A fifty year old man in Estonia will be lucky to enjoy another 10 years of healthy life whereas a man in Denmark of the same age could easily enjoy well over 20 years. These are the sort of substantial inequalities the Lancet has highlighted in a survey of healthy life years (HLYs) from the age of 50 years across the EU.
HLYs have been welcomed as a more useful indicator of a nation’s health than life-expectancy alone. For example, the HLY inequalities data demonstrates clearly that the EU target of an employment rate of older workers (55-64 years) of 50% by 2010 is unlikely to be achieved in some countries unless there are substantial health improvements.
Life expectancy in the EU is increasing but how many of these extra years are spent in good health? HLY data helps answer this question. Using statistics on life expectancy and activity limitation, the researchers calculated the differences across 25 countries.
In general, the higher a country’s gross domestic product (GDP) and spending on elderly care, the more HLYs a person aged 50 can expect. In general the researchers found that the 15 ‘established’ EU countries had higher life expectancies and HLYs at 50 years than the 10 ‘newer’ EU countries, but with some overlap.
- For men, the highest life expectancies were 80.4 years (Italy) and 80.3 years (Sweden), while the lowest were 71.3 years (Latvia) and 71.7 years (Lithuania). See the table, right, from the UK Daily Mail.
- HLYs at 50 years for men were highest in Denmark (23.6 years) and Malta (21.7), and lowest in Estonia (9.0 years) and Hungary (10.8 years).
The researchers also found that for men across all the countries, long-term unemployment was associated with fewer HLYs at 50 years while life-long learning was associated with more HLYs at 50 years.
In the newer countries, relatively small increases in expenditure could make a big difference. While a 1% increase in spending on elderly care would result in just a one-year increase in HLY at 50 years in the 15 established EU countries, it would generate a 13-year increase in the ten newly joined EU countries.
HLY's 'a valuable measure that allows regional comparisons'
The author, Professor Carol Jagger, University of Leicester, UK, and her colleagues said: ‘Generally, citizens of the established European community have both longer and healthier lives than do most of those of the ten new EU countries.
‘In future years we will be able to compare whether countries are experiencing compression or expansion of morbidity similarly. A major target for Europe is that the employment rate for older workers should reach 50% by 2010. However, the low HLYs at 50 years for some countries, especially those of the ten newly joined EU countries, coupled with already early retirement ages suggest that this target will not be achieved in some countries unless substantial health improvements are made. The present work shows that monitoring HLYs can be used to assess whether such targets are realistic.’
In an accompanying Comment in The Lancet, Dr Errol Crook and Dr Terry Hundley of the Department of Internal Medicine and Center for Healthy Communities at the University of South Alabama, USA, say: ‘We believe that HLYs at age 50 years is a valuable measure that allows regional comparisons for health and health outcomes. It provides more data than life expectancy does, by providing some insight into health status. Commendably, the European Union has supported its use. How health-care policy decisions are made and how health-care resources are invested will require more detailed data, but HLYs at age 50 years will be an appropriate measure to determine return on investment.’