Title: Inequalities in Healthy Active Life Expectancy: the role of time, place, person and methods (InHALE)
Funder: Economic and Social Research Council

Abstract: The UK, as most other countries, has seen remarkable increases in life expectancy over the last century. Indeed over the last decade life expectancy at birth has increased by just under 3 years for men, to reach 77 years, and just over 2 years for women, to reach 81.5 years, with little evidence of any slowing down. These gains are not simply reductions in premature mortality; life expectancy at older ages also continues to increase, for example at age 65 increases of over two years for men and over one year for women are seen. However not all sections of the population have experienced these increases, with larger gains in less deprived areas and in higher social classes. Life expectancy does not really tell us how healthy our ageing population is. Healthy Life Expectancy (HLE) adds a quality dimension to life expectancy and tells us how many of our remaining years are expected to be healthy ones. We already know that life and healthy life expectancy at birth and at age 65 vary considerably across England and Wales. In this project we shall try to find out the extent to which it is social or health factors that drive these differences. In particular we will find out whether HLE at different ages (early, mid and late life) in local authorities has increased, decreased or remained the same between 1991 and 2001, whether areas with low healthy life years at young ages also have low healthy life years at older ages and whether changes over time are related to social factors (such as levels of unemployment, deprivation or proportion of ethnic minorities). We are also interested in whether there are areas whose healthy life years at age 50 are below 15 years which may pose problems when the pension age is increased to 65 for women by 2020, with further increases for both men and women after 2024. These analyses are necessary if we are to have a better understanding of why some areas in England and Wales have better levels of health than others. Nevertheless they can only indicate that higher levels of HLE are associated with such factors and cannot prove these factors cause levels of HLE. To help determine the causal pathway we shall use two nationally representative longitudinal studies to confirm the contribution of social, health and lifestyle factors to HLE. One particular focus will be on the effect of obesity on HLE (and life expectancy free of disability) and whether obesity acts through incresing the onset of ill-health (or disability), reducing the capacity to recover from ill-health (or disability) or whether it increases mortality. Despite the fact that the terms such as 'adding life to years' and 'healthy active life expectancy' are now commonly employed as targets for health research, there are only a handful of researchers within the UK that are competent in these methods. A further purpose of this project is therefore to document more fully than has been done to date, the different methods of calculating healthy life expectancy with both cross-sectional and longitudinal data. This will allow researchers to appreciate the advantages and disadvantages of each method, enabling future researchers to make appropriate informed decisions. This documentation will form the basis of a workshop for health researchers to increase capacity to undertake healthy life expectancy research. Healthy Life Expectancy is gaining much interest across government departments including HM Treasury and the Department of Work and Pensions, professional groups such as actuaries as well as Public Health Observatories and Local Authorities. Our project will provide valuable information for these groups to aid planning and promote healthy ageing.


Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;1.2 PSYCHOLOGICAL AND SOCIOECONOMIC PROCESSES
Health categories: GENERIC HEALTH RELEVANCE