Goal 1: Increase Quality and Years of Healthy Life

Healthy People 2010: Understanding and Improving Health¹ highlighted the importance of increasing and maximizing both years and quality of healthy life. Progress toward this goal is currently assessed by measuring life expectancy and healthy life expectancies. These assessments result in the following conclusions:

• Life expectancy continues to improve for the populations that could be assessed in the midcourse review.
• Women continue to have a longer life expectancy than men, and the white population has a longer life expectancy than the black population.
• Three different measures of healthy life expectancy demonstrate gender and racial differences: expected years in good or better health, expected years free of activity limitations, and expected years free of selected chronic diseases.
• Expected years in good or better health and expected years free of activity limitations increased slightly, and expected years free of selected chronic conditions decreased.

Life Expectancy

Life expectancy is the average number of years persons born in a given year could be expected to live based on the age-specific death rates in that year. Since the launch of Healthy People 2010, life expectancy at birth and at age 65 has increased for all groups discussed here (Table 4 and Figure 6). In 2001–02, life expectancy for the total population was 77.2 years, an increase from 76.8 years in 1999–2000. Improvements in overall life expectancy are likely related to improvements in disease-specific death rate objectives within the Healthy People 2010 focus areas. Death rates have declined for many causes of death, including female breast cancer (3-3), cervical cancer (3-4), prostate cancer (3-7), coronary heart disease (12-1), stroke (12-7), and HIV (13-14). Compared with the rest of the world, the United States has room for further improvement. In 2001, male life expectancy ranked 26 and female life expectancy ranked 25 out of 37 selected countries.²

Table 4.  Life Expectancy at Birth and at Age 65, in Years

Figure 6.  Expected Years of Life by Gender and Race, 2001–02

Between 1999–2000 and 2001–02, the percent increase in life expectancy was greater for persons aged 65 years and older (2.2 percent) than for the total population (0.5 percent). Men (74.5 years) had a lower life expectancy than women (79.8 years), and the black population (72.2 years) had a lower life expectancy than the white population (77.7 years) in 2001–02. However, between 1999–2000 and 2001–02, the black population had a greater relative increase in life expectancy at birth (1.0 percent) than the white population (0.4 percent). Life expectancy for both men and women increased by about 0.5 percent.

Life expectancy usually is not calculated for racial and ethnic populations other than for the white population and the black population due to the inconsistencies in the method of reporting racial and ethnic origins on the death certificate in comparison with the U.S. Census, surveys, and birth certificates.³

Major gains in life expectancy since the early 1900s are largely attributable to the control of infectious diseases through improved sanitation, vaccines, antimicrobials, and nutrition, and advances in medical research and treatment. Much of the recent gain in life expectancy has been concentrated in the older population. The increase in life expectancy has been accompanied by chronic diseases and injury becoming major causes of death, and a rise in the number of persons with functional limitations. As a result, measuring longevity is no longer sufficient to describe the health of a population. Preventing disabling conditions, improving function, relieving physical pain and emotional distress, and maximizing health across the life span have become as important public health goals as increasing life expectancy.⁴

Measuring Quality and Years of Healthy Life

Quality of life is affected by changes in physical health, psychological health, social relationships, level of independence, the environment, and personal beliefs.⁵ Healthy People 2010 focuses on how changes in health status and activity limitations affect Americans at the population level. Given the multidimensional nature of health, assessing quality and years of healthy life is a much more complex process than measuring life expectancy, and the field is evolving. Various measures are used nationally and internationally to measure healthy life. These measures fall into three general categories:

• Self-assessments of overall health status by individuals or their proxies.
• Composite measures that include multiple dimensions of health. Scores on the various dimensions are combined into a single measure using a predetermined algorithm (for example, SF-36, Healthy Days).^{6, 7}
• Measures that combine death rates and health (where the health measure can be either of the types described above or a measure of a single dimension of health). These measures use years to quantify healthy life (for example, healthy life expectancies, Years of Healthy Life [YHL]).

The original Healthy People 2010 publication mentioned several possible measures of population health: "self-perceived" health status; healthy days; and the measure used in Healthy People 2000, YHL.⁸ In response to the need to measure Goal 1 of Healthy People 2010, NCHS convened a workshop to select measures that best capture the complexity of assessing years of healthy life within the context of Healthy People 2010.⁹ As a result, three measures of healthy life expectancies that combine death rates with different measures of health were selected to track progress toward Goal 1. The measures are expected years in good or better health, expected years free of activity limitation, and expected years free of selected chronic diseases. The current set of healthy life expectancies has evolved from the YHL measure used to track the years and quality of life in Healthy People 2000. YHL combined information about death rates, self-rated health, and activity limitation into a single measure. The current set of healthy life expectancies separates the self-rated health component from the limitation of activities component to better track and understand change over time. For more details on these measures, see the Technical Appendix.

Data for these three healthy life expectancies have been analyzed for the period 1999–2002. This short time period limits interpretation of true trends. Previous research on healthy life expectancies indicated a dramatic increase in years of healthy life during the 1980s and 1990s; however, results of the current analysis are mixed. More certain conclusions about the trends in healthy life expectancy cannot be made until data for future years are analyzed.

Description of Healthy Life Expectancies for Healthy People 2010
The healthy life expectancies are calculated using a life-table technique. This technique combines information about average health states and death rates to produce age-specific estimates of expected years of healthy life (see Technical Appendix for details on the methodology).

Expected years in good or better health is defined as the average number of years a person can expect to live in good or better health. This measure assesses healthy life using a single global assessment question that asks a person to rate his or her health as "excellent," "very good," "good," "fair," or "poor."

Expected years free of activity limitation is defined as the average number of years a person can expect to live free from limitation in activities, the need for assistance in personal or routine care needs, or the need to use special equipment because of health problems.

Expected years free of selected chronic diseases is defined as the average number of years a person can expect to live without developing one or more of the following selected conditions for which nationally representative data are available annually: arthritis, asthma, cancer, diabetes, heart disease, high blood pressure, kidney disease, or stroke.

Healthy Life Expectancy at Birth
Table 5 and Figure 7 present healthy life expectancies at birth for each of the three measures. Life expectancy is included in the figures for comparison purposes. Based on data from 2001–02, individuals in the United States can expect to live 68.6 years in good or better health, 65.5 years without activity limitation, and 47.5 years without selected chronic diseases. Expected years in good or better health and expected years free of activity limitations increased by 0.1 years between 1999–2000 and 2001–02. Expected years free of selected chronic diseases declined by 1.2 years.

Table 5. Healthy Life Expectancies at Birth, in Years

Figure 7. Life Expectancy and Healthy Life Expectancies at Birth, 2001–02

Women have higher values for all three healthy life expectancies, but they can also expect to spend a greater proportion of their lives in fair or poor health. Based on data from 2001–02, women can expect to live 79.8 years, of which 70.4 years will be in good or better health. Women can, therefore, expect to spend 12 percent (79.8–70.4 = 9.4/79.8 x 100) of their lives in fair or poor health, 16 percent with activity limitation, and 39 percent with one or more selected chronic diseases. Men can expect to spend 10 percent of their lives in fair or poor health, 15 percent with activity limitation, and 37 percent with one or more selected chronic diseases.

Compared with the white population, it is expected that the black population will spend a greater proportion of life in unhealthy life states. Based on data for 2001–02, it is expected that the black population at birth will spend 15 percent of life in fair or poor health, 18 percent of life with activity limitation, and 42 percent of life with one or more selected chronic diseases.

Table 6 and Figure 8 present healthy life expectancies at age 65 years and older. Based on 2001–02 data, it is expected that individuals aged 65 years and older will live an additional 13.2 years in good or better health, 11.6 years without activity limitation, and 4.4 years without one or more selected chronic diseases. Between 1999–2000 and 2001–02, for those aged 65 years and older, expected years in good or better health and expected years free of activity limitations increased, and expected years free of selected chronic diseases declined.

Table 6.  Healthy Life Expectancies at Age 65, in Years

Figure 8.  Life Expectancy and Healthy Life Expectancies at Age 65, 2001–02

Source:  National Health Interview Survey (NHIS), NCHS, CDC; National Vital Statistics System (NVSS), NCHS, CDC.

Similar to the patterns at birth, it is expected that women aged 65 years and older will live a greater number of years in a healthy life status, but they will spend a greater proportion of their lives with activity limitation. Based on data from 2001–02, it is expected that older women will spend 40 percent of their remaining lives with activity limitation. It is expected that men will spend 35 percent of their remaining lives with activity limitation.

However, it is expected that older men will spend a slightly greater proportion of their remaining lives with selected chronic diseases (78 percent) than older women (74 percent). Expected years in good or better health increased 0.4 years for women, and there was no change for men. Between 1999–2000 and 2001–02, expected years free of activity limitations increased 0.4 years for men and 0.5 years for women aged 65 years and older. Expected years free of selected chronic diseases declined 0.6 years for older men and 0.1 years for older women.

Similar to the patterns found at birth, the older black population can be expected to spend a greater proportion of its remaining life in unhealthy states than the older white population. Based on data for 2001–02, persons in the black population at age 65 can be expected to live 38 percent of their life in fair or poor health, 46 percent with activity limitation, and 81 percent with selected chronic diseases. The older black population experienced a greater absolute increase in expected years in good or better health and expected years free of activity limitation than the older white population. Expected years free of activity limitation increased 0.8 years for the older black population and 0.4 years for the older white population.

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