Country reports:

Rationale and user views

Carol Jagger

Purpose of the Country Reports

• To provide results of trends and trade-offs for each MS• in a standardised format• eaily readable• without ranking countries

• To provide overall values for all the EU

• To provide a simple explanation of HE issues including interpretation

Format

Four A4 pages on folded A3• Front

• HE background

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.

What is HE

HE scenarios

Calculating HE

Data sources

Index of report

Format

Four A4 pages on folded A3• Front

• HE background

• Back• Overall EU values

LE trends by gender

Contact details

E U p r o f i l e ( S o u r c e : E u r o p e a n C o m m u n i t y H o u s e h o ld P a n e l , 1 9 9 5 - 2 0 0 3 )

T h e b o x p lo t 1 b e lo w s h o w s t h e d i s t r i b u t io n o f l i f e e x p e c ta n c i e s ( L E ) a n d d i s a b i l i t y - f r e e l i f e e x p e c ta n c i e s ( D F L E ) a t b i r t h f o r t h e 1 2 E U M e m b e r S ta t e s o v e r t h e p e r io d 1 9 9 5 -2 0 0 3 a n d s e p a r a t e ly f o r m a l e s a n d f e m a le s . T h e k e y p o i n t s a r e :

T h e r e i s m o r e v a r ia b i l i t y i n D F L E a m o n g t h e E U M e m b e r S t a te s t h a n in l i f e e x p e c t a n c i e s O v e r t h e p e r io d 1 9 9 5 -2 0 0 3 f o r m e n t h e g a i n i n t o t a l y e a r s w a s g r e a te r t h a n th e g a in i n y e a r s f r e e o f

d i s a b i l i t y In w o m e n t h e r e w a s o n ly a s l i g h t im p r o v e m e n t , o n a v e r a g e , i n l i f e e x p e c t a n c y w i th a s im i la r g a in i n

d i s a b i l i t y - f r e e l i f e y e a r s .

L if e E x p e c t a n c y a t b ir t h : M e n

1 9 9 5 1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3

7 0

7 5

8 0

8 5

L if e E x p e c t a n c y a t b ir t h : W o m e n

1 9 9 5 1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3

7 0

7 5

8 0

8 5

D is a b i l i t y - F r e e L i f e E x p e c t a n c y a t b ir t h : M e n

1 9 9 5 1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3

5 5

6 0

6 5

7 0

7 5

D is a b i l i t y - F r e e L i f e E x p e c t a n c y a t b ir t h : W o m e n

1 9 9 5 1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3

5 5

6 0

6 5

7 0

7 5

1 B o x p lo t s ( o f t e n c a l le d " b o x a n d w h is k e r " p lo t s ) a r e a w a y o f s u m m a r iz in g a d i s t r ib u t io n o f s c o r e s . T h e " b o x " s h o w s th e m e d ia n

s c o r e a s a l in e a n d th e f i r s t ( 2 5 th p e r c e n t i l e ) a n d th i rd q u a r t i l e ( 7 5 th p e r c e n t i l e ) a s th e lo w e r a n d u p p e r p a r t s o f th e b o x . T h e

" w h i s k e r s " a b o v e a n d b e lo w th e b o x e s r e p r e s e n t t h e l a r g e s t a n d s m a l l e s t o b s e r v a t io n s l e s s th a n 1 .5 b o x le n g th s f r o m th e e n d o f th e

b o x . O c c a s io n a l ly s c o r e s a r e s h o w n a s o p e n c i r c l e s " o " a n d th e s e re p r e s e n t o u t l i e r s .

A b o u t E H E M U T h e E u r o p e a n H e a l th E x p e c t a n c y M o n i to r in g U n i t ( E H E M U ) i s f u n d e d b y t h e E u r o p e a n P u b l i c H e a l th P r o g r a m m e ( 2 0 0 4 -2 0 0 7 ) a n d i s a c o l l a b o r a t io n b e tw e e n : C R L C a n d U n i v e r s i ty o f M o n t p e l l i e r ( F r a n c e ) , U n i v e r s i t y o f L e ic e s t e r ( U K ) , t h e S c i e n t i f i c In s t i t u te o f P u b l ic H e a l t h ( IS P B e l g i u m ) a n d t h e F r e n c h N a t io n a l In s t i t u te o f D e m o g r a p h y ( I N E D ) . E H E M U a i m s to p r o v i d e a c e n t r a l f a c i l i t y f o r t h e c o -o r d in a te d a n a l y s i s , i n te r p r e ta t i o n a n d d i s s e m in a t io n o f l i f e a n d h e a l th e x p e c t a n c ie s t o a d d t h e q u a l i t y d im e n s i o n to t h e q u a n t i t y o f l i f e l i v e d b y th e E u r o p e a n p o p u la t i o n s . F u r th e r d e t a i l s a b o u t E H E M U c a n b e f o u n d o n th e w e b s i t e : w w w .h s . l e .a c .u k / r e v e s / e h e m u t e s t / i n d e x .h t m l .

DFLE trends by gender

Format

Four A4 pages on folded A3• Front

• HE background

• Back• Overall EU values

• Middle• Left – trends over time• Right – trade-off between HE measures

LE and DFLE

trends for women

Key results

L i f e e x p e c t a n c y ( L E ) a n d D i s a b i l i t y - F r e e L i f e E x p e c t a n c y ( D F L E ) a t b i r t h b y g e n d e r , B e l g i u m c o m p a r e d t o o t h e r E U c o u n t r i e s ( S o u r c e : E u r o p e a n C o m m u n i t y H o u s e h o l d P a n e l , 1 9 9 5 - 2 0 0 3 )

5 2

5 4

5 6

5 8

6 0

6 2

6 4

6 6

6 8

7 0

7 2

7 4

7 6

7 8

8 0

8 2

8 4

1 9 9 4 1 9 9 5 1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4

L E

D F L E

5 2

5 4

5 6

5 8

6 0

6 2

6 4

6 6

6 8

7 0

7 2

7 4

7 6

7 8

8 0

8 2

8 4

1 9 9 4 1 9 9 5 1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4

L E

D F L E

W o m e n 1 9 9 5 1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 L E 8 0 . 2 8 0 . 4 8 0 . 6 8 0 . 6 8 0 . 8 8 0 . 8 8 1 . 1 8 1 . 2 8 1 . 3 D F L E 6 6 . 4 6 8 . 5 6 8 . 3 6 5 . 4 6 8 . 4 6 9 . 1 6 8 . 8 6 9 . 0 6 9 . 2 % D F L E / L E 8 2 . 7 8 5 . 2 8 4 . 8 8 1 . 2 8 4 . 6 8 5 . 5 8 4 . 9 8 5 . 0 8 5 . 1

M e n 1 9 9 5 1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 L E 7 3 . 4 7 3 . 8 7 4 . 1 7 4 . 3 7 4 . 4 7 4 . 6 7 4 . 9 7 5 . 1 7 5 . 4 D F L E 6 3 . 3 6 4 . 1 6 6 . 5 6 3 . 3 6 6 . 0 6 5 . 7 6 6 . 6 6 6 . 9 6 7 . 4 % D F L E / L E 8 6 . 2 8 6 . 8 8 9 . 7 8 5 . 1 8 8 . 7 8 8 . 1 8 9 . 0 8 9 . 1 8 9 . 4

K e y p o i n t s : A m o n g w o m e n L E a t b i r t h i n c r e a s e s b y 1 . 1 y e a r s b e t w e e n 1 9 9 5 a n d 2 0 0 3 , w i t h a h i g h e r i n c r e a s e i n

D F L E b y 2 . 8 y e a r s a n d a d e c r e a s e i n y e a r s w i t h d i s a b i l i t y b y 1 . 7 y e a r s ( f r o m 1 3 . 8 y e a r s t o 1 2 . 1 y e a r s ) , s u g g e s t i n g a c o m p r e s s i o n o f m o r b i d i t y .

A m o n g m e n L E a t b i r t h i n c r e a s e s b y 2 y e a r s b e t w e e n 1 9 9 5 a n d 2 0 0 3 a n d D F L E i n c r e a s e s b y 4 . 1 y e a r s , s u g g e s t i n g a c o m p r e s s i o n o f m o r b i d i t y a s t h e n u m b e r o f y e a r s w i t h d i s a b i l i t y d e c r e a s e s b y 2 . 1 y e a r s ( f r o m 1 0 . 1 y e a r s t o 8 y e a r s ) , s u g g e s t i n g a c o m p r e s s i o n o f m o r b i d i t y l i k e a m o n g w o m e n .

F o r b o t h w o m e n a n d m e n , L E a n d D F L E i n c r e a s e . L E i s i n t h e m i d d l e o f t h e E u r o p e a n t r e n d s w h i l e D F L E a r e q u i t e i n t h e h i g h e s t l e v e l o f E u r o p e a n t r e n d s .

W o m e n

M e n

LE and DFLE

trends for men

HE using different

measures – trade-

offs

Other national results

Key results

L i f e e x p e c t a n c y a t a g e 6 5 a n d e x p e c t e d y e a r s i n s e v e r a l h e a l t h s t a t u s e s a c c o r d i n g t o p e r c e i v e d h e a l t h , c h r o n i c d i s e a s e s a n d d i s a b i l i t y : B e l g i u m ( S o u r c e : E u r o b a r o m e t e r , 2 0 0 2 )

8 . 3

7 . 9

1 0 . 6

1 0 . 9

1 1 . 9

1 4 . 0

9 . 2

1 0 . 4

5 . 7

9 . 3

3 . 8

7 . 8

5 . 2

7 . 8

1 . 8

2 . 5

1 . 5

1 . 0

4 . 0

5 . 7

1 . 5

1 . 5

0 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 2 0 2 1 2 2 2 3 2 4 2 5

I n d i c a t e u r g é n é r i q u e H

I n d i c a t e u r g é n é r i q u e F

R A h

R A f

M C h

M C f

S P h

S P f

E x p e c t e d y e a r s

L E a t a g e 6 5 a n d e x p e c t e d y e a r s i n v e r y g o o d o r g o o d p e r c e i v e d h e a l t h i n f a i r p e r c e i v e d h e a l t h i n b a d a n d v e r y b a d p e r c e i v e d h e a l t h

L E a t a g e 6 5 a n d e x p e c t e d y e a r s w i t h o u t c h r o n i c d i s e a s e w i t h c h r o n i c d i s e a s e

L E a t a g e 6 5 a n d e x p e c t e d y e a r s w i t h o u t a c t i v i t y r e s t r i c t i o n w i t h m o d e r a t e a c t i v i t y r e s t r i c t i o n s w i t h s e v e r e a c t i v i t y r e s t r i c t i o n s

L E a t a g e 6 5 a n d e x p e c t e d y e a r s 1

i n g o o d h e a l t h i n f a i r h e a l t h i n b a d h e a l t h

W o m e n

M e n

W o m e n

W o m e n

W o m e n

M e n

M e n

M e n

P u b l i s h e d r e s u l t s a n d o t h e r r e p o r t s o f h e a l t h e x p e c t a n c i e s f o r B e l g i u m

B o s s u y t N , G a d e y n e S , D e b o o s e r e P , V a n O y e n H . S o c i o - e c o n o m i c i n e q u a l i t i e s i n h e a l t h e x p e c t a n c y i n B e l g i u m . P u b l i c H e a l t h 2 0 0 4 ; 1 1 8 ( 1 ) : 3 - 1 0 .

V a n O y e n H , B o s s u y t N , D e b o o s e r e P , G a d e y n e S , T a f f o r e a u J . D i f f e r e n c e s i n h e a l t h e x p e c t a n c y i n d i c a t o r s i n B e l g i u m b y r e g i o n . A P H 2 0 0 2 ; 6 0 : 3 4 1 - 3 6 2 .

M i e r m a n s P - J , V a n O y e n H . R a p p o r t d e S a n t é : E t u d e d e l a s i t u a t i o n d e l a s a n t é e n B e l g i q u e s u r l a b a s e d e s c h i f f r e s d e l a m o r t a l i t é e t d e l ' e s p é r a n c e d e v i e . B r u x e l l e s : I n s t i t u t S c i e n t i f i q u e d e l a S a n t é P u b l i q u e , S e r v i c e d ' é p i d é m i o l o g i e ; 2 0 0 2 . R e p o r t N o . : I H E / E P I r e p o r t s n ° 2 0 0 2 - 0 3 1 .

K e y p o i n t s : I n 2 0 0 2 , L E a t a g e 6 5 i n B e l g i u m w a s 1 9 . 7 y e a r s f o r w o m e n a n d 1 5 . 9 y e a r s f o r m e n . B a s e d o n t h e E u r o b a r o m e t e r 5 8 , a t a g e 6 5 , w o m e n s p e n t 7 . 9 y e a r s i n g o o d h e a l t h , 9 . 3 y e a r s i n f a i r

h e a l t h a n d 2 . 5 y e a r s i n b a d h e a l t h ( s e e a b o v e f o r d e f i n i t i o n o f g o o d h e a l t h ) . M e n o f t h e s a m e a g e s p e n t 8 . 3 y e a r s i n g o o d h e a l t h c o m p a r e d t o 5 . 7 a n d 1 . 8 y e a r s i n f a i r o r b a d

h e a l t h r e s p e c t i v e l y . A l t h o u g h t o t a l y e a r s l i v e d b y m e n a r e l e s s t h a n t h o s e f o r w o m e n , t h e y e a r s s p e n t i n g o o d h e a l t h

a c c o r d i n g t o t h e g e n e r i c i n d i c a t o r w e r e g r e a t e r f o r m e n t h a n w o m e n . T h e s e r e s u l t s s h o u l d b e i n t e r p r e t e d c a u t i o u s l y g i v e n t h e s m a l l s a m p l e s i z e ( i n B e l g i u m 1 2 7 w o m e n a n d 8 8 m e n a g e d 6 5 + y e a r s ) a n d t h e l a c k o f t h e i n s t i t u t i o n a l p o p u l a t i o n . H o w e v e r t h e y s e r v e a s a n e x a m p l e o f f u t u r e y e a r l y c a l c u l a t i o n s o f t h e “ Y e a r s o f H e a l t h y L i f e ” a n d o t h e r h e a l t h e x p e c t a n c y i n d i c a t o r s w h i c h w i l l b e p o s s i b l e o n c e t h e S I L C - s u r v e y d a t a b e c o m e r o u t i n e l y a v a i l a b l e .

1 T h e g e n e r i c h e a l t h i n d i c a t o r c a l c u l a t e d f r o m t h e p r e v i o u s t h r e e h e a l t h d i m e n s i o n s . G o o d h e a l t h i s d e f i n e d a s e i t h e r v e r y g o o d

p e r c e i v e d h e a l t h , n o a c t i v i t y r e s t r i c t i o n a n d n o c h r o n i c d i s e a s e , o r g o o d p e r c e i v e d h e a l t h , n o a c t i v i t y r e s t r i c t i o n a n d n o c h r o n i c

d i s e a s e ; b a d h e a l t h i s d e f i n e d a s v e r y b a d p e r c e i v e d h e a l t h a n d s e v e r e a c t i v i t y r e s t r i c t i o n o r b a d p e r c e i v e d h e a l t h a n d s e v e r e

a c t i v i t y r e s t r i c t i o n ; f a i r h e a l t h i s t h e r e m a i n d e r .

Data sources

• Issue 0• ECHP for trends• Eurobarometer for different measures – trade-offs

Consultation

• Issue 0 of the Country Reports was prepared for each country and sent with a questionnaire to:• Public Health network• Expert network

• Questionnaire had open ended questions and covered the structure, format and layout, data sources, whether results were comparable to those from national series

• Replies received from 12 Public Health and 17 Experts

• Very positive feedback but disliked:• use of Eurobarometer • Use of compositie indicator from Eurobarometer

Future Country Reports

• Issue 0• ECHP for trends• Eurobarometer for different measures – trade-offs

• Issue 1• ECHP for trends• SILC (SHARE) for different measures – trade-offs

• Further issues• SILC for trends and trade-offs• EHIS (better comparability across countries)

UK briefing for Ministers