Health Expectancy Indicators

By Robine, Jean-Marie; Romieu, Isabelle et al. | Bulletin of the World Health Organization, February 1999 | Go to article overview

Health Expectancy Indicators


Robine, Jean-Marie, Romieu, Isabelle, Cambois, Emmanuelle, Bulletin of the World Health Organization


Voir page 184 le resume en francais En la pagina 185 figura un resumen en espanol.

Data on life expectancy, infant mortality and the causes of death used to be seen as a sufficient basis for assessing population health status and determining public health priorities. As mortality rates decline and life expectancy increases, however, more and more questions arise about the quality of the years lived. The former indicators remain indispensable as there are still major inequalities in mortality between countries and between groups within countries. These indicators have yet to be acquired in some countries. Nevertheless, changes during the last 20 years have demonstrated the need for indicators of a new type, namely disability-free life expectancy, healthy life expectancy or active life expectancy. These provide information on the functional state and vitality of populations as well as on their quality of life, and they are appropriate for the epidemiological conditions of today.

The notion of health expectancy was introduced in the USA in the 1960s (1). In 1984, a general model of health transitions was proposed which distinguished between total survival, disability-free survival and survival without disabling chronic disease and led to the calculation of life expectancy, disability-free life expectancy and life expectancy without chronic disease (2). This model makes it possible to assess changes in mortality, morbidity and disability conditions simultaneously. Changes in the differences between the three indicators allows the occurrence of the different health scenarios proposed to be assessed: expansion of chronic diseases and disabilities, compression of morbidity, contradictory changes including the scenario of dynamic equilibrium, or postponement of all morbid events at older ages.

Most researchers working on the development of health expectancy calculations are now members of the Reseau Esperance de Vie en Sante (REVES). A first estimate of health expectancy, generally expressed as disability-free life expectancy, is available in many countries. An increasing number of countries have chronological series of health expectancies, which allow them to monitor changes in population health status. Health expectancies are increasingly used to assess changes in population health status, particularly in respect of older people. In each country the calculation of health expectancies makes it possible to estimate differences between men's and women's health and between socioeconomic categories or regions, and to observe the changes that occur.

The calculation of gains in health expectancy resulting from the elimination of specific pathologies makes it possible to define public health priorities in relation to the expected effects on life expectancy, disability-free life expectancy and time lived with disability. A health expectancy figure is the combination of a life expectancy figure with a concept of health which makes it possible to calculate the number of years lived in the different health states. Consequently, there are as many possible health expectancies as there are concepts of health. For example, we can introduce the notions of physical, mental or social well-being, models of disease consequences and disability processes, models of performance for daily living activities, or models of "successful ageing".

In 1994, REVES proposed a classification system of health expectancies based on the concepts of the international classifications of diseases (3) and their consequences (4), and on those of perceived health and adjustments to health (5). This makes it possible to distinguish between life expectancies with or without disease, life expectancies with or without impairment, and life expectancies with or without disability. It is also possible to distinguish life expectancies in good or bad perceived health. The table below shows how the different concepts of the classification system are used in China (6). …

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