The EHLEIS project of the European health expectancy monitoring unit

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Information Systemexpectancies

Health&Life

European10 000

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0 10 20 30 40 50 60 70 80 90 100 110

Sx LEx

0 100 000 83,0

10 99 907 82,1

20 99 744 80,3

30 99 457 77,6

40 98 950 74,0

50 98 063 69,5

60 96 517 64,1

70 93 848 57,8

80 89 322 50,6

90 81 882 42,5

100 70 296 33,5

110 53 858 23,6

European health expectancy monitoring unit

Initial objectives of EHEMU:

• To provide annual comparable health expectancy estimates for all European Union countries, in association with Eurostat

• To analyse and interpret the results

• To educate policy makers, politicians and the public in health expectancy as an indicator of population health

Ehemu: the “European health expectancy monitoring unit”

• Creation of a website to make all information accessible

Ehemu “kick off projects”

Ways in which these objectives have been fulfilled to date:

Ehemu “kick off projects”

• Creation of a website to make all information accessible

Ehemu “kick off projects”

Ways in which these objectives have been fulfilled to date:

• Production of pedagogical documents: country reports, interpreting guide, calculation guide…

EHEMU Country Reports

I ssue 0 August 2005

HEALTH EXPECTANCY I N BELGI UM

What is health expectancy?

Health expectancies were first developed to address whether or not longer life is being accompanied by an increase in the time lived in good health (the compression of morbidity scenario) or in bad health (expansion of morbidity). So health expectancies divide life expectancy into life spent in different states of health, from say good to bad health. In this way they add a dimension of quality to the quantity of life lived.

How is the effect of longer life measured?

The general model of health transitions (WHO, 1984) shows the differences between life spent in different states: total survival, disability-free survival and survival without disabling chronic disease. This leads naturally to life expectancy (the area under the 'mortality' curve), disability-free life expectancy (the area under the 'disability' curve) and life expectancy without chronic disease (the area under the 'morbidity' curve).

The general model of health transition (WHO, 1984): observed mortality and hypothetical morbidity and disability survival curves for females, USA, 1980.

There are in fact as many health expectancies as concepts of health. The commonest health expectancies are those based on

self-perceived health

activities of daily living

chronic morbidity.

How do we compare health expectancies?

Health expectancies are independent of the size of populations and of their age structure and so they allow direct comparison of different population sub-groups: e.g. sexes, socio-professional categories, as well as countries within Europe.

Health expectancies are most often calculated by the Sullivan method (Sullivan, 1971). However to make valid comparisons, the underlying health measure should be truly comparable. This is not yet the case for European countries because of the varying definitions of health used.

To address this, the European Union has decided to include a small set of health expectancies among its European Community Health Indicators (ECHI), covering the dimensions of chronic morbidity, functional limitations, activity restrictions and perceived health. Specific questions have now been included in the various European surveys: the European Community Household Panel (ECHP), Eurobarometer, and Statistics on Income and Living Conditions (SILC), to improve comparability between countries. In addition, a new EU structural indicator based on a health expectancy has been proposed, to be known as Healthy Life Years.

What is in this report?

This report is produced by the European Health Expectancy Monitoring Unit (EHEMU) as part of a country series. In each report we present:

a description of the main purpose of health expectancies

the trend in health expectancies for all EU MS showing the country of interest, based on data from the ECHP between 1995 and 2001

health expectancies based on different dimensions of health for the country of interest, based on data from the Eurobarometer (Issue 0) and SILC (Issue 1 onwards)

trends in health expectancies over time for the EU, based on the ECHP

References

World Health Organization. The uses of epidemiology in the study of the elderly: Report of a WHO Scientific Group on the Epidemiology of Aging. Geneva: WHO, 1984 (Technical Report Series 706).

Sullivan DF (1971) A single index of mortality and morbidity. HSMHA Health Reports 86:347-354.

Further details on the calculation and interpretation of health expectancies can be found on www.REVES.net and in Robine JM, Jagger C, Mathers CD, Crimmins EM Suzman RM, Eds. Determining health expectancies. Chichester UK: Wiley, 2003.

Ehemu “kick off projects”

• Creation of an interactive database to compute life and health expectancies for the European countries, using European surveys

Ehemu “kick off projects”

Different projects conducted so far to fulfil these objectives:

• Creation of a website to make all information accessible

• Production of pedagogical documents: country reports, interpreting guide, calculation guide…

Ehemu “kick off projects”

Ehemu “kick off projects”

Different projects conducted so far to fulfil these objectives:

• Building networks of resource-persons from each MS: network of policy makers / network of DFLE expert

• Creation of an interactive database to compute life and health expectancies for the European countries, using European surveys

• Creation of a website to make all information accessible

• Production of pedagogical documents: country reports, interpreting guide, calculation guide…

EHLEIS objectives:

• Continue the Ehemu « basic » activitiesupkeep of the website and Information System Produce future issues of the country reports for each of the MSProvide scientific resources to the TF-HE

• Develop data analysis using the Information system resourcesinsights into gender gaps in HE trade-offs between health dimensions through scientific reports

• Develop new instruments to analyse patterns and trendsDecomposition techniques to assess contributions to differences in HE

• EducationOrganise a training workshop in HE Organise a European Health Expectancy conference

EHLEIS: the new project (2007-2010) (EU Grant agreement n° 2006109)

EHLEIS: the new project

The participants to the projects

Jean-Marie Robine Isabelle Romieu (INSERM-FR)

Coordination of the project WP1

All participants Dissemination of the results WP2

Herman van Oyen (Public health institute-BE)

Evaluation of the project WP3

Jean-Marie Robine Emmanuelle Cambois Sophie Leroy (INED-FR)

Developing and maintaining the Information System WP4

Carol Jagger Clare Gillies (Leicester Univ-UK)

Identifying causes of inequalities between countries WP5

Herman van Oyen Identifying causes of the gender gaps between countries WP6

Wilma Nusselder (Roterdam Univ- Nth)

Decomposition techniques WP7

Gabriel Doblehammer (Max Planck Institute-G)

Training on health expectancies WP8

Jitka Rychtaříková (Praga Univ. C R)

European health expectancy conference WP9

EHLEIS: the new project

Resources :

• Team of experts responsible for the development of the different WP• Ehemu website • Networks of collaborators from the EU-25 MS

Expected results:

• New HE estimates from SILC and EHIS more readily-accesible • Basic information on trends in HLY in the EU-25• New insights on health inequalities between the EU-25• New tools for analysis using decomposition techniques • Better understanding of cultural differences in health• Better trained public health professionals• Exchange of information between producers and policy users of health indicators

… to be continued !