Elsevier

The Lancet

Volume 357, Issue 9269, 26 May 2001, Pages 1685-1691
The Lancet

World Health Report 2000
Healthy life expectancy in 191 countries, 1999

https://doi.org/10.1016/S0140-6736(00)04824-8Get rights and content

Summary

We describe here the methods used to produce the first estimates of healthy life expectancy (DALE) for 191 countries in 1999. These were based on estimates of the incidence, prevalence, and disability distributions for 109 disease and injury causes by age group, sex, and region of the world, and an analysis of 60 representative health surveys across the world. We used Sullivan's method to compute healthy life expectancy for men and women in each WHO member country. Japan had the highest average healthy life expectancy of 74·5 years at birth in 1999. The bottom ten countries are all in sub-Saharan Africa, where the HIV-AIDS epidemic is most prevalent, resulting in DALE at birth of less than 35 years. Years of healthy life lost due to disability represent 18% of total life expectancy in the bottom countries, and decreases to around 8% in the countries with the highest healthy life expectancies. Globally, the male-female gap is lower for DALE than for total life expectancy. Healthy life expectancy increases across countries at a faster rate than total life expectancy, suggesting that reductions in mortality are accompanied by reductions in disability. Although women live longer, they spend a greater amount of time with disability. As average levels of health expenditure per capita increase, healthy life expectancy increases at a greater rate than total life expectancy.

Section snippets

Life expectancy and causes of death

We developed new life tables and detailed cause of death distributions for all 191 WHO Member States starting with a systematic review of all available evidence from surveys, censuses, sample registration systems, population laboratories, and national vital registration systems on levels and trends of child and adult mortality.23 In countries with a substantial HIV epidemic, separate estimates were made of the numbers and distributions of deaths due to HIV/AIDS and these deaths were

Disability prevalence from burden of disease analysis

WHO is currently updating and revising estimates of the Global Burden of Disease for 14 mortality subregions of the world for the year 2000. These revisions draw on a wide range of data sources, and various methods have been developed to reconcile often fragmented and partial estimates of epidemiological variables that are available from different studies.10, 26 These analyses are used to calculate years lost due to mortality, years lived with disability, and total disability-adjusted life

Disability prevalence from health surveys

We analysed 64 household interview surveys which included nationally representative health status and disability data for 46 countries. To improve the comparability of health status data derived from surveys with different designs and numbers and types of questions, we used confirmatory factor analysis to estimate one general underlying latent construct, non-fatal health status.22 There were some countries, such as Ireland, Greece, and the USA (men only) where the latent health factor scores

Global patterns of healthy life expectancy

Japan leads the world with an estimated average healthy life expectancy of 74·5 years at birth in 1999 (table). Healthy life expectancy in Japan was 77·2 years for women and 71·9 years for men in 1999. After Japan, in second and third places, are Australia and France, followed by a number of other industrialised countries of Western Europe. Canada is in twelfth place with an uncertainty range of 8–14 in ranking and the USA in 24th place (70·0 years with a ranking range of 22–27). Other

Some conclusions

Despite the fact that people live longer in the richer, more developed countries, and have greater opportunity to acquire non-fatal disabilities in older age, disability has a greater absolute (and relative) impact on healthy life expectancy at birth in poorer countries. Separating life expectancy into equivalent years of good health and years of lost good health thus widens rather than narrows the difference in health status between rich and poor countries. Cross-sectionally, at the the global

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