Improving international comparability of health expectancy indicators

Task Force on Health Expectancies, European Commission, Luxembourg, 2 June 2008

General agreement on need to develop data on health expectancies

at national and international level

Need to move beyond life expectancy to assess population health status and the performance of health systems

Efforts to develop health expectancies at all levels:

- national level (European and non-European countries)

- EU level (HLY adopted as one structural indicator)

- OECD level (part of new work programme)

- more global level (WHO work) 2

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Need to improve collaboration between national and international

activities

Achieve synergy and consistency between various initiatives at national, European and global levels

Aim to develop health expectancy indicators that would be:

- reliable within countries

- comparable across countries

- feasible to update on a regular basis

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Why develop reliable and comparable data on health expectancies?

Examples of recent OECD projects that would have benefitted from reliable and comparable data on health expectancies:

1) Evaluating the contribution of growing spending on health care as a determinant of health improvements 2) Projecting of health and long-term care spending, in a context of population ageing

Because of current data limitations, life expectancy continues to be used as main indicator of health

Improving availability of comparable data on health expectancies

Since the late 1990s, OECD Health Data has included indicators of health expectancies produced by other international organisations:

- DFLE estimates for EU countries, now calculated by Eurostat

- HALE estimates for all countries previously calculated by WHO (most recent estimates for 2002)

But the use of these indicators is hampered by limited availability, reliability and comparability of DFLE and HALE estimates

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Steps required to improve the reliability and comparability of

health expectancies

Develop and adopt a valid and standard set of questions to measure health and disability

Develop and adopt a valid and standard method to assign a value to different health and disability status

Develop and adopt a valid and standard method to address missing information for certain population groups (children, people in institutions, etc.)

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What types of health expectancies?

In the US, three types of health expectancies reported under Healthy People 2010 Initiative:

- life expectancy in “good or better health”

- life expectancy “free of selected chronic diseases”

- life expectancy “free of activity limitation” (disability)

Information from these measures can be considered

complementary

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Simple and more advanced measures of health expectancies

1. Simple measures - based on a single question (e.g., self-rated general

health or general disability)

- based on simple valuation of different health or disability status (dichotomous, value of 0 or 1)

- example: LE in “good health”, DFLE

2. More advanced measures

- based on more elaborated set of questions (which may be less general and subjective)

- based on more elaborated valuation of different health status (continuous scale, value ranging from 0 to 1)

- example: HALE

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Strengths and weaknesses of simple and more advanced measures

Need for a scientific assessment of the merits and limitations of different types of simple and more advanced measures (in terms of feasibility, reliability and cross-country comparability)

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Limitations in comparability of self-rated general health

1. Results for these countries are not directly comparable with those for other countries, due to methodological differences in the survey questionnaire resulting in an upward bias.

Source: Health at a Glance 2007 – OECD Indicators.

Percentage of adults reporting to be in good or better health, 2005%

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Weak correlation between self-rated health and life expectancy

Source: OECD Health Data 2007.

AUS

BEL

CAN

CZE

DNK

FIN

FRA

DEU

HUN

ISLIRL

ITA

JPN

KOR

LUX

MEX

NLD

NLZ

NOR

POL

PRTSVK

ESP

SWE

CHE

TUR

GBR

USA

30

40

50

60

70

80

90

70 72 74 76 78 80 82 84

% o

f adu

lts

repo

rting

to

be in

goo

d he

alth

Life expectancy at birth (years)

Development of reliable and comparable measures of health and disability status

At European level:- mini European health module in SILC

- more elaborated set of questions on health and disability status in EHIS

At more global level:- Budapest Initiative on health status measures (undertaken

as a joint WHO/Eurostat/UNECE initiative) developing a set of health and disability questions that could be used for

health expectancies

- Washington City Group on Disability Statistics also

developing questions on disability

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OECD role in promoting international comparability on health expectancies

OECD is in a good position to play a “bridge” function between the approaches developed in Europe and at a broader level

Link different activities to develop reliable and comparable measures of health expectancies, with a view to achieve synergy and convergence (as opposed to divergence)

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What is the OECD planning to do?

Planning to organise a meeting of experts on health expectancy indicators, from European and non-European countries, in 2009 or 2010

Aims of experts meeting would be to:

- Review ongoing activities to promote development of comparable data on health expectancies

- Seek consensus on a small set of recommended survey questions for countries to implement, which would allow calculation of such measures

Meeting could be organised jointly with EC and WHO

Possible links with goals and activities of this Task Force

Common goal: Having health expectancy measures that are comparable and used also outside Europe

Begin two-way exchange of information with Budapest Initiative and Washington City Group (already proposed in Strategic Plan for this Task Force)

Organise joint meetings or events to:

- address methodological issues

- demonstrate utility of available data on health expectancies at national and international level, for monitoring population health and assessing the performance of health systems

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