1. Health Expectancies: UK experience Task Force on Health Expectancies: 8 th June 2006 Madhavi Bajekal

2. Background First UK report: Health Expectancy and its Uses, edited by Bone, M, Bebbington, A, Jagger C. (HMSO, 1995) Regular articles in Health Statistics Quarterly 2000 onwards (ONS publication) –Research papers plus reports to update time series –Methodological developments –http://www.statistics.gov.uk/statbase/Product.asp?vlnk= 6725 Product page on ONS website with latest figures –http://www.statistics.gov.uk/StatBase/Product.asp?vlnk= 12964&Pos=1&ColRank=2&Rank=240http://www.statistics.gov.uk/StatBase/Product.asp?vlnk= 12964&Pos=1&ColRank=2&Rank=240

3. Two types of health expectancy series calculated annually by ONS HLE (Healthy Life Expectancy) Over the last 12 months, would you say your health has on the whole been? –Good –Fairly good –Not good DFLE (Disability-free Life Expectancy) 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. –Yes/No. If Yes a) What is the matter with you? b) Does this illness or disability limit your activities in any way? –Yes/No

4. Sources of Data

5. What are health expectancies used for in the UK? Monitoring population health –Over time (survey data) –Geography (4 countries, sub-national (NUTS 1 & NUTS 4), area typologies ) Monitoring inequalities –By area deprivation (survey + Census) –Between social groups (LS) European comparisons –European Health Expectancy Monitoring Unit –EU-SILC (harmonisation of instruments) Forecasting future need for health and care

6. Policy: Health expectancies as indicators of progress DWP: Poverty and Social exclusion of elderly (HLE 65) ODPM: Sustainable development (HLE birth) DoH: Improving standards of care of older people (HLE 65)

7. UK Parliament: healthy ageing Parliamentary Office for Science & Technology (POST) produced summary of concept, key issues for MPs, 2006 Report of Lords Science & Technology Committee, 2005-6. Ageing: Scientific aspects –Recommendations: longitudinal survey of disability, objective measurement (performance tests), more research Pensions Commission: Challenges and Choices, 2004 –Extend retirement age to 70 in future –SES variation in HLE

8. LE and DFLE for men at age 65 in Great Britain, 1981-2002 (HSQ 19, HSQ 29)

9. LE and DFLE for women at age 65 in Great Britain, 1981-2002 (HSQ 19, HSQ 29)

10. Trends : HLE and DFLE (HSQ 19, HSQ 29) LE and HLE increased for both sexes between 1981 and 2001 Male LE increased at a greater rate than female LE HLE has not increased as fast as LE, gap widened since early 1990s The gender difference in the number of expected years without disability has stayed the same

11. Comparisons between countries in UK 2001 (HSQ 29)

12. Males: LE and DFLE at birth by deprivation deciles, England, 1996-99 (HSQ 25)

13. Females: LE and DFLE at birth by deprivation deciles, England, 1996-99 (HSQ 25)

14. ONS latest research: Trends in mild, moderate and severe disability-free life expectancy Mild DFLE based on self reported no limiting longstanding illness Moderate DFLE based on inability to perform Instrumental Activities of Daily Living (IADLs e.g. shopping, preparing meals and cleaning windows) without human assistance Severe DFLE based on inability to perform Activities of Daily Living (ADLs e.g. bathing, feeding and getting in and out of bed) without human assistance. NB: Findings of this research are tentative and must not be reported or circulated without authors permission

15. Overview of analysis Gender differences: overall difference by sex using 2001 estimates as example Trends between 1981 and 2001 (estimated using data for five time points - 1980, 1985, 1994, 1998, 2001).

16. Gender Differences at age 65 in years without disability. 2001, Great Britain (NB: findings not to be quoted or circulated without authors permission) YearsMenWomen Life Expectancy15.919.0 Mild DFLE9.210.6 Moderate DFLE12.612.8 Severe DFLE14.716.3

17. Trends (1a) _Males @65: Number of expected years in each health state. 1980-2001, GB (NB: findings not to be quoted or circulated without authors permission)

18. Trends (1b) _ Males @65: Proportion of expected life in each health state. 1980-2001, GB (NB: findings not to be quoted or circulated without authors permission)

19. Trends (2a) _Females @65: Number of expected years in each health state. 1980-2001, GB (NB: findings not to be quoted or circulated without authors permission)

20. Trends (2b) _ Females @65: Proportion of expected life in each health state. 1980-2001, GB (NB: findings not to be quoted or circulated without authors permission)

21. Preliminary conclusions: (NB: findings not to be quoted or circulated without authors permission) Gender Differences: –Men can expect to spend a larger proportion of their remaining life free from disability compared to women. –Men can also expect to spend a higher proportion of remaining life with a mild disability, whereas women spend more time with a moderate or severe disability Trends: are not the same for men and women. –The amount of time spent healthy for women has increased since 1980, supporting the theory of compression of morbidity –For men, the magnitude of the change less marked: proportion of life with mild disability has increased and severe disability decreased, supporting the theory of dynamic equilibrium.

22. Limitations Uneven time points Not enough time points to see a definite trend Need to check consistency of finding with other survey sources (e.g. Health Survey for England) Response rate for the GHS is falling Assumptions had to be made about the health of those in long-stay care homes Severe disability definition fairly objective, but moderate/ mild disability definitions more likely to vary with social factors, cultural norms and environmental factors.

23. Future work plan ONS Understanding change in LE / HLE –Decomposition methods (eg. Arriga, Nusselder) Over time - by age, gender, cause Between groups/areas - by age, gender cause –Pseudo-cohort analysis (GHS 1971 onwards) –Joint project with academics (UCL), industry (life insurance provider), and ONS to look at contribution of determinants of increase in LE from 1970s (eg medical, lifestyle, socio-economic) Methodological developments –Review of self-assessed health measures –Multi-category response weights – eg. health-adjusted LE –Multi-state life tables (mortality-linked panel data)