Substantial inequalities in healthy life years (HLYs) from the age of 50 years exist in the 25 countries of the European Union (EU). The higher a country's gross domestic product (GDP) and spending on elderly care, the more HLYs a person at 50 can expect to live. And the EU target of having the employment rate of older workers (55-64 years) at 50% by 2010 is unlikely to be achieved in some countries unless there are substantial health improvements. These are the conclusions of an Article published Online first and in and upcoming edition of The Lancet, written by Professor Carol Jagger, University of Leicester, UK, and colleagues.
While life expectancy in the EU is increasing, it is unclear whether most of these extra years are spent in good health. This information would be crucial to both contain health-care costs and increase labour-force participation for older people. Using statistics on life expectancy and activity limitation, the researchers calculated the differences across the 25 countries.
As expected there were variations between men and women, but 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). 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). For women, life expectancy was highest in France (85.4 years), Italy (85.3 years) and Spain (85.0 years), while the lowest values were again in Latvia (79.3 years) and Hungary (79.4 years). HLYs for women at 50 years were highest in Denmark (24.1 years) and Malta (22.5 years), and lowest in Estonia (10.4 years) and Hungary (11.4 years). In the UK, life expectancy for men was 79.5 years and women 82.7 years, and HLYs at 50 years were 19.7 years for men and 20.8 years for women. They also found that for men only across all the countries, long-term unemployment was associated with fewer HLYs at 50 years, and life-long learning was associated with more HLYs at 50 years.
The authors say: "Our finding that a 1% increase in spending on elderly care would result in a 1-year increase in HLY at 50 years in the 15 established EU countries, compared with a 13-year increase in the ten newly joined EU countries, draws attention to the dissimilarities."
They conclude: "Generally, citizens of the established European community (15 EU countries) 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 (defined as 55 years of age) 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, Dr Errol Crook and Dr Terry Hundley, Department of Internal Medicine and Center for Healthy Communities, University of South Alabama, Mobile, AL, 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."
For Professor Carol Jagger, University of Leicester, UK please contact University of Leicester Press Office: T) +44 (0) 116 252 2485 / +44 (0) 7711 927821 E) cxj@le.ac.uk / pressoffice@le.ac.uk
Dr Errol D Crook, Department of Internal Medicine and Center for Healthy Communities, University of South Alabama, Mobile, AL, USA T) +1 251-471-7900 E) ecrook@usouthal.edu
Notes to editors: *'Established' EU countries (EU15): Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, UK.
**'New' EU countries (EU10): Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia, Slovenia.
***The total life expectancies shown here were worked out by adding 50 to the life expectancies at 50 years shown in the paper.
****For full details of early retirement ages and all other data for the 25 countries, see figure 1 page 3 and table 2 page 5.
For full Article and Comment see: http://press.thelancet.com/EU25final.pdf
The Lancet