Healthy Life Expectancy in Developing Countries in Asia

Vicki L. LambCenter for Demographic StudiesDuke University

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Life Expectancy (LE)

The expected number of years to be lived from age x (typically from birth)Measure of population healthLE is increasing over time in Asia and around the world

3

Life expectancy at birth:Selected Asian countries, 1990-2002

55

60

65

70

75

80

1988 1992 1996 2000 2004

Year

Lif

e E

xpec

tanc

y

ChinaIndiaIndonesiaMalaysiaPhilippinesSingaporeSri LankaThailand

World Bank Indicators, 2003

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Life Expectancy (LE)

The expected number of years to be lived from age x (typically from birth)Measure of population healthLE is increasing over time in Asia and around the worldResult: an increase in Asian populations, particularly at older ages

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Percent of total population aged 65 years and older, 1990-2002

2

3

4

5

6

7

8

1988 1992 1996 2000 2004

Year

Per

cent

65+

ChinaIndiaIndonesiaMalaysiaPhilippinesSingaporeSri LankaThailand

World Bank Indicators, 2003

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Major Question:

What is the state of health associated with longer life ?

More ill-health and disabilities, and greater suffering?Longer period of life in good health? Dynamic equilibrium between health and years of life?

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Healthy life expectancy (HLE)

The expected number of years to be spent in good health from age x“Health” usually refers to functional abilities or self-rated healthAdvantage of HLE: ease in interpretation

LE @ 65 = 20.9 yrs*; HLE @ 65 = 18.3 yrs*

% of LE in good health: HLE/LE = .88*Females in Japan, 1995

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Estimating healthy life expectancy using the Sullivan (1971) method and life tables:DPR = Disability prevalence rate for age x

from survey data

1. Lx(hs) = (1 - DPR) * Lx [person years spent in health]

2. Tx(hs) = x=t L [x(hs) + t] [total person years lived in

health]

3. ex(hs) = Tx(hs) / lx [healthy life expectancy]

Note: hs=healthy state

ax

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REVES: Réseau Espérance de Vie en Santé

International Research Network on Health Expectancy First meeting in Quebec in 1989Concern over the effects of increased life expectancy on population healthGoals are to collect, standardize, and improve national estimates of HLE

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REVES research on developing countriesFirst estimates of HLE for developing countries were presented at the 3rd REVES meeting in 1991:

China (Grab, Dowd, and Michel),Taiwan (Tu and Chen), andBurma, Indonesia, Sri Lanka, and Thailand, (Lamb and Andrews)

Additional countries (e.g., Latin America) have been studied since that time

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HLE estimates in Asia (year of study):

Burma (1989)China (1987, 1992, 1998-2000)Indonesia (1989)S. Korea (1984, 1989)N. Korea (1989)Malaysia (1984)Philippines (1984)

Singapore (1995)Sri Lanka (1989)Taiwan (1986, 1991) Thailand (1986, 1989, 1995, 1996)Japan (1966, 1970, 1974-85, 1987, 1990, 1995)

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What are the trends in life expectancy and healthy life expectancy in the developing countries in Asia?

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Life Expectancy (LE) and Healthy Life Expectancy (HLE), China, 1987

0

10

20

30

40

50

60

70

Yea

rs o

f ex

pect

ed li

fe

0 15 25 45 65 75

Age

LE-FemalesHLE-FemalesLE-MalesHLE-Males

•Females are advantaged with more years of life and more years of healthy life.Grab et al., 1991

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Similar trends in other Asian countries:

10

12

14

16

18

20

22

10 12 14 16 18 20 226

8

10

12

14

16

18

6 8 10 12 14 16 18

Life Expectancy @ 65 Healthy Life Expectancy @ 65

Males Males

Females

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Percent of life to be spent in health @ 65, (HLE/LE) China, 1987

0102030405060708090

100

Per

cent

0 15 25 45 65 75

Age

FemalesMales

•Males have the advantage with a greater percent of healthy life years.

Grab et al., 1991

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0.5

0.6

0.7

0.8

0.9

1

0.5 0.6 0.7 0.8 0.9 1Males

Females

Percent of Healthy Life @ 65 in selected Asian countries:

Taiwan,1986

Burma, 1989

China,1992

Taiwan,1991China,1987

Malaysia,1984

S. Korea,1984

Indonesia,1989

N.Korea,1989

Sri Lanka,1989

Thailand,1989

Thailand,1986 [SRH]

Thailand,1995 [SRH]

Thailand,1996

Singapore,1995

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Trends in HLE

For several countries we have more than one estimate

These estimates can show us possible trends in HLE and percent HLE

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Trends in LE @ 65 for selected countries:

12

14

16

18

20

22

12 14 16 18 20 22Males

Females

Taiwan1986;1991

China1987;1992

Thailand1986;1989;1996

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Trends in HLE @ 65 for selected countries:

6

8

10

12

14

16

18

6 8 10 12 14 16 18Males

Females

Thailand [SRH] 1986;1995

Taiwan1986;1991

China1987;1992

Thailand1989;1996

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Results:

For all three countries:Years of total life expectancy has increasedYears of healthy life expectancy has increased

What about percent HLE?

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Trends in % HLE for selected countries:

0.5

0.6

0.7

0.8

0.9

1

0.5 0.6 0.7 0.8 0.9 1

Thailand [SRH] 1986;1995*Little change*

Taiwan1986;1991

China1987;1992

Thailand1989;1996*Little change*

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Results:

There has been an increase in the percent of HLE years for China and Taiwan

The Thailand rates show little change

More research is needed

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Issues in measuring/studying HLE:

Accurate estimates of population health and disability via national health surveys:

representative samplesconsistent measures of “health”

Valid life tables to estimate trends in mortality:

source of life table datayear of life table estimates VS. the year the health data are collected

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Why study Healthy Life Expectancy?

Population aging and increased LECompare health of older persons in countries at different levels of development“Elderly dependency load” reconsiderations

• how long can persons work• how long can persons be self-sufficient

Policy concerns on the well-being and care of older persons in poor health