Healthy Life Expectancy in Developing Countries in Asia Vicki L. Lamb Center for Demographic Studies Duke University

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

3 Life expectancy at birth: Selected Asian countries, World Bank Indicators, 2003

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

5 Percent of total population aged 65 years and older, World Bank Indicators, 2003

6 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?

7 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 health Advantage of HLE: ease in interpretation 65 = 20.9 yrs * ; 65 = 18.3 yrs * % of LE in good health: HLE/LE =.88 *Females in Japan, 1995

8 Estimating healthy life expectancy using the Sullivan (1971) method and life tables: DPR = Disability prevalence rate for age x from survey data 1.L x(hs) = (1 - DPR) * L x [person years spent in health] 2.T x(hs) =  x=t L [x(hs) + t] [total person years lived in health] 3.e x(hs) = T x(hs) / l x [healthy life expectancy] Note: hs=healthy state

9 REVES: Réseau Espérance de Vie en Santé International Research Network on Health Expectancy First meeting in Quebec in 1989 Concern over the effects of increased life expectancy on population health Goals are to collect, standardize, and improve national estimates of HLE

10 REVES research on developing countries First estimates of HLE for developing countries were presented at the 3 rd REVES meeting in 1991: China (Grab, Dowd, and Michel), Taiwan (Tu and Chen), and Burma, Indonesia, Sri Lanka, and Thailand, (Lamb and Andrews) Additional countries (e.g., Latin America) have been studied since that time

11 HLE estimates in Asia (year of study): Burma (1989) China (1987, 1992, ) 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, , 1987, 1990, 1995)

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

13 Life Expectancy (LE) and Healthy Life Expectancy (HLE), China, 1987 Females are advantaged with more years of life and more years of healthy life. Grab et al., 1991

14 Similar trends in other Asian countries: Life 65Healthy Life 65 Males Females

15 Percent of life to be spent in 65, (HLE/LE) China, 1987 Males have the advantage with a greater percent of healthy life years. Grab et al., 1991

16 Males Females Percent of Healthy 65 in selected Asian countries: Taiwan,1986 Burma, 1989 China,1992 Taiwan,1991 China,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

17 Trends in HLE For several countries we have more than one estimate These estimates can show us possible trends in HLE and percent HLE

18 Trends in 65 for selected countries: Males Females Taiwan 1986;1991 China 1987;1992 Thailand 1986;1989;1996

19 Trends in 65 for selected countries: Males Females Thailand [SRH] 1986;1995 Taiwan 1986;1991 China 1987;1992 Thailand 1989;1996

20 Results: For all three countries: Years of total life expectancy has increased Years of healthy life expectancy has increased What about percent HLE?

21 Trends in % HLE for selected countries: Thailand [SRH] 1986;1995 *Little change* Taiwan 1986;1991 China 1987;1992 Thailand 1989;1996 *Little change*

22 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

23 Issues in measuring/studying HLE: Accurate estimates of population health and disability via national health surveys: representative samples consistent measures of “health” Valid life tables to estimate trends in mortality: source of life table data year of life table estimates VS. the year the health data are collected

24 Why study Healthy Life Expectancy? Population aging and increased LE Compare 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