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One of the biggest stories in the UK in recent days was the revelation that the country’s “healthy life expectancy” has cratered in as little as half a decade. The number of years the average Briton spends in good health fell from just over 63 in 2019 to 61 by 2023, according to analysis by the Health Foundation think-tank.
There are good reasons to be concerned that Britain may have a problem with working-age wellbeing. So expanding our measure of population health beyond the life-or-death binary of average lifespan is an admirable goal: we need to account for the quality of years lived. But I worry that using a catch-all and imperfect measure risks muddying rather than clarifying the picture of what is going wrong, and thus where efforts to improve health should be concentrated.
The first issue is that healthy life expectancy is a crude blend of two very different things: life expectancy (the most precise statistic in all of demography, a simple tabulation of population and deaths) and self-reported health status (a much less objective concept and one which is well known to have several drawbacks).
A quick look at the international data is enough to raise eyebrows. The EU’s data on healthy life expectancy places Bulgaria second highest out of 27 countries, despite it ranking third lowest for core life expectancy. If that isn’t puzzling enough, consider that these and other healthy life expectancy rankings, from the WHO for example, are also inconsistent with one another, both in levels and direction of travel.
The issues at play are well understood. First, there is the simple fact that subjective data is much less robust than mortality records. The annual survey used by the Office for National Statistics as part of its healthy life expectancy measure shows a decline in the share of Britons reporting that their health was at least “good” between 2011 and 2021, but the decennial census shows an improvement over the same period. The census and the survey differ in scale, coverage, timing and mode of delivery, all of which can influence the estimates even if underlying population health is unchanged. Notably, these factors aren’t even consistent from one survey to the next.
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Then there is the issue of what to make of how people assess their own health. For decades, researchers have known that measures of health problems and disability tend to be influenced by social and cultural variations in individual reporting. This means differences in prevalence are often at least partially due to reticence or stigma around particular health issues. What is considered good health can also be quite different from one country to another — even from one generation to another — and failing to account for these differences in reporting styles may yield misleading results.
But arguably more important than these technical flaws is the fact that even a perfect picture of healthy life expectancy data crams several disparate stories into one: it obscures more than it reveals. Here again, the case of the UK is illustrative. If we drill down into more detailed data on people’s health conditions, we find that over recent years physical health has been stable or improving for all age groups. The deterioration in overall self-rated health is coming almost entirely from answers to questions about mental health, especially among young adults.
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This has major implications for what should be done to reverse the trend. Reading that “UK healthy life expectancy falls from 63 to 61” conjures images of ailing sixtysomethings and discussions about chronic or debilitating disease from middle age. But this is a misreading of the true situation, facilitated by a clunky measure. “Britons’ physical health holds up quite well, but younger adults and young women in particular are reporting increasing mental health problems” may be a mouthful, but it’s a much more accurate summary of what the underlying data actually shows. And one that could guide the policy debate towards solutions that have a chance of working.
Britain is far from alone in facing these challenges. Across much of the world, the social, economic and technological shifts of the past two decades have made health problems and mortality more multi-faceted and less concentrated on the elderly. Accurately diagnosing these problems will require better tools than an imprecise summary statistic. Once we do that, we can get on with addressing them.
[email protected], @jburnmurdoch
