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 live Life 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: –Sullivans 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 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 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 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,

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

Future changes planned in GHS design – implications for HE series Series on current basis – last year 2004 ( 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