The cross-sectional average length of healthy life (HCAL): a measure that summarizes the history of cohort health and mortality

[Healthy life expectancy: a critical look at the benefits and potential of the demographic health indicator]

Demographic ageing yields many societal consequences that depend strongly on the health status of the population. Special indicators have been developed for tracking and assessing population health, which are referred to with the overarching term healthy life expectancy (HLE). The derivation of HLE is intuitive and easily comprehensible. However, an overly simplistic interpretation hides the extreme complexity inherent in adding the health dimension to the life table. This makes HLE compared to classic life expectancy (LE) extremely sensitive to certain conceptual and methodological features. In the article, this is presented in more detail for three aspects: the underlying definition of health, the choice of survey data as a basis for estimating health status, and the reporting behavior of survey participants. It is shown that the impact on HLE can be enormous, leading to considerable bias in the interpretation of levels and trends, but also in the analysis of differences between populations. Nevertheless, the extension of classical LE to HLE is an important achievement that must not be abandoned. Therefore, the article also discusses ways in which the HLE indicator could be made more robust and reliable. Until this is achieved, however, the high methodological sensitivity of HLE must not be ignored if it is used to assess the health status of populations and as a basis for health policy measures.

Comparing Cohort Survival in Good Health: A Research Note on Decomposing Sex Differentials in the United States

We introduce a method for decomposing differences in healthy cross-sectional average length of life (HCAL). HCAL provides an alternative to the health expectancy (HE) indicator by including the health and mortality history of all cohorts present at a given time. While decompositions of HE differences account for contributions made by health and mortality, differences in HCAL are further disentangled into cohort-specific contributions. In this research note we illustrate the technique by analyzing the sex gap in health and mortality for the United States. We use the harmonized version of the Health and Retirement Survey data and define the health status in terms of activities of daily living. Our results suggest that the female advantage in cohort survival is partly compensated by women's lower cohort-specific health levels. At older ages, however, the sex differences in health are not large enough to compensate men's disadvantage in cohort survival.

The impact of population's educational composition on Healthy Life Years: An empirical illustration of 16 European countries

Healthy Life Years (HLY) is a prominent summary indicator for evaluating and comparing the levels of population health status across Europe. Variations in HLY, however, do not necessarily reflect underlying differences in health and mortality levels among countries and the indicator is particularly sensitive when broken down by subpopulations. For instance, despite European countries showing large HLY inequalities by educational level, these countries are also heterogenous regarding their population composition by educational attainment, which most likely affects their HLY levels. We demonstrate how this compositional effect shapes HLY levels by providing estimates for HLY by educational attainment and gender for 16 European countries using the Sullivan method. We use prevalence data about limitations in daily activities from the European Union Statistics on Income and Living Conditions (EU-SILC) and mortality data from the Eurostat database. Finally, we adjust for compositional effects by means of standardization. The education-adjusted HLY estimates do not differ much from conventional HLY. Yet, we find that in some countries HLY levels are indeed affected by the population composition by educational attainment. For example, low-, medium-, and high educated individuals in Portugal show more HLY than their counterparts in Poland. Still, Poland's total HLY value slightly exceeds that of Portugal, indicating favorable health and mortality conditions in Poland. It is Poland's lower relative number of low educated individuals in its population that is responsible for producing this higher total HLY value. We conclude that differentials in HLY due to differences in the relative size of educational subpopulations are generally small in HLY across Europe but they can play an important role for countries that experienced large differences in their educational expansion.