厚生労働科学研究費補助金（循環器疾患・糖尿病等生活習慣病対策総合研究事業）
研究報告書

健康寿命の国際的な指標化に関する検討

研究要旨

研究協力者

尾島

俊之

浜松医科大学健康社会医学講座教授

研究分担者

橋本

修二

藤田保健衛生大学医学部衛生学講座教授

研究協力者

川戸美由紀

藤田保健衛生大学医学部衛生学講座講師

JA EHLEIS（健康・平均寿命情報システムに関する欧州共同事業）に参画して、国際的な指標化に関する検討を行うことが本研究の主目的である。併せて、日本における健康寿命の状
況を海外に報告するとともに、国際的な健康寿命に関する動向を情報収集し、健康寿命の算定、活用に関する国際的ハーモナイゼーションを図ることを目的とした。2013 年 4 月に開催された会合において、健康日本２１（第二次）、健康寿命の将来予測の結果、欧州で算定されている健康
寿命指標についての日本における値の推定結果、日本における所得及び学歴による平均寿命格差の推定結果についての報告を行った。また、新しい指標の開発に向けて提案を行うなど、議論に参画した。さらに、日本の健康寿命に関する情報について英語による発信をして欲しい旨の要望を得たため、健康日本２１（第二次）参考資料の健康寿命に関する部分について英語訳を行った。
Ａ．研究目的
健康寿命は、健康日本２１（第二次）において、最も代表的な健康指標として採用されてお事業）では、国際的な連携によって、健康寿命をベースとした新しい総合健康指標の開発に取り組んでいる。

り、日本国内における都道府県別の比較や、まこの JA EHLEIS に参画して、国際的な指標

た年次による推移が検討されている。健康寿命化に関する検討を行うことが本研究の主目的ではもともと国際的に開発された指標であることある。併せて、日本における健康寿命の状況をから、国際的な比較を行うことにより、諸外国

海外に報告するとともに、国際的な健康寿命にと比較した日本の特徴を明らかにすることがで関する動向を情報収集し、健康寿命の算定、活きる。その結果は、これからの日本の保健施策

用に関する国際的ハーモナイゼーションを図るを検討する上でも有用であると考えられる。

ことを目的とした。

一方、健康寿命は、健康日本２１（第二次）
で使用されている「日常生活に制限のない期間

Ｂ．研究方法の平均」や、「自分が健康であると自覚してい2013 年 4 月 17～19 日に、フランス・パリにる期間の平均」の他にも、何を健康／不健康とおいて開催された、JA EHLEIS（健康・平均寿

定義するかによって、さまざまな指標の算定が命情報システムに関する欧州共同事業）に、参可能である。どのような健康寿命が有用である加の招聘に応えて参画した。日本の状況を報告かについては、保健医療状況の変化など時代のするとともに、欧州及び米国での状況について

変遷にともなって変わってくる可能性がある。

情報収集し、新しい総合健康指標の開発に向け

そこで、JA EHLEIS（Joint Action Europeanての検討を行った。さらに、プロジェクトリー

Health and Life Expectancies Information System、 ダーである Dr. Jean-Marie Robine（Institut
健康・平均寿命情報システムに関する欧州共同national de la santé et de la recherché médicale,France、フランス国立衛生医学研究所）と日本（participation）に焦点をあてた総合健康指標の健康寿命の状況について個別の意見交換を行の開発が重要ではないかという議論が出たため、った。

それを中心とした意見を報告した。また、現在、

さらに、JA EHLEIS において、日本の健康

欧州で使用されている３つの健康寿命指標につ寿命に関する情報について、英語による発信を

いて、改変の必要性の有無などについての意見して欲しい旨の要望を得たため、健康日本２１を述べた。また、参加に焦点をあてた指標とし（第二次）参考資料の健康寿命に関する部分にて「閉じこもり」または「社会的孤立」の指標

ついて英語訳を行った。その他の日本における化についての提案を行った。

健康寿命に関する情報についても、順次、英語

なお、この会合には、EU 各国（20 か国＋

による情報発信を行っていく予定にしている。

α）、欧州委員会（Eurostat、SANCO）、OECDなどの公衆衛生研究所・行政・大学関係者など

Ｃ．研究結果2013 年 4 月に開催された会合において、日が参加した。EU 域外からは、米国（CDC）と日本が招聘されて参加した。

本からの報告としては、本報告の後ろに掲載し最後に、健康日本２１（第二次）参考資料のている "Healthy Life Expectancies in Japan" と健康寿命に関する部分の英語訳の結果について"Concept for a new Global Disability Indicator"

は、本報告の後ろに掲載している通りである。

の２本の報告を行った。"Healthy Life

なお、この翻訳は、当分担研究班の責任においExpectancies in Japan" においては、健康日本２て行ったものであり、厚生労働省による公式訳

１（第二次）、前年度の「健康寿命における将ではない。ただし、健康日本２１（第二次）

来予測と生活習慣病対策の費用対効果に関する（厚生労働省告示第四百三十号（平成 24 年 7研究」班による健康寿命の将来予測の結果、欧月 10 日）国民の健康の増進の総合的な推進を州で算定されている健康寿命指標についての日図るための基本的な方針）の公式訳で使用され本における値の推定結果、日本における所得及ている用語についてはそれに準拠して翻訳を行

び学歴による平均寿命格差の推定結果についてった。

の報告を行った。なお、JA EHLEIS では欧州
各国の健康寿命について、「日常生活に制限のＤ．考察ない期間の平均」（Global Activity Limitation

JA EHLEIS の会合において、日本と欧州のIndicator (GALI) に基づく Life expectancy

健康寿命の比較を報告した際に、特にスウェーwithout activity limitation）、「慢性疾患の無い

デンとの比較で日本の平均寿命は長いのに対し、期間の平均」（Life expectancy without chronic

健康寿命が短いことに対しては、日本におけるmorbidity）、「自分が健康であると自覚してい延命治療などによる部分があるのではないかとる期間の平均」（Life expectancy in very good or

いうコメントが寄せられた。また、所得や学歴

good perceived health）の３つの指標について、による平均寿命格差の状況については、欧州と毎年算定している。

比較して驚異的に格差が小さいというコメント"Concept for a new Global Disabilityが寄せられた。

Indicator" においては、事前にメール上で意見会合における新しい総合健康指標の検討に関交換し、作成された working paper などについしては、狭い意味での参加だけではなく、活動ての議論を行った。事前の検討においては、（activities）なども含めたより広い ICF の概念

ICF (International Classification of Functioning,を考慮した指標とするのが良いのではないかと

Disability and Health) における参加の意見が出された。そのため、提案を行った閉

じこもりや社会的孤立などについてよりは、米国 CDC などで検討されている、activity of daily

１．論文発表なし

living (ADL)の要素に着目した健康寿命につい

２．学会発表ての検討を深めてはどうかという意見などが出

1) T Ojima, S Hashimoto, I Tsuji, H Tsutsui, Tされた。

Noda, M Nakamura, K Kondo, M Lagergren , H

健康日本２１（第二次）参考資料の健康寿命

Van Oyen, JM Robine. Healthy Life Expectancy

に関する部分の英語訳については、その情報提in Japan and comparison with EU. 6th European

供によって、日本における健康寿命の検討状況

Public Health Conference. 13-16 Nov 2013,などについての国際的な理解が得られる一助に

Brussels, Belgium. (Eur J Public Health 2013;なると考えられた。

23(suppl1):44.)

Ｅ．結論

Ｇ．知的財産権の出願・登録状況（予定を含

JA EHLEIS（健康・平均寿命情報システム

む）に関する欧州共同事業）に参画し、健康寿命の１．特許取得

国際的な指標化に関する検討を行うと共に、日なし。

本と欧米との健康寿命の状況などについての情報交換を行った。

２．実用新案登録なし。
３．その他

Ｆ．研究発表なし。

April 18, 2013

Contents

JA-EHLEIS

Healthy Life Expectancies
in JapanToshiyuki OJIMA, MD, DrPH
Professor of
Department of Community Health and Preventive Medicine,
Hamamatsu University School of Medicine, JAPANHealth Japan 21 (2nd edition)• Governmental actions about
healthy life expectancies in Japan• Selected results of the ResearchGroup about Healthy Life Expectancy
in Japan• Preliminary results about healthy life
expectancy in Japan

Four main conceptsof the Health Japan 21 (2nd edition)• Published as the Official Public Notice #430 of
Minister of Health, Labour and Welfare Japanin July 10, 2012according to the Health Promotion Law
Chair of the planning committee was Prof. Ichiro
TSUJI in Tohoku University
http://www.mhlw.go.jp/bunya/kenkou/kenkounippon21.html(in Japanese)

Health Japan 21 (2nd ed)
set 64 target indices

http://www.maff.go.jp/e/ccasia/18/pdf/as18_crd08e_appendix_1_item9_japan.pdf(English chart)

Gap between life expectancy (LE) and healthy life expectancy (HLE)
years

Target #1. Extend the healthy life expectancy• More than the increase of life expectancy• Healthy life expectancy without activity limitationfrom the data of the Comprehensive Survey of
Living Conditions• Healthy life expectancy by self perceived healthshould also be used as the supplemental indicesTarget #2. Reduce the health inequity• Measured by the gap of the healthy life expectancy
between the 47 prefectures

Men

Women

LE

HLE without activity limitation
Gap between LE and HLE

Source: LE (2000): The life table by the Ministry of Health, Labour and Welfare
HLE (2000): The Research Group about Healthy Life Expectancy

Official supplemental paper for Health Japan 21 (2nd edition)

Healthy life expectancy without activity limitation by prefectures

Time trend of life expectancy (LE) and healthy life expectancy (HLE)
Men

Women

Women:

Men:
LE
HLE

1991

1994

1997

2000

1991

1994

1997

2000

Top
75.32 (Shizuoka)
Bottom72.37 (Shiga)
Gap
2.95 years

Top
71.74 (Aichi)
Bottom
68.95 (Aomori)Gap2.79 years

Source: LE (2000): The life table by the Ministry of Health, Labour and Welfare
HLE (2000): The Research Group about Healthy Life Expectancy

Source: The Research Group about Healthy Life Expectancy

Official supplemental paper for Health Japan 21 (2nd edition)

Official supplemental paper for Health Japan 21 (2nd edition)

Contents

Healthy Life Expectancies
calculated by the research group• Governmental actions about healthy
life expectancies in Japan• Selected results of the ResearchGroup about Healthy Life
Expectancy in Japan• Preliminary results about healthy life
expectancy in Japan(1) Disability free life expectancy (without activity limitation)
日常生活に制限のない期間の平均– Used for the Health Japan 21 (2nd edition)– Using self-administered questionnaire data

(2) Life expectancy with self-perceived health
自分で健康であると自覚している期間の平均– Using self-administered questionnaire data

(3) Disability free life expectancy (without care need)
日常生活動作が自立している期間の平均– Using Long-term Care Insurance Data

* (1) and (2) are useful for national and prefectural level(3) is especially useful for municipality level
Principal Investigator: Prof. Shuji HASHIMOTO in Fujita Health University

Question for activity limitation
Q6 Do you have any health problem which affect dailyliving now?
1 Yes 2 No
Q6-1 How is it affect ? Select all of applicable items.
1 Activity of daily living
2 Going out
3 Working, housekeeping, studying
4 Physical activities
5 Others

Life Expectancy at age 0 and expected years in Japan
12.8
Without activity limitation

Women

73.6

Men

70.4

Women

73.3

Men

69.9

9.2

With activity limitation(by the national Comprehensive Surveyof Living Conditions questionnaire)in good, rather good, or ordinary
perceived healthin bad or rather bad perceived health

13.1
9.7
3.2

Without care need

Women

83.2

Men

78.2

1.5
With care need(by the Long‐term care Insurance Data)0

Used in the national Comprehensive Survey of Living Conditions conductedby the Ministry of Health, Labour and Welfare of Japanese government

2040

Expected years

60

80Observed data and forecasting for
healthy life expectancy without activity limitation

Life Expectancy at age 65 and expected years in Japan
8.6
Without activity limitation

Women

15.3

With activity limitation

Observed
Forecasting: continue current prevalence
Forecasting: extrapolated
Forecasting: possible target

5.7(by the national Comprehensive Survey of
Living Condition questionnaire)

Men

13.1
7.4

in good, rather good, or ordinary
perceived healthin bad or rather bad perceived health

Women

16.5
5.2

Men

Women

13.7
3.4

Women

Without care need

20.5
1.6

With care need

Men

17.2

(by the Long‐term care Insurance Data)

Men
0

5

10

15

20

25

Expected years

Contents• Governmental actions about healthy
life expectancies in Japan• Selected results of the ResearchGroup about Healthy Life Expectancy
in Japan• Preliminary results about healthy
life expectancy in Japan

Methods of conversion• Subjects: 2,700 randomly selected residents of 20+ years
old in 6 municipalities in Shizuoka prefecture, Japan• Self administered mail survey• Response: 1,774 (66.0%)• Questionnaire:– Activity limitation, the same as the Japanese national survey– Activity limitation by GALI
– Chronic morbidity, the same as EU– Self perceived health, the same as the Japanese national survey• Conversion table was made and applied to the national data

• Limitations– Not a nationally representative sample– Sample size might not be enough

Conversion table
Activity limitation(national Comprehensive
Age
Survey of Living
Conditions qestionnaire) group
With
20-39
40-64
65-74
75TotalWithout
20-39
40-64
65-74
75TotalActivity limitation (GALI)
With
With
severe moderate Without
17.4%
34.8%
47.8%
22.2%
44.4%
33.3%
23.1%
50.0%
26.9%
52.7%
35.1%
12.2%
35.1%
39.9%
25.0%
1.2%
5.8%
93.0%
.7%
8.2%
91.0%
1.1%
13.9%
85.0%
2.2%
25.0%
72.8%
1.1%
10.8%
88.1%

Results are almost same between men and women.
Conversion tables from self perceived health to chronic morbidity,
and from activity limitation to chronic morbidity are also made.

Total
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%

France and Sweden are selected just as examples,
because it is too busy if all of the EU countries are on the figure

Comments• GALI of Japan is around the midpoint
between France and Sweden.
• Duration with chronic morbidity of Japan islong as France.
• Duration with bad health of Japan is longer
than France and Sweden. Majority ofJapanese are with “ordinary” health.

Life expectancies by the quantile of income

Life expectancy by education attainment

Methods of life expectancy
inequality estimation• Subjects: 21,047 community dwelling older
people in 8 municipality in Japan• Followed up 2 - 4.5 years• Hazard ratios were calculated by quantile
of income and education attainment• These data are from the AGES project• Applied to the national life table in 2000

Practices to reduce heath inequality andto extend the healthy life expectancy in Japan• Community health promotion volunteers (86.8%)• Salon or café for older people (67.0%)• Following up children by public health nurses according totheir household economic situation (65.5%)• Community bus service by public sectors (59.1%)• Providing healthy lunch and cooking education atelementary schools (almost 100%)( ) : proportion of active municipalities

from the preliminary results of the Research Group
about Social Determinants of Health and collaborated survey

April 19, 2013
JA-EHLEIS seminar

Concept for a new
Global Disability Indicator
Toshiyuki OJIMA, MD, DrPH

General comments• Excellent working paper withcomprehensive and detailed discussion• Focusing on measuring participation of
ICF is quite reasonable• Scoring system according to the selected
criterion is very useful.

Professor of
Department of Community Health and Preventive Medicine,
Hamamatsu University School of Medicine, JAPAN

Framework of health expectancies
Current set of health expectancies
1. GALI
2. Chronic morbidity
3. Perceived health
The working paper are discussing about
criticism of GALI.
Problems of chronic morbidity and perceived
health should also be discussed.

New framework of health expectancies
1. GALI
2. Chronic morbidity
3. Perceived health

Change to a new indicator?
Then, we should focus on
activity limitation
Add a new indicator as the 4th one?
Then, focusing on participation
might be meaningful challenge

Measuring participation would be important, because it is more
affected by social system including interpersonal interaction andtransportation than biological conditions.
Changing “chronic morbidity” to a new indicator might be anotheroption.

Subcategories of “activities and participation” in ICF
1.
2.
3.
4.
5.
6.
7.
8.
9.

Learning and applying knowledge
General tasks and demands
Communication
Mobility
Self-care
Domestic life
Interpersonal interactions and relationships
Major life areas
Community, social and civic life

Activity

Participation

Covering all of the subcategories of “activities and participation” would be quitedifficult.
If we focus on “participation”, “community, social and civic life” or “interpersonal
interactions and relationships” would be useful.

Conclusion• GALI would be a good indicator, even if it
has some problems.
• If we use a new indicator instead of GALI,
the new indicator should be focused on
activity limitation like GALI.
• If we add a new indicator or change
instead of chronic morbidity, “participation”
would be a key concept.

Homeboudness

Questionnaire of homeboundness• We often assess homeboudness for older
people in Japan.
• It is highly related to their health and life
prognoses and a major risk factor• It is a kind of objective behavioral measurement
for participation• Importance of going out might be sometimes
questionable• How often do you go out? (Going out include
visiting neighbours, shopping, going to thehospital)a. 4 times or more/week b. 2 or 3 times/weekc. once/week
d. 2 or 3 times/monthe. a few times/year
f. do not go out

Selected reference: Bruce ML, et al. Psychiatric statusamong the homebound elderly: an epidemiologic
perspective. J Am Geriatr Soc 1992; 40(6): 561-566.

We regard people who go out less thanonce/week as homebound.

Another participation indicator• If we focus on “participation”
rather than activity, how about
to consider “social isolation” ?

Developing a new indicator
is a really meaningful
challenge
Thank you!

Extension of healthy life expectancy and reduction of health disparities
in the Reference Material for Health Japan 21 (the second term)i. Introduction
Healthy life expectancy is defined as the length of life that an individual lives without limitationin daily activities due to health problems. Extension of healthy life expectancy is given as one of
the goals presented in Health Japan 21. At the time, however, clarity was lacking in the concept ofhealthy life expectancy and methods of estimating it, and no specific figure or goals for healthy
life expectancy were presented.
With recent developments in research, however, there is growing consensus with regard to theconcept of healthy life expectancy and methods of estimating it. Health Japan 21 (the secondterm) shows current figures for healthy life expectancy as well as how those goals are viewed.
ii. Basic philosophy(i) Extension of healthy life expectancy
Extension of healthy life expectancy is a core issue in Health Japan 21 (the second term), and its
inclusion as an indicator is essential to the program. Showing current figures for healthy life
expectancy and regularly estimating subsequent changes are beneficial in managing the progressof a national health promotion movement.
Various definitions of healthy life expectancy and ways of estimating it exist. First, with regard
to the definition of healthy life expectancy, a mutually complementary evaluation is possible bytaking the more objective “average period of time spent without limitation in daily activities” as
the main index, and the more subjective “average period of time individual consider themselves as
healthy” as a secondary index. Next, for the method of estimation, calculations based on
Comprehensive Survey of Living Conditions data (disability-free life expectancy using the
Sullivan method) are thought to be the most appropriate based on considerations of consistency
and feasibility with current public statistics and other factors.
In setting target values, the focus is on the difference between life expectancy and healthy life
expectancy. The difference between life expectancy and healthy life expectancy is the “unhealthy
period” in which an individual spend with limitation in daily activities. The difference between
life expectancy and healthy life expectancy (period of time spent without limitation in daily
activities) was 9.13 years in men and 12.68 years in women in 2010 (Figure 1).
If this difference with healthy life expectancy grows as life expectancy increases, the period
during which large expenditures for medical care and care benefits are consumed will become
longer. If the difference between life expectancy and healthy life expectancy can be reduced bypreventing disease, promoting health, and avoiding the need for care, we can expect not only toprevent decreases in individuals’ quality of life, but also to reduce the social security burden. It isvery important that we approach this problem from the perspective of launching a new national
health promotion movement that also contributes to a sustainable social security system.
Figure 1. Difference between life expectancy and healthy life expectancy
years
60

65

70

75

80

85

90

79.55

Male
70.42

86.30

Female73.62
Life Expectancy

12.68 years

Healthy Life Expectancy(period of time spent without limitation in daily
activities)

Diference between life expectancy andhealthy life expectancy(Sources: Life expectancy (2010): “Complete Life Table 2010” by Ministry of Health, Labourand Welfare; healthy life expectancy: Health and Labour Sciences Research Grants “Study on
future predictions of healthy life expectancy and cost-effectiveness of measures to prevent
lifestyle-related diseases”)(ii) Reduction of health disparities
The health disparities are defined as differences in health status among a population due toregion and socioeconomic status. Given that data on regional disparities are collected withconsiderable accuracy, and that effects can be expected when local governments advances theirown independent efforts after identifying the gaps between themselves and other local
governments, the focus in current plans is placed on regional disparities.
For each local government, identifying and analyzing factors in the healthy life expectancy gap,
and thinking of strategies to extend healthy life expectancy, are important in advancing healthpromotion.
Various indices may be considered in elucidating existing health gaps between local

governments and strengthening efforts to close those gaps, but the most important is healthy life
expectancy.
iii. Present status and goals(i) Extension of healthy life expectancy
Target measure

Average period of time spent without limitation in daily activities

Present status

Men 70.42 years, women 73.62 years (2010)

Goal

To extend healthy life expectancy more than increase of life expectancy*(2022)

Data source

Health and Labour Sciences Research Grants “Study on future predictions ofhealthy life expectancy and cost-effectiveness of measures to prevent
lifestyle-related diseases”
Note: Estimations based on Comprehensive Survey of Living Conditions*To accomplish the above goals, not only the “average period of time spent without limitation”
but “average period of time individuals consider themselves as healthy.”“Average period of time spent without limitation in daily activities” was calculated using the
Sullivan method, with basic data taken from Comprehensive Survey of Living Conditions andLife Table (see the latter page for the calculation method). The figures used in current values were
calculated based on the Health and Labour Sciences Research Grants “Study on future predictionsof healthy life expectancy and cost-effectiveness of measures to prevent lifestyle-related diseases.”
A comparison of period of time spent without limitation in daily activities (healthy life
expectancy) between 2001 and 2012 revealed that it rose from 69.40 years to 70.42 years in men,an increase of 1.02 years, and from 72.65 years to 73.62 years in women, an increase of 0.97 years.
Meanwhile, life expectancy during the period years rose from 78.07 years to 79.55 years in men,an increase of 1.48 years, and from 84.93 years to 86.30 years in women, an increase of 1.37 years(Figure 2).
According to Population Projection of Japan (January 2012 estimates) by National Institute ofPopulation and Social Security Research, life expectancy in the years from 2013 to 2022 ispredicted to rise from 80.09 years to 81.15 years in men, an increase of 1.06 years, and from 86.80
years to 87.87 years in women, an increase of 1.07 years (Figure 3).

Figure 2. Trends in life expectancy and healthy life expectancy

years

years

Male

90
85

85

80

80
78.64

78.07

75
70

69.4

69.47

2001

2004

Female

90

79.19

85.99

85.59

84.93

86.3
Life
expect
ancy

79.55
75

70.33 70.42

65

72.65

70

72.69

73.36 73.62

65
2007

2001

2010

2004

2007

2010

(Sources: Life expectancy: Ministry of Health, Labour and Welfare’s “Abridged Life Table” in
2001, 2004, and 2007, “Complete Life Table” in 2010; healthy life expectancy: Health and Labour
Sciences Research Grants “Study on future predictions of healthy life expectancy andcost-effectiveness of measures to prevent lifestyle-related diseases”)
Figure 3. Life expectancy projection (2013–2022)
year

Female

90
85
80

86.8

87.87
86.93 87.05 87.18 87.3 87.42 87.53 87.65 87.76

80.09 80.21 80.34 80.46 80.58 80.775

80.81 80.93 81.04 81.15

Male

70
65
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022

(Source: “Population Projection of Japan (January 2012 estimates)” by National Institute ofPopulation and Social Security Research)
It is predicted that in the future not only the period of health but also the period of unhealth will
become longer as life expectancy increases. Therefore, greater efforts to promote the health ofcitizens are important, so that the healthy life expectancy is extended by more than the increase of

life expectancy (delay the time when people reach an unhealthy state). In this way we can aim toshorten the unhealthy period. At present, however, there is little evidence to infer how much, andthrough which prevention measures, lifestyle-related diseases can be decreased, and by how much
this will extend healthy life expectancy. Further advances in research are needed.
Therefore, the goal was taken to be “to extend healthy life expectancy more than the increase oflife expectancy.” For healthy life expectancy, it is also important to try to extend the “period oftime individuals consider themselves as healthy” together with the “period of time spent without
limitation in daily activities.” The period of time individuals consider themselves as healthy wascompared between 2001 and 2010, and found to rise from 69.55 years to 69.90 years in men, an
increase of only 0.35 years, and from 72.94 years to 73.32 years in women, an increase of only
0.37 years. Although these amounts of increase do not reach the targeted amount of exceeding theincrease of life expectancy, they are noted because in the next 10 years it will be necessary to be
mindful of trying to also achieve a certain level of extension in the period of time individuals
consider themselves as healthy together with extension in the period of time spent without
limitation in daily activities.
(ii) Reduction of health disparities
Target measure

Reduction in gap among prefectures in average period of time spent
without limitation in daily activities

Current status

Men 2.79 years, women 2.95 years (2010)

TargetReduction in gap among prefectures (2022)

Data source

Health and Labour Sciences Research Grants “Study on future predictionsof healthy life expectancy and cost-effectiveness of measures to prevent
lifestyle-related diseases”
Note: Estimations based on Comprehensive Survey of Living Conditions

In 2010, the places where average period of time spent without limitation in daily activities
were longest were Aichi Prefecture for men (71.74 years) and Shizuoka Prefecture for women(75.32 years). The shortest were Aomori Prefecture for men (68.95 years) and Shiga Prefecture forwomen (71.37 years). These are differences of 2.79 years for men and 2.95 years for women(Figure 4).
Reduction in gap among prefectures was established as a goal. In working to achieve this goal,
however, we must assume that the figure for the prefecture with the longest healthy life
expectancy is the goal each prefecture is working toward as it makes efforts to extend healthy life
expectancy.

Figure 4. Average period of time spent without limitation in daily activities by prefecture(2010)
FemaleMale
Aichi
Shizuoka
Chiba
Ibaragi
Yamanashi
NaganoKagoshima
Fukui
Ishikawa
Gumma
MiyazakiKanagawa
Gifu
Okinawa
Yamagata
Mie
Tochigi
Shiga
SaitamaToyamaKumamoto
Yamaguchi
Akita
ShimaneWakayama
Kyoto
Miyagi
Nara
Saga
Hiroshima
Tottori
Hokkaido
Tokyo
Fukushima
Hyogo
NigataTokushima
KagawaOita
FukuokaOkayama
Ehime
Iwate
Osaka
Nagasaki
Kochi
AomoriShizuoka
Gumma
Aichi
Okinawa
Tochigi
ShimaneMiyazakiIbaragi
Ishikawa
Kagoshima
Fukui
Yamanashi
ToyamaKanagawa
Gifu
Fukushima
NaganoAkita
Ehime
Yamagata
Kumamoto
Miyagi
NigataYamaguchi
Saga
Mie
Chiba
Kyoto
Okayama
Wakayama
AomoriIwate
Tottori
Oita
Hokkaido
Kochi
Hyogo
SaitamaNagasaki
Nara
Tokyo
KagawaTokushima
Fukuoka
Osaka
Hiroshima
Shiga

71.74
71.68
71.62
71.32
71.20
71.17
71.14
71.11
71.10
71.07
71.06
70.90
70.89
70.81
70.78
70.73
70.73
70.67
70.67
70.63
70.58
70.47
70.46
70.45
70.41
70.40
70.40
70.38
70.34
70.22
70.04
70.03
69.99
69.97
69.95
69.91
69.90
69.86
69.85
69.67
69.66
69.63
69.43
69.39
69.14
69.12
68.95

66

68

70

72

75.32
75.27
74.93
74.86
74.86
74.64
74.62
74.62
74.54
74.51
74.49
74.47
74.36
74.36
74.15
74.09
74.00
73.99
73.89
73.87
73.84
73.78
73.77
73.71
73.64
73.63
73.53
73.50
73.48
73.41
73.34
73.25
73.24
73.19
73.19
73.11
73.09
73.07
73.05
72.93
72.88
72.76
72.73
72.72
72.55
72.49
72.37

70

72

74

76

Difference between the longest and the shortest

Difference between the longest and the shortest

2.79 years

2.95 years(Source: Health and Labour Sciences Research Grants “Study on future predictions of healthy life
expectancy and cost-effectiveness of measures to prevent lifestyle-related diseases”)

<Method of calculating healthy life expectancy>
Method of calculating “average period of time spent without limitation in daily activities”“Average period of time spent without limitation in daily activities” is calculated using the
Sullivan method (a method widely used to calculate healthy life expectancy), with informationfrom Comprehensive Survey of Living Conditions and Life Table as basic data. Thus, a responseof “No” to the question, “Do health problems currently have some effect on your daily activities?”in Comprehensive Survey of Living Conditions is taken to indicate limitation-free daily activities,
and the percentages of people without limitation in daily activities were obtained for each sex andage group. Stationary population and number of survivors were obtained from Life Table. The
percentage of people without limitation in daily activities was then multiplied by the stationary
population for each sex and age group to obtain the stationary population without limitation indaily activities. Next, the totals for given age groups were divided by the number of survivors to
obtain the “average period of time spent without limitation in daily activities.”
In prefectures, Comprehensive Survey of Living Conditions data, prefectural population, andnumber of deaths are used as basic data. The percentages of people without limitation in daily
activities in each prefecture by sex and age group are obtained from the Comprehensive Survey of
Living Conditions. Using the life table methodology of Chiang (a widely used method of
calculating life tables), the stationary population and number of survivors in the prefecture are
obtained. The average period of time spent without limitation in daily activities is obtained using amethod similar to the above from the percentage of people without limitation in daily activities,
stationary population, and number of survivors.
In municipalities, when surveys are conducted in conformance with the Comprehensive Surveyof Living Conditions, the basic data are taken to be the percentages of people without limitation indaily activities by sex and age group according to those surveys, the population of the municipality,
and the number of deaths. The “average period of time spent without limitation in daily activities”
can be obtained using the same method as for the prefectures. When a survey is not conducted andexisting data are used, care information from long-term care insurance, the population, and thenumber of deaths in the municipality are used as basic data. “Average period of time spent
independent in daily activities” (an index like “average period of time spent without limitation indaily activities”) can then be obtained with a method similar to the above. In municipalities withsmall populations, the addition of a certain handling method needs to be considered in calculating
the index (taking the number of deaths in multiple years, using 95% confidence intervals of theindex, etc.). In municipalities with very small populations calculation of the index is difficult.

Note: Method of calculating “average period of time individuals consider themselves as
healthy”“Average period of time individuals consider themselves as healthy” is calculated using the
Sullivan method with information from Comprehensive Survey of Living Conditions and Life
Table as basic data. Responses of “Good,” “Rather good,” or “Ordinary” to the Comprehensive
Survey of Living Conditions question of “How is your current state of health?” are taken to
indicate that individuals consider themselves as healthy. Using the percentage of these responses,“average period of time individuals consider themselves as healthy” is obtained using the same
method as for “average period of time spent without limitation in daily activities.” In prefectures,“average period of time individuals consider themselves as healthy” is obtained with the same
method as for “average period of time spent without limitation in daily activities.”
In municipalities, similar to “average period of time spent without limitation in daily activities,”
it is possible to obtain the “average period of time individuals consider themselves as healthy” incases when a survey is conducted by taking the percentage of individuals consider themselves as
healthy by sex and age group from the survey, the municipal population, and the number of deaths
as basic data. In municipalities with small populations, the addition of a certain handling methodneeds to be considered in calculating the index. In cases when a survey is not conducted,
calculation of the index is difficult. This is because municipalities have no index similar to“average period of time individuals consider themselves as healthy” in municipalities in existing
data. Calculation of the index is also difficult for municipalities with very small populations.
(Source: Health and Labour Sciences Research Grants “Study on future predictions of healthy life
expectancy and cost-effectiveness of measures to prevent lifestyle-related diseases”)

Results of the calculation in 2010
Prefecture
Hokkaido
Aomori
Iwate
Miyagi
Akita
Yamagata
Fukushima
Ibaragi
Tochigi
Gumma
Saitama
Chiba
Tokyo
Kanagawa
NigataToyamaIshikawa
Fukui
Yamanashi
NaganoGifu
Shizuoka
Aichi
Mie
Shiga
Kyoto
Osaka
Hyogo
Nara
Wakayama
Tottori
Shimane
Okayama
Hiroshima
Yamaguchi
Tokushima
KagawaEhime
Kochi
Fukuoka
Saga
Nagasaki
Kumamoto
Oita
MiyazakiKagoshima
Okinawa
All Japan

Average period of time spent without
limatation in daily activities
Male
Female
70.03
73.19
68.95
73.34
69.43
73.25
70.40
73.78
70.46
73.99
70.78
73.87
69.97
74.09
71.32
74.62
70.73
74.86
71.07
75.27
70.67
73.07
71.62
73.53
69.99
72.88
70.90
74.36
69.91
73.77
70.63
74.36
71.10
74.54
71.11
74.49
71.20
74.47
71.17
74.00
70.89
74.15
71.68
75.32
71.74
74.93
70.73
73.63
70.67
72.37
70.40
73.50
69.39
72.55
69.95
73.09
70.38
72.93
70.41
73.41
70.04
73.24
70.45
74.64
69.66
73.48
70.22
72.49
70.47
73.71
69.90
72.73
69.86
72.76
69.63
73.89
69.12
73.11
69.67
72.72
70.34
73.64
69.14
73.05
70.58
73.84
69.85
73.19
71.06
74.62
71.14
74.51
70.81
74.86
70.42
73.62

Average period of time individuals consider
themselves as healthy
Male
Female
69.33
73.08
68.89
73.46
68.81
72.40
70.80
73.35
69.56
73.07
70.81
73.44
69.66
73.58
71.09
73.99
69.94
74.33
70.35
74.77
70.62
72.98
71.32
73.53
69.89
73.08
70.85
74.12
69.36
73.92
69.42
73.72
70.12
73.18
70.23
74.34
70.49
74.77
70.76
73.56
70.32
73.29
71.01
74.86
70.60
73.37
70.21
73.07
70.10
73.03
69.56
73.31
68.69
72.12
68.98
72.72
71.10
74.03
70.44
73.76
69.67
72.67
69.62
74.23
69.20
73.73
68.97
72.59
68.92
72.24
69.03
72.45
69.27
72.86
68.70
73.45
68.64
71.92
68.89
72.14
69.80
73.28
69.19
73.73
69.66
73.76
69.13
72.85
71.55
75.31
70.77
74.70
70.46
73.84
69.90
73.32

(Source: Health and Labour Sciences Research Grants “Study on future predictions of healthy life
expectancy and cost-effectiveness of measures to prevent lifestyle-related diseases”
http://toukei.umin.jp/kenkoujyumyou/)iv Measures needed for the future
All of the activities presented in Health Japan 21 (the second term) are things that willcontribute to extending healthy life expectancy. Monitoring the shifts in healthy life expectancy istherefore important in terms of managing the progress of this plan. Healthy life expectancy
therefore should be calculated, and its trends investigated, each time a large-scale survey isconducted every three years in the Comprehensive Survey of Living Conditions.
While healthy life expectancy in each prefecture is calculated and announced, calculation of thehealthy life expectancy in each municipality in the prefectures is desirable for the nation as awhole. Using each type of survey and statistic, it also would be desirable for prefectures to clarify
the status of the health disparity in municipalities in their prefecture and make efforts to close
those gaps. Doing this, however, requires a high level of statistical knowledge and skill in terms ofthe calculation procedures used in life tables and the handling of data in municipalities with small
populations. Technical support for prefectures (training sessions, disclosure of calculation software,etc.) should be provided.
In approaching the issue of extending healthy life expectancy, the roles of promoting health andpreventing disease are extremely important. Various other approaches are also needed, including
early detection of disease, prevention of increasing disease severity with proper treatment
management, prevention of the need for care, and provision of care services. Systems need to be
developed for the seamless, integrated provision of these approaches matched to the health level
and risks and health, welfare, and care needs of each person.
In the coming years the health disparity will also need to be monitored from perspectives otherthan healthy life expectancy. Aggregation of data from the various surveys carried out by thenational government (Comprehensive Survey of Living Conditions, National Health and Nutrition
Survey, Patient Survey, Survey of Long-term Care Benefit Expenditures) would help to enable
comparisons of things such as lifestyle, health status, disease, and use of long-term care insurancein each prefecture, and is encouraged. It is also desirable that results of those comparisons beannounced.
Translated by Toshiyuki Ojima and Shuji Hashimoto