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Healthy Life Years (HLY)
The Healthy Life Years (HLY) indicator (also called disability-free life expectancy) measures the number of remaining years that a person of a certain age is still supposed to live without disability. Healthy Life Years is a solid indicator to monitor health as a productivity/economic factor. Healthy Life Years introduces the concept of quality of life. It is used to distinguish between years of life free of any activity limitation and years experienced with at least one activity limitation. The emphasis is not exclusively on the length of life, as is the case for life expectancy, but also on the quality of life.
HLY is a functional health status measure that is increasingly used to complement the conventional life expectancy measures. The HLY measure was developed to reflect the fact that not all years of a person's life are typically lived in perfect health. Chronic disease, frailty, and disability tend to become more prevalent at older ages, so that a population with a higher life expectancy may not be healthier. Indeed, a major question with an aging population is whether increases in life expectancy will be associated with a greater or lesser proportion of the future population spending their years living with disability. If HLY is increasing more rapidly than life expectancy in a population, then not only are people living longer, they are also living a greater portion of their lives free of disability.
Any loss in health will, nonetheless, have important second order effects. These will include an altered pattern of resource allocation within the health-care system, as well as wider ranging effects on consumption and production throughout the economy. It is important for policy-makers to be aware of the opportunity cost (i.e. the benefits forgone) of doing too little to prevent ill-health, resulting in the use of limited health resources for the diagnosis, treatment, and management of preventable illness and injuries.
How is HLY calculated?
The indicator is calculated following the Sullivan method which is widely used by experts across the world since the 1970's. It is based on prevalence measures of the age specific proportion of population with and without disabilities and on mortality data. Its interest lies in its simplicity, the availability of its basic data and its independence of the size and age structure of the population. The health status of a population is inherently difficult to measure because it is often defined differently among individuals, populations, cultures, and even across time periods. The demographic measure of life expectancy has often been used as a measure of a nation's health status because it is defined by a single vital characteristic of individuals and populations -- death. However, the measure of life expectancy has limited utility as a gauge of a population's health status because it does not provide an estimate of how healthy people are during their lifespan.
The idea for the development of a measure of "health expectancy" (the partitioning of the demographic measure of life expectancy into healthy and non-healthy years of life) originated with a report published in 1969 by the U.S. Department of Health, Education and Welfare. The report noted that both good health and long life are fundamental objectives of human activity, but that despite the substantial rise in life expectancy in the 20th century the overall health status of the population was unknown. In fact, it was recognized that accompanying the rise in life expectancy was the emergence of chronic diseases -- thus raising concerns about the future health status of the population if death rates continued to decline.
The two components of the calculation of the HLY in the EU are the mortality tables and the activity limitation data assessed by health surveys. Life tables which give mortality data for calculating life expectancy are fully available as a demographic long-term series based in the standard procedures of causes of death registration harmonised at EU level.
Activity limitation data comes from the Eurostat survey Statistics on Income and Living Conditions (EU-SILC) that contains a health module. This health section includes a global question on activity limitation known as the General Activity Limitation Indicator (GALI) especially designed for estimating the HLY. EU-SILC has been used since 2004 and provides data for all MS from 2007 onwards. Before 2004, HLY was calculated with data on self-perceived disability coming from the Eurostat survey European Community Household Panel (ECHP). The change of the data source for calculating the prevalence of disability in 2004 created a break in series.
Data on HLY in the EU
A Healthy Life Years (HLY) improvement is the main health goal for the EU. The European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) aims to increase the average healthy lifespan of Europeans by 2 years by 2020. At present HLY at birth in the EU is, on average, 15 years shorter than overall life expectancy for men and 20 years shorter for women.
Data shows clear differences between Member States in life expectancies without disability.
Since 2005, the HLY at birth has been measured in the EU27 around 62.5 for women and 61.5 for men. Trends over time on Healthy Life Years and Life expectancy are available from the Heidi data tool:
- See Healthy life years at birth and at 65, by gender
- See Life expectancy at birth and at age 65, by gender
Eurostat publishes more statistics on HLY at age 50 and HLY in percentage of the total life expectancy:See also Healthy Life Years and Life expectancy at age 50, by gender in Eurostat Online Database.
Some suggest that life expectancy has reached its limits; however, there is no evidence for this. Female life expectancy has risen for 160 years at a rate of 3 months per year. In 1840 the longest survivors were Swedish women who lived an average of 45 years, while now the life expectancy of French, Italian and Spanish women is around 85 years. Before 1950 most of the gain was due to a reduction in premature deaths. In recent decades it has been due to an improvement in the survival of people over 65. The old notion that even under favorable circumstances human beings have a characteristic lifespan is now being challenged. The enduring belief that the ceiling is finally about to be reached has repeatedly been disproved over the last 100 years. If the current trend of life expectancy increasing by 2.5 years per decade persists, the average lifespan may be 100 years by 2070.
The disability burden expressed in health-care expenditure (in kind and in cash) and pensions is a major proportion of national expenditure. Increasing age and life years spent in poor health mean greater medical needs in particular with regard to pathologies such as degenerative vascular diseases, cancer, and Alzheimer's and other neurodegenerative diseases. The sick elderly are a greater financial commitment than their healthy counterparts. If the retirement age is to be raised, people must be physically able to work and enjoy healthy life years.
The percentage of the population aged 65 and over, which started to rise sharply from the latter part of the last century, is continuing to rise. In 2010, 17% of the EU27 population were aged 65 and over (Member States ranging from 11% to 21%), and this is likely to rise to around 30% by 2060 (Source: Eurostat, EUROPOP2010 convergence scenario).
HLY and allocation of resources
HLY has been proposed as an appropriate indicator for the short-term allocation of social and health resources.
The EU population is aging and as the post-war generation reaches retirement, the pace of ageing will increase dramatically, with profound social effects. One major difficulty in planning for future health and long term care needs, however, is the lack of agreed estimates of future numbers and needs. HLY could provide some of these estimations.
Many of the studies of health expectancy focus on measures such as physical impairment or disability in functional tasks or presence of a specific chronic disease. However, self-assessed health, being much more global and subjective in nature, can incorporate a variety of aspects of health including cognitive and emotional as well as physical status, and therefore provide insights into the needs of an aging society.
Hence, self-assessed health measures as HLY may be a particularly important indicator of the potential demand for health services and long-term care needs of the elderly population.
Developments of HLY as EU structural indicator
The "Healthy Life Years" indicator is part of the core set of the European Structural Indicators.
In 2000, the Lisbon European Council invited the Commission to draw up an annual report on progress on the basis of structural indicators relating to employment, innovation, economic reform and social cohesion. In 2003, the Commission issued first such report on structural indicators.
In 2003, the newly established Network of Competent Authorities on Health Information and Knowledge recommended a set of first phase core indicators on health status. The set included an indicator to measure Healthy Life Years.
In April 2004, the Commission reported to the European Council on delivering Lisbon reforms for the enlarged Union, and proposed integrating public health into the Lisbon strategy by 2005, as a contribution to growth and sustainable development.
The Communication was modified in October 2004 to add new indicators and to introduce a structural indicator on health: the Healthy Life Years (HLY).
In 2003, DG Health and Consumers co-financed under the Public Health Programme a project on the European Health Expectancy Monitoring Unit (EHEMU).
The EHEMU aimed to : (1) contribute to ensuring the quality of calculation and the interpretation of outcomes (trends, cross national differences.) for HLY to be properly and comparably produced, (2) contribute to ensuring the dissemination of necessary knowledge in each country to public health actors and / or statistical agencies' staff who routinely work with HLY, (3) act as repository for data on EU health expectancies, including past data, for comparison with the new emerging harmonised data, (4) develop web-based training material for interpreting and calculating health expectancies for a wide audience, (5) contribute to improving and developing the European health monitoring system by collaboration with other similar initiatives.
The HLY is a health expectancy indicator that combines information on mortality and morbidity and partitions the total years lived at any age into those spent in different 'health' states, however 'health' is defined. This indicator was preferred to other possible health expectancy indicators such as Disability Adjusted Life Years (DALY) or Health Adjusted Life Expectancies (HALE).
The Task Force on Health Expectancies is one of the technical groups established to take forward work in specific areas, and would report back to the Expert Group on Health information, former Health Information Committee. These technical groups have a specific and time-limited mandate to achieve a specific result, rather than becoming a standing structure.
For other technical groups, see here.
Are we living longer, healthier lives? (The EHEMU project)
The first results of the EHEMU project consisted of four technical reports analysing the statistical estimates based on the European Community Household Panel (ECHP) survey, made to fulfil the requirements for Healthy Life Years to be an EU Structural Indicator.
The first report: Disability-Free Life Expectancy (DFLE) in EU Countries from 1991 to 2003
The second EHEMU report: Are we living longer, healthier lives in the EU? Disability-Free Life Expectancy (DFLE) in EU Countries from 1991 to 2003 based on the European Community Household Panel (ECHP)
The 2006 health expectancy calculations report from EHEMU Estimations of health expectancy at age 65 in European Union countries in 2004 is based on 2004 SHARE survey which included 22 000 Europeans aged 50 and above. All the calculations are presented for a population aged 65 and above.
The EHEMU website hosts an information system which facilitates the calculation of life and health expectancies in 25 countries within the EU.
The EHEMU database provides European life and health expectancy data including a calculation guide, reports and analyses.
The Sullivan method is used for calculations of health expectancies.
The raw health data enabling the calculation of health expectancies are provided by Eurostat, DG SANCO and Mannheim University and originate from different European surveys (ECHP, EUROBAROMETER, SILC, SHARE).
SHARE (The Survey of Health, Ageing and Retirement in Europe) is co-ordinated centrally at the Mannheim Research Institute for the Economics of Aging. Eleven countries have contributed micro data to the 2004 SHARE baseline study.
Data collected include health variables (e.g. self-reported health, physical functioning, cognitive functioning, health behaviour, use of health care facilities), psychological variables (e.g. psychological health, well-being, life satisfaction), economic variables (e.g. current work activity, job characteristics, opportunities to work past retirement age, sources and composition of current income, wealth and consumption, housing, education), and social support variables (e.g. assistance within families, transfers of income and assets, social networks, volunteer activities). Based on probability samples in all participating countries, SHARE represents the non-institutionalized population aged 50 and older.
The SHARE main questionnaire consists of 20 modules (supplemented by a self-completion questionnaire). Some modules concerning the household rather than the individual are only answered by the designated respondent. Using the physical health data several types of health expectancies were calculated: life expectancy in perceived health, without chronic disease, without limitation of mobility, without limitation in activities of daily living (washing, eating...), without limitation in everyday domestic tasks, referred to as instrumental activities (using the phone, making a hot meal...).
The European Health and Life Expectancy Information Systems (EHLEIS) Project
The European Health and Life Expectancy Information Systems (EHLEIS) project continued the work of the European Health Monitoring Expectancy Unit (EHEMU), a collaboration between the Universities of Montpellier, Leicester and the Belgian Institute of Public Health, on determining whether the EU population is living longer and healthier lives.
EHLEIS monitored and explored gender gaps and inequalities in health expectancies between EU MS, specifically identifying explanatory factors for convergent or divergent trends. Through the continued updating of an online information system of health and life expectancy, a training workshop and a conference for policy makers demonstrating best practice, EHLEIS aimed at ensuring that the EU and its Member States maximally utilise the Eurostat Survey on Income and Living Conditions (SILC) and the European Health Interview Survey (EHIS), alongside national data, to compute HLY and monitor population health with both harmonised data and methods.
The strategy of EHLEIS was to disseminate high quality information on Healthy Life Expectancies through a wide range of means including a dedicated website, ad-hoc technical reports, regular country reports, a training workshop, the European conference and its proceedings and scientific papers.
Uptake of the HLY
The awareness of and uptake of the Healthy Life Years indicator at European and national level were evaluated in 2006. Results of the evaluation, undertaken by Rand Europe for the Commission, are available at Evaluating the Uptake of the Healthy Life Years Indicator - Final report.
The evaluation aimed at helping the Commission better understand how to increase the uptake of the HLY indicator and how to raise the profile of health within non-health policies, particularly those addressing or shaped by demographic change. Uptake involves both awareness and use, defined as 'having knowledge of the indicator' (awareness) and use of the HLY indicator in practice (e.g. in policy making and/or impact assessment).