International Trends in Health Expectancies: a Review

Abstract

Abstract. Are we living longer but in worse health? Are the increases in life expectancy at older ages in developed countries occurring because we are keeping sick or disabled people alive longer or because we are saving people from death but leaving them in states of disability and handicap? This question was addressed in a symposium entitled International Trends in Health Expectancies. This review paper summarises the international evidence presented at that symposium on trends in health expectancies in developed countries. Health expectancies provide a powerful tool for monitoring the health of older populations, testing hypotheses about the evolution of health, and developing public policy. The available international evidence of time series of health expectancies for older people suggests that increases in disability prevalence began in the late 1960s and 1970s at the time when mortality rates at older ages began to decline significantly, but that these increases were confined to the less severe end of the disability spectrum. There is no evidence of expansion of morbidity based on more severe measures of disability prevalence. Recently emerging evidence from Europe and North America suggests that disability prevalence rates among older people may be starting to decline and we may actually be starting to see compression of morbidity in low mortality populations.