”Are Things Getting Better or Worse, and Why? The Role of Social Indicators to Inform Public Policy”
ISA – Working Group 06 “Social Indicators
Conference Track at 1st ISA Forum “Sociological Research and Public Debate”
Barcelona, September 5 – 8, 2008
Session 1: Indicators and Their Use to Guide Policies in the Field of Health
Chair: Heinz-Herbert Noll, GESIS-ZUMA, Mannheim, Germany
Lars Eric Kroll; Thomas Lampert; Cornelia Lange; Thomas Ziese
Title: Healthy Life Expectancy as an indicator to compare the health of societies
Healthy life expectancy is an important indicator to describe the consequences of demo-graphic change for different societies. Possible scenarios are an overall increase of the years people are suffering diseases or functional limitations (“expansion of morbidity”), a decline of the morbid time in the life course (“compression of morbidity”) and a “dynamic equilibrium” of morbidity and mortality. We will discuss the concept and problems of the indicator healthy life expectancy for policy advice.
Data and Methods
Data of the German Socio-Economic Panel (GSOEP) for 1984 to 2006 (n=185,275) allow us to estimate trends of healthy life expectancy using different definitions of health status (severe disability; functional limitations; self-perceived health status) based on Sullivan’s method for Germany. We will discuss three important problems in the measurement of healthy life expec-tancies empirically.
First Trends based on four different conceptualisations of health status show a large extend of variation. It turns out that only minor changes in the wording of the underlying questions have a strong impact on the resulting estimates. Second the age-specific rise in the denial rate of surveys leads to an overestimation of health status among the elderly. It is shown that this problem can be reduced using a parametric modelling of the age related risk of morbidity, instead of the common approach that estimates the prevalence of morbidity in 5year age-groups. Third a monitoring of social inequalities in healthy life expectancy (as intended by the EU) has to include inequalities in life expectancy in addition to inequalities in health status. Otherwise population estimates would likely underestimate socio-economic inequalities in healthy life expectancies.
While the importance of the indicator healthy life expectancy is rising, problems regarding its conceptualization and measurement are getting into the focus. Our results have shown three important limitations of the indicator in terms of the validity and reliability of its measure-ment. In our opinion a meaningful application of the concept in policy advice should report results based on different health indicators to account for the multi-dimensionality of health and the difficulties in its measurement.