Healthy Life Years

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Life expectancy and healthy life expectancy by gender Healthy life expectancy bar chart -world -sex.png
Life expectancy and healthy life expectancy by gender

The Healthy Life Years (HLY) indicator, also known as disability-free life expectancy (DFLE) or Sullivan's Index, is a European structural indicator computed by Eurostat. It is one of the summary measures of population health, known as health expectancies, [1] composite measures of health that combine mortality and morbidity data to represent overall population health on a single indicator. [2] HLY measures the number of remaining years that a person is expected to live at a certain age without the disability.

Contents

History

LEB (orange) and HLY (green). WHO 2019 data. Healthy Life Years and LEB.svg
LEB (orange) and HLY (green). WHO 2019 data.

The European Union has decided to include a small set of health expectancies among its European Community Health Indicators (ECHI) to provide synthetic measures of disability, chronic morbidity, and perceived health. Therefore the Minimum European Health Module (MEHM), composed of 3 general questions covering these dimensions, [3] has been introduced into the Eurostat EU-Statistics on Income and Living Conditions Survey (EU-SILC) [4] to improve the comparability of health expectancies between countries. In addition life expectancy without long term activity limitation, based on the disability question, was selected in 2004 to be one of the structural indicators to be examined every year, during the European Spring Council for assessing the EU strategic goals (Lisbon Strategy) under the name of “Healthy Life Years” (HLY). [5] Furthermore the European Union is co-funding a Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (CHRODIS-JA). [6] This aims to promote and facilitate a process of exchange and transfer of good practices between European countries and regions, addressing chronic conditions, with a specific focus on health promotion and prevention of chronic conditions, multi-morbidity and diabetes.

Detailed information on the Health Expectancies in Europe are available from the EurOhex Advanced research on European health expectancies [7] while latest Healthy Life Years values can be found on the general public website devoted to the Healthy Life Years. [8]

Context

The dramatic increase in the life expectancy in the most developed countries in general and in the countries of the European Union in particular represents one of the most significant achievements of recent decades. The further challenge confronts the European Community:

"increasing life expectancy must be by the increase of its part spent in "good" health".

In this context, the classical mortality indicators are no longer sufficient to monitor the health status of the populations of the European countries. The availability of health expectancy indicators dividing life expectancy into life spent in different states of health is useful to health authorities in the field of public health and health policies provided that these indicators allow comparisons over time, between geographic areas and between socio-economic groups. As the post-war generation reaches the retirement age, the pace of ageing increases dramatically, with the profound societal effects. HLY is an important indicator which is based on the following assumptions:

Productivity behind Healthy Life Years monitoring


Healthy life years can also be seen as a productive tool for the econometric analysis, though some scholars claim that one that is based on the self-rated health indicator is better.

The consequences of increasing the number of healthy life years can be advantageous in the economic world. An increase in these years is one of the EU's health policy goals. That is because an increase in the number of healthy life years will not only improve the situation of an individual (in regards to their health and leading a long life during which they are able to do all the fundamental life activities without experiencing any limitations or disability) but would also lead to lower healthcare expenditures (though in a countries with high onset of chronic diseases having disabling influence this might not be the case). It would also increase the possibility that people will be willing to and be able to continue working later.

Statistical findings

In 2015, the number of healthy life years among women in the EU-28 was 63.3.

Data sources and availability

Eurostat calculates information about the healthy life years at birth, at ages 50, and 65. The data is calculated and collected by using mortality statistics as well as self perceived longstanding activity limitations- a dimension that captures longstanding limitation in regards to health and/or disability to perform usual and frequent activities. An example of a question that might be asked concerning the longstanding activity limitation is: "For the last six months, to what extent have you been limited because of a health problem in activities that people usually do?" Some available answers are "severely limited", "limited but not severely", or "not limited at all".

Limitations of the data


The indicators used to calculate healthy life years are self-reported and from that perspective could be distracting. The collected data is influenced by the subjective perception as well as social and cultural background. That is because people from different social backgrounds, race and ethnicity, and socioeconomic status can provide different judgements of their health. Another limitation in regards to the way the data is collected is the consideration of institutionalized people. For example, people living in health and social care institutions, who are expected to be more likely to face limitations than the rest of the population that is living in private households, are not covered or surveyed when collecting the data for healthy life years calculations and expediencies. This therefore impacts the results by limiting it and making it less inclusive.

Sociological challenges

Health status is hard to define and can differ greatly from one person to another. One of the reasons is that it can be influenced by various factors affecting their evaluation of their health. Which is more, being healthy and feeling well can be defined and measured in many different ways. General symptoms mean the assessment of physical and psychological sensations that could usually be determined by a physician or a psychiatrist. Yet, they can only be felt by the patient who will subjectively explain what they feel. These assessments are usually stereotyped to pain and/or feeling of anxiety. These measures are not always observable and their tolerance can vary from one person to another depending on the social background of the person. Therefore, to combine the measures of the different health concepts that people have in their minds into a single number, there is a need to have a conceptual model that would take into consideration that health is a continuum that ranges from perfect health to death.

Another problem is that the average level of health itself (not only the ways of its evaluation) is subject to the influence of different factors and is different in various sub-groups (as mortality does). The examples of such characteristics are: 1) race, and 2) ethnic group. They are the possible independent characteristics influencing as a result also the total amount of healthy life years. Different races and nationalities lead different lifestyles, eat different kinds of food, and live in different environments geographically. All these factors when taken into account could impact the chance of people getting certain diseases or losing their ability to perform a daily life activity. For example, if a certain group of people who pertain to a certain race or ethnic group, where they eat primarily unprocessed food, then these people are less prone to certain diseases and are more likely to live disease free lives for a longer time than people whose diet consists of highly processed food. [10]

Moreover, even people of the same culture and race but of different socioeconomic status could live different number of healthy life years. People of different socioeconomic status are from (or/and can afford) different living conditions associated with initially different levels of spending and the level of development of housing and communal services. For example, consider a poor family that could only afford living in a poor neighborhood where the underground water pipes have very high exposure to lead and where their house lies beside a canal where industries spit their toxic emissions. The members of this family are, according to health science, expected to suffer from health issues earlier in their lives because their lifestyle according to their socioeconomic status forces them to be exposed daily to toxic substances in their environment and to drink water that has high levels of lead. Both of these life circumstance are factors known to cause high blood pressure, kidney failures, etc. With these adverse health effects, these people would have limited ability or in other words are not considered as healthy as members of a family from their same race who live in a wealthy town where their water pipes are tested every now and then.

Overall, many sociological factors need to be considered when calculating the number of healthy life years that people can live. These factors can include but are not limited to: race, ethnicity, household upbringing, and socioeconomic status.

See also

Related Research Articles

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Human life expectancy is a statistical measure of the estimate of the average remaining years of life at a given age. The most commonly used measure is life expectancy at birth. This can be defined in two ways. Cohort LEB is the mean length of life of a birth cohort and can be computed only for cohorts born so long ago that all their members have died. Period LEB is the mean length of life of a hypothetical cohort assumed to be exposed, from birth through death, to the mortality rates observed at a given year. National LEB figures reported by national agencies and international organizations for human populations are estimates of period LEB.

<span class="mw-page-title-main">Diseases of affluence</span> Health conditions thought to be a result of increasing wealth in society

Diseases of affluence, previously called diseases of rich people, is a term sometimes given to selected diseases and other health conditions which are commonly thought to be a result of increasing wealth in a society. Also referred to as the "Western disease" paradigm, these diseases are in contrast to so-called "diseases of poverty", which largely result from and contribute to human impoverishment. These diseases of affluence have vastly increased in prevalence since the end of World War II.

The social determinants of health are the economic and social conditions that influence individual and group differences in health status. They are the health promoting factors found in one's living and working conditions, rather than individual risk factors that influence the risk for a disease, or vulnerability to disease or injury. The distribution of social determinants is often shaped by public policies that reflect prevailing political ideologies of the area.

<span class="mw-page-title-main">Disability-adjusted life year</span> Measure of disease burden

Disability-adjusted life years (DALYs) are a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability, or early death. It was developed in the 1990s as a way of comparing the overall health and life expectancy of different countries.

A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term chronic is often applied when the course of the disease lasts for more than three months. Common chronic diseases include diabetes, functional gastrointestinal disorder, eczema, arthritis, asthma, chronic obstructive pulmonary disease, autoimmune diseases, genetic disorders and some viral diseases such as hepatitis C and acquired immunodeficiency syndrome. An illness which is lifelong because it ends in death is a terminal illness. It is possible and not unexpected for an illness to change in definition from terminal to chronic. Diabetes and HIV for example were once terminal yet are now considered chronic due to the availability of insulin for diabetics and daily drug treatment for individuals with HIV which allow these individuals to live while managing symptoms.

<span class="mw-page-title-main">Epidemiological transition</span>

In demography and medical geography, epidemiological transition is a theory which "describes changing population patterns in terms of fertility, life expectancy, mortality, and leading causes of death." For example, a phase of development marked by a sudden increase in population growth rates brought by improved food security and innovations in public health and medicine, can be followed by a re-leveling of population growth due to subsequent declines in fertility rates. Such a transition can account for the replacement of infectious diseases by chronic diseases over time due to increased life span as a result of improved health care and disease prevention. This theory was originally posited by Abdel Omran in 1971.

<span class="mw-page-title-main">Overcrowding</span> Excess of people in a space

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<span class="mw-page-title-main">Disease burden</span> Impact of diseases

Disease burden is the impact of a health problem as measured by financial cost, mortality, morbidity, or other indicators. It is often quantified in terms of quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs). Both of these metrics quantify the number of years lost due to disability (YLDs), sometimes also known as years lost due to disease or years lived with disability/disease. One DALY can be thought of as one year of healthy life lost, and the overall disease burden can be thought of as a measure of the gap between current health status and the ideal health status. According to an article published in The Lancet in June 2015, low back pain and major depressive disorder were among the top ten causes of YLDs and were the cause of more health loss than diabetes, chronic obstructive pulmonary disease, and asthma combined. The study based on data from 188 countries, considered to be the largest and most detailed analysis to quantify levels, patterns, and trends in ill health and disability, concluded that "the proportion of disability-adjusted life years due to YLDs increased globally from 21.1% in 1990 to 31.2% in 2013." The environmental burden of disease is defined as the number of DALYs that can be attributed to environmental factors. Similarly, the work-related burden of disease is defined as the number of deaths and DALYs that can be attributed to occupational risk factors to human health. These measures allow for comparison of disease burdens, and have also been used to forecast the possible impacts of health interventions. By 2014, DALYs per head were "40% higher in low-income and middle-income regions."

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Eileen M. Crimmins is the AARP Chair in Gerontology at the USC Davis School of Gerontology of the University of Southern California. Her work focuses on the connections between socioeconomic factors and life expectancy and other health outcomes.

Australia is a high income country, and this is reflected in the good status of health of the population overall. In 2011, Australia ranked 2nd on the United Nations Development Programme's Human Development Index, indicating the level of development of a country. Despite the overall good status of health, the disparities occurring in the Australian healthcare system are a problem. The poor and those living in remote areas as well as indigenous people are, in general, less healthy than others in the population, and programs have been implemented to decrease this gap. These include increased outreach to the indigenous communities and government subsidies to provide services for people in remote or rural areas.

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<span class="mw-page-title-main">Health in Norway</span> Overview of health in Norway

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<span class="mw-page-title-main">EuroHealthNet</span> Non-profit health organisation

EuroHealthNet is a non-profit partnership of organisations, agencies and statutory bodies working to contribute to a healthier Europe by promoting health and health equity between and within European countries. EuroHealthNet promotes health through its partnership framework by supporting members’ work in the EU and associated states through policy and project development, networking, and communications.

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