Health Expectancies in the UK and its constituent countries, 1981 – 2001

Claudia Breakwell Madhavi Bajekal

What are health expectancies?

• While life expectancy provides an estimate of average expected life-span, health expectancy partitions total life expectancy into years free from health related problems and years lived in ill-health.

Average Expected number of years to liveLife Expectancy

Number of years spent free from ill-health

Number of years spent in ill health

Why are health expectancies important?

• Compression of morbidity– new cohorts of older people would be healthier, and therefore make

fewer demands on care.

• Expansion of morbidity– that increased survival to older ages was simply a result of medical

advances with people being kept alive longer, but in poorer health, and would result in escalating demand for care services

• Dynamic equilibrium– Under this scenario the proportion of the life span with serious

illness or disability stabilises or decreases, whereas the proportion with moderate disability or less severe illness increases.

Opportunity for All: Tackling Poverty and Social Exclusion

• Monitored by: The Department for Work and Pensions

• Objective: to improve opportunities for older people to live secure, fulfilling and active lives

• Basis: Healthy Life Expectancy (self-perceived general health)

• Indicator: increase in HLE at age 65 in England

National Service Framework for Older People: Standard Eight

• Monitored by: The Department of Health

• Objective: The promotion of health and active life at older age

• Basis: Extend the health expectancies of older people

• Indicators: HLE and DFLE at age 65 in England

Two types of health expectancy calculated by ONS – based on GHS questions

• Healthy Life Expectancy (HLE)– Defined as years expected to be spent in ‘good’ or ‘fairly good’ health.

Based on the question…

‘Over the last 12 months, would you say your health has on the whole been: good, fairly good or not good?’

• Disability-free Life Expectancy (DFLE)– Defined as years expected to be spent free from limiting long-standing

illness or disability. Based on the question…

‘Do you have any long-standing illness, disability or infirmity? By long-standing I mean anything that has troubled you over a period of time or that is likely to affect you over a period of time.If ‘Yes’:(a) What is the matter with you?(b) Does the illness or disability (Do any of these illnesses or disabilities) limit your activities in any way?”

Sources & Methods

• Data sources: – Mid-year population estimates provided by ONS – Life tables provided by GAD (3 year average)– Health status in households: rates of ‘good’ and ‘fairly

good’ health and with no limiting illness, GHS and CHS (3 year average to correspond to the life tables)

– Health status and population in communal establishments, 2001 Census

• Method: – Sullivan’s method to calculate health expectancies– GHS and CHS samples grossed up to the household

population estimates from the LFS.

Recent improvements to methods

• Following the re-launch of the GHS in 2000 two changes – in method and coverage - were made that were likely to effect the health expectancy series. These changes were incorporated into the new 2001 estimates:

– The introduction of weighting

This caused a slight reduction in each health expectancy estimate due to the slightly raised ‘not good’ and LLSI rates in most age bands. The effect for men was larger than for women.

– The inclusion of under 16s in the general health question

This caused the HLE at birth to fall for males and rise for females. The proxy not good health rate (of 16-19 year olds) used prior to 2001 was shown to be higher than the actual rate for girls and lower than the actual rate for boys.

Overview of analysis

• Between constituent countries of the UK in 2001

• Trends between 1981 and 2001 for Great Britain and England

• Both above types of analysis– Separately by sex (2)– For HLE, DFLE (2)– At birth, at age 65 (2)

Results

• In this presentation we focus on the results for– Disability-free life expectancy (DFLE)– Males– At birth and at age 65

• Comparison across the constituent countries of the UK

• The trends between 1981 and 2001 in comparison with the corresponding life expectancy

LE and DFLE for males at birth: by country, 2001

60.3 60.7 57.7 58.8 57.8

15.4 15.3 17.8 14.5 17.4

0

10

20

30

40

50

60

70

80

UK ENGLAND WALES SCOTLAND NORTHERNIRELAND

WithDisability

WithoutDisability

• While England has the highest disability-free life expectancy for men at birth it is males in Scotland that can expect to spend the fewest number of years in ill-health of all the countries of the UK.

LE and DFLE for males at age 65: by country, 2001

8.8 8.9 7.3 8.7 7.6

7.1 7.18.4 6.2 8.1

0

2

4

6

8

10

12

14

16

18

UK ENGLAND WALES SCOTLAND NORTHERNIRELAND

WithDisability

WithoutDisability

• Males at age 65 living in Wales and Northern Ireland can expect to live over half of the rest of their lives with some form of disability.

LE and DFLE for males at birth in Great Britain, 1981-2001

50

55

60

65

70

75

80

1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1997 1999 2001 2001

DFLE

LE

LE and DFLE for males at age 65 in Great Britain, 1981 - 2001

0

2

4

6

8

10

12

14

16

18

1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1997 1999 2001 2001

DFLE

LE

Future changes planned in GHS design – implications for HE series

• Series on current basis – last year 2004 (2003-2005 GHS)• 2005 GHS(L) and EU-SILC

– Four year rotating panel. Implications for 3-year average as only 25% of the sample will be fresh cross-sectional each year.

– General health question – 5 point and 3 point• Parallel series for 3-5 years to assess differences

– Severity of LLSI• Decomposition of DFLE into mild, moderate and severe DFLE

– The CHS is also becoming longitudinal

• 2008 IHS– Potential for robust local level estimates if general health and LLTI

questions are included in core

Health Expectancies in the UK and its constituent countries, 1981 – 2001

Claudia Breakwell Madhavi Bajekal