulations; and to develop clinical treatment guidelines and population reference values. HESs have also been utilized to prepare health measurement tools and diagnostic methods; in training and research and to increase health awareness among population.

Also in Mediterranean countries, which are considered a low risk population for cardiovascular disease (CVD), the increase in body mass index (BMI) has become a public health priority. To evaluate the feasibility of a CVD and obesity surveillance network, forty General Practitioners (GPs) were engaged to perform a screening to assess obesity, cardiovascular risk, lifestyle habits and medication use.