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ImportanceofHealthyLifeExpectancy
forHealthPromotionPolicyỤ๪ ⪽SatoshiEzoe,MD,MPH,MPA,PhD
SeniorCoordinator
CancerControlandHealthPromotionDivision
HealthServiceBureau
MinistryofHealth,Labour andWelfare

NationalComparisonofHealthyLifeExpectancy,2010
Male

FemaleRanking

Country/Area

HealthyLife
Expectancy

1
2
3
4
5
6
6
6
6
10

Japan
Singapore
Switzerland
Spain
Australia
AndorraCanadaIsraelItaliaSweden

䠓䠌䠊䠒
䠒䠕䠊䠒
䠒䠕䠊䠍
䠒䠔䠊䠔
䠒䠔䠊䠐
䠒䠔䠊䠏
䠒䠔䠊䠏
䠒䠔䠊䠏
䠒䠔䠊䠏
䠒䠔䠊䠌

Ranking

Country/Area

HealthyLife
Expectancy

1
2
3
3
5
6
7
8
8
10

Japan
Spain
Singapore
Korea
Switzerland
AndorraTaiwanFranceItaliaAustralia

䠓䠑䠊䠑
䠓䠏䠊䠌
䠓䠎䠊䠒
䠓䠎䠊䠒
䠓䠎䠊䠐
䠓䠎䠊䠎
䠓䠎䠊䠌
䠓䠍䠊䠕
䠓䠍䠊䠕
䠓䠍䠊䠔

䛆VRXUFH䛇 GlobalBurdenofDisease2010- 61 -

HealthyLifeExpectancy㸦2013㸧
60

65

70

75

80

85

90 䠄㼥㼑㼍㼞䠅

80.21

㻹㼍㼘㼑
71.19

9.02 㼥㼑㼍㼞㼟

࠙VRXUFHࠚ

86.61

㻲㼑㼙㼍㼘㼑
74.21
㼘㼕㼒㼑㻌㼑㼤㼜㼑㼏㼠㼍㼚㼏㼥㼘㼕㼒㼑㻌㼑㼤㼜㼑㼏㼠㼍㼚㼏㼥㸦㸧 㻹㼕㼚㼕㼟㼠㼞㼥㻌㼛㼒㻌㻴㼑㼍㼘㼠㼔㻌㻘㻌㻸㼍㼎㼛㼡㼞 㼍㼚㼐㻌㼃㼑㼘㼒㼍㼞㼑 $EULGJHG 㻸㼕㼒㼑㻌㼀㼍㼎㼘㼑㻌㻞㻜㻝㻟㼔㼑㼍㼘㼠㼔㼥㻌㼘㼕㼒㼑㻌㼑㼤㼜㼑㼏㼠㼍㼚㼏㼥㻌㸦 &DQFHU&RQWURODQG+HDOWK3URPRWLRQ'LYLVLRQ

12.40 㼥㼑㼍㼞㼟㼔㼑㼍㼘㼠㼔㼥㻌㼘㼕㼒㼑㻌㼑㼤㼜㼑㼏㼠㼍㼚㼏㼥 䠄㼀㼔㼑㻌㼜㼑㼞㼕㼛㼐㻌㼛㼒㻌㼠㼕㼙㼑㻌㼟㼜㼑㼚㼠㻌㼣㼕㼠㼔㼛㼡㼠㻌㼞㼑㼟㼠㼞㼕㼏㼠㼕㼛㼚㻌㼕㼚㻌㼐㼍㼕㼘㼥㻌㼍㼏㼠㼕㼢㼕㼠㼕㼑㼟䠅䠰䡄䡁 㼓㼍㼜㻌㼛㼒㻌㼘㼕㼒㼑㻌㼑㼤㼜㼑㼏㼠㼍㼚㼏㼥㻌㼍㼚㼐㻌㼔㼑㼍㼘㼠㼔㼥㻌㼘㼕㼒㼑㻌㼑㼤㼜㼑㼏㼠㼍㼚㼏㼥

Measures
Current data
Goal

Extension of healthy life expectancy (average period of timespent without restrictions in daily activities)
Male71.19 years㸪Female74.62 years 㸦2013㸧
To increase healthy life expectancy more than the increase of life
expectancy㸦2022㸧
Cancer Control and Health Promotion Division

Data source

SeculartrendofLifeExpectancy
andHealthyLifeExpectancyinJapan㼘㼕㼒㼑㻌㼑㼤㼜㼑㼏㼠㼍㼚㼏㼥䠄㼅㼑㼍㼞䠅

䠄㼅㼑㼍㼞䠅

Male

90

Female

90
85

85

84.93

85.59

85.99

86.30

86.61

72.65

72.69

73.36

73.62

74.21

2001

2004

2007

2010

2013

80

80
75

㼔㼑㼍㼘㼠㼔㼥㻌㼘㼕㼒㼑㻌㼑㼤㼜㼑㼏㼠㼍㼚㼏㼥

80.21
79.19 79.55
78.07 78.64

70
69.40 69.47

70.33 70.42 71.19

75
70
65

65
2001

2004

2007

2010

2013

࠙VRXUFHࠚ㼘㼕㼒㼑 㼑㼤㼜㼑㼏㼠㼍㼚㼏㼥㻌㻔㻞㻜㻜㻝㻘㻌㻞㻜㻜㻠㻘㻌㻞㻜㻜㻣㻘㻌㻞㻜㻝㻟㻕  㻹㼕㼚㼕㼟㼠㼞㼥㻌㼛㼒㻌㻴㼑㼍㼘㼠㼔㻌㻸㼍㼎㼛㼡㼞 㼍㼚㼐㻌㼃㼑㼘㼒㼍㼞㼑 $EULGJHG 㻸㼕㼒㼑㻌㼀㼍㼎㼘㼑㻌㻞㻜㻜㻝㻘㻌㻞㻜㻜㻠㻘㻌㻞㻜㻜㻣㻘㻌㻞㻜㻝㻟㼘㼕㼒㼑㻌㼑㼤㼜㼑㼏㼠㼍㼚㼏㼥㻌㻔㻞㻜㻝㻜㻕  㻹㼕㼚㼕㼟㼠㼞㼥㻌㼛㼒㻌㻴㼑㼍㼘㼠㼔㻌㻸㼍㼎㼛㼡㼞 㼍㼚㼐㻌㼃㼑㼘㼒㼍㼞㼑 &RPSOHWH㻸㼕㼒㼑㻌㼀㼍㼎㼘㼑㻌㻞㻜㻝㻜- 62 -

Theaverageoflengthoflifethatanindividualisfullyfunctionalfordailyactivitiesbyprefecture㸦2010㸧
FemaleMale
Aichi
Shizuoka
Chiba
Ibaraki
Yamanashi
NaganoKagoshima
Fukui
Ishikawa
Gunma
MiyazakiKanagawa
Gifu
Okinawa
Yamagata
Tochigi
Mie
SaitamaShiga
ToyamaKumamoto
Ymaguchi
Akita
ShimaneWakayama
Miyagi
Kyoto
Nara
Saga
Hiroshima
Tottori
Hokkaido
Tokyo
Fukushima
Hyogo
NigataTokushima
KagawaOita
FukuokaOkayama
Ehime
Iwate
Osaka
Nagasaki
Kochi
Aomori

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

65.00

2.79y/o
70.00

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

Shizuoka
Gunma
Aichi
Tochigi
Okinawa
ShimaneMiyazakiIbarakiIshikawa
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

75.00

65.00

70.00

㼃㼑㻌㼍㼕㼙㻌㼠㼛㻌㼐㼑㼏㼞㼑㼍㼟㼑㻌㼔㼑㼍㼘㼠㼔㻌㼐㼕㼟㼜㼍㼞㼕㼠㼕㼑㼟㻌㼎㼥㻌㼜㼞㼑㼒㼑㼏㼠㼡㼞㼑㻌㼎㼥㻌㼑㼤㼠㼑㼚㼐㼕㼚㼓㻌㼔㼑㼍㼘㼠㼔㼥㻌㼘㼕㼒㼑㻌㼑㼤㼜㼑㼏㼠㼍㼚㼏㼥㻌㼍㼘㼘㻌㼛㼢㼑㼞㻌㼠㼔㼑㻌㼏㼛㼡㼚㼠㼞㼥㻚

2.95y/o75.00

࠙sourceࠚHealth and Labour Sciences Research Grants㸧

Health Japan 21 (The 2nd term)
National Action Plan for NCDs prevention and control (2013FY-2022FY)This direction declares basic matters for comprehensive implementation ofnational health promotion through improvement of lifestyle and social environment.
Basic goals for implementation of in National Health Promotion
1) Extension of healthy life expectancy and decrease in health disparities
2) Primary and secondary prevention of non-communicable diseases
3) Improvement and maintenance of function for social abilities
4) Establishment of a social environment where health of individuals is protected and supported
5) Nutrition and healthy diet, physical activity and exercise, proper rest, alcohol use, tobacco use,
and oral healthMultisectral Approach
1) Establishment of an effective structure to solve
community health issues.
2) Encouragement of programs and liaisonsconstructively derived from variousorganizations.
3) Professionals involved in health promotion.
*Local governments also establish their health promotion plans.
ᵣᵶᵡᵣᵰᵡᵧᵱᵣ

(EX. Smart Life Project)
Extension of multisectral collaboration
for national health promotion movement
into private sectors.

ᵢᵧᵣᵲRelated Action Plans-Specific Health Check-ups and Specific
Health Guidance (The 2nd term)
Promote health guidance focused on metabolic syndrome aswell as non-obese smokers and hypertensive population.

-Healthcare planning (The 6th term)
Strengthen regional medical cooperation to enhance home
medical care.

-Basic Plan to Promote Cancer Control
Programs (Revised in Jun. 2012)
ᵱᵫᵭᵩᵧᵬᵥ
ᵡᵣᵱᵱᵟᵲᵧᵭᵬ

Further improve quality of cancer control under medical andsocial context.

- 63 -

Targets and indicators in Health Japan 21
ExampleofspecifictargetsinHealthJapan21(the2nd term)
current

targetMeandurationinwhichpeoplecanlivewithnolimitationondailylifeitem

M 70.42 yo
F 73.62 yoLonger than thatof life expectancy

ReduceageͲstandardizedmortalityrateduetocancertounder75yrs (per
100,000persons)

84.3 deaths

73.9 deaths

Meansystolicbloodpressure

M 138mmHg
F 133mmHg

M 134mmHg
F 129mmHg

Numberofnewlyintroduceddialysispatientduetodiabetes

16,247 people 15,000 people

Proportionofobesity(BMIӍ25)amongmalesaged20yrs to60yrs

31.2%

28%

Totalamountofsaltintake(g/day)

10.6g

8g

numberofstepsindailylifeamongpeopleaged20to64

M 7,841 steps M 9,000 steps
F 6,883 steps F 8,500 steps

Reducetheproportionofpeopledrinkingalcoholatlevelshighenoughto
increasetheirriskoflifestyleͲrelateddiseases*

M 15.3%
F 7.5%

M
F

Adultsmokingrate

19.5%

12%

Numberofpeopleover80whohavemorethan20oftheirownteeth.

25.0%

50%

13%
6.4%

ͤ pure alcohol consumption per day 䠖 Male 40g or more, Female 20g or more

Extendthehealthylifeexpectancy,reductionofthehealthinequity
Improvementofthequalityoflife

Reducingtheincidenceof
NCDs,preventionfrom
NCDsbecomingsevere

Improvementofsocialenvironment

Maintainandimprovethesociallifefunction<Nutrition status>
Maintaindesirable
weight<Food intake>

Reducemalnutrition

Increasepeoplethosewhotake
appropriatequalityandquantity
offoods.
•Reducesaltintake•Increase:fruits,vegetables

Increaseparticipantsforsocialactivities
1. Strengthencommunityrelationsthroughfood
2. Increasethenumberofindividualswho
participantsthevoluntaryactivitiesrelatedto
eatinghabit,foodeducation
Improveaccessforhealthresources,ensureequity
1. Increasethenumberofentitieswhoaddress
healthylifestyle
2. Supportprivatesectorswhoaddresshealth
promotion
3. Increasethenumberoflocalcommunitieswho
addressfoodproblems,nutritionstatus.

<Eating habit><eating environment>

Haveamealtogether,notalone
Develophealthy
lifestyle(threemealsaday)䠘child food䠚䠘adult food䠚 䠘aged䠚
Life stage

Increasethe
numberof
appropriate
entitiesand
restaurants

Increasethe
numberof
appropriate
processing
facilities

Social environment- 64 -

8

PreventionofLifestyleͲRelatedDiseases
Lifestyle-related diseases account for
approximately 57% of deaths in 2012.

Disease structure in Japan has shifted from infectious
diseases to lifestyle-related diseases .
Transition of mortality in Japan (main cause-specific)(per 100,000 population)
Malignantneoplasm(cancer) 286.6

Heart disease
157.9
Pneumonia
98.4
Cerebrovasculardisease(stroke) 96.5
Tuberculosis
1.7* Medical care fees related to lifestyle-related diseases account for approximately 30% (8.9 trillion yen) of general medical
treatment fees (27.8 trillion yen) (FY2011).

Urgent need to implement comprehensive prevention of life style-related diseases.

DeterminantsofHealthinJapan,2007
Tobacco smoking
High blood pressure
Physical inactivity

Smoking,129000

High blood glucose
High dietary sodium intake

Cardiovascular

Alcohol use
H. pylori

CancerHigh LDL choesterol
Hepatites C virus

Diabetes Mellitus

Low PUFA intake

Respiratory

High body mass index
Hepatitis B virus

Other NCD

Low fruit and vegetable intake
Human papillomavirus

Injuries

HTLV-1High TFA intake

0

20

40

60

80

100

120

140

Annualnumberofdeaths,thousands䛆source䛇 Resources:IkedaN,etal. WhathasmadethepopulationofJapanhealthy? Lancet2011;378:1094Ͳ1105
IkedaN,etal.PLoSMed2012;9:e1001160- 65 -

Percentdistributionofmaincausesofrequring careinJapan,2013
Lifestyle-related diseases account for approximately 30% of requring care

Total

18.5

4.5 2.3
2.8 2.4 13.4

15.8

10.9

11.8

17.6
Cerebrovasculardiseases
Heartdisease
Diabetes

Requiringhelp

11.5 7.0 3.2
15.4
2.8 2.9

3.6

20.7

14.6

Malignantneoplasm

18.3

respiratorydisease
Astheniaduetoaripeage
DementiaLongͲtermcare

0%

Articulardiseases

3.4 1.9 12.6
2.9 2.2

21.7

20%

21.4

6.8 10.9

16.2

Fracture
Othercauses

40%

60%

80%

100%

࠙VRXUFHࠚ㻯㼛㼙㼜㼞㼑㼔㼑㼚㼟㼕㼢㼑 㻿㼡㼞㼢㼑㼥㻌㼛㼒㻌㻸㼕㼢㼕㼚㼓㻌㻯㼛㼚㼐㼕㼠㼕㼛㼚㼟  㻹㼕㼚㼕㼟㼠㼞㼥㻌㼛㼒㻌㻴㼑㼍㼘㼠㼔㻌㻸㼍㼎㼛㼡㼞 㼍㼚㼐㻌㼃㼑㼘㼒㼍㼞㼑“SmartLifeProject”
Inordertodisseminateanddevelop“theNationalHealthyLifestyleMovement”whichstartedat
2008,create“Smartlifeproject”aimingatwidelyparticipationfromprivatesectors.

MHLW
Promoteparticipationforactivityᵮᶐᶇᶔᵿᶒᶃᴾᶑᶃᶁᶒᶍᶐ

Media

Foodservice
industryFood
industry

Sportclub

Throughoutenterpriseactivitysuchas
commoditiesandservice,raiseawareness
aboutnationalmovementandhealth
promotion

Throughoutadvocacyactivitiesforstaff
andofficials,raiseawarenessabouthealth
promotion

staff

CustomerSocietyͲwideNationalmovement- 66 -

13

Integrated Community Care System{ Realization of an integrated community care system which provides housing, healthcare, long-term care, prevention, andlivelihood support services in a unified manner enables the elderly to live in their community and familiar environment
throughout their life even if they come to need advanced level care.
[Measuresbasedonfiveperspectives]
FollowingmeasuresbasedonfiveperspectivesshouldbeimplementedcomprehensivelyandconsecutivelytorealizeIntegrated Community
Care.
1.CooperationwithHealthcareServices
2.ImprovementandReinforcementofLTCServices
3.PromotionofPreventionProgrammes
4.Ensuringvariouslifesupportservicessuchaswatchingover,mealsͲonͲwheelsandshopping,andAdvocacy
5.SufficientsupplyofElderlyHousings(CollaborationwithMLIT)

Healthcare

Integratedcommunitycaresystemin2025

Long-term careCommuting to
medicalfacilities/carefacilities

Integrated
community care
support center/care manager

Housing
Living support/
long-term careprevention
Old people’s club, residents’ association, long-term careprevention, living support, etc.

- 67 -*Integratedcommunitycaresystem
regardsitsunitasjuniorͲhighschool
districtwhichnecessaryservicescanbeprovidedwithinapprox.30
minutes.

ᅜ㝿ಖ೺እ஺ᡓ␎䛸᪥ᮏ෌⯆ᡓ␎䛻䛚䛡䜛೺ᗣᑑ࿨䛾ព⩏ᖹᡂ䠎䠒ᖺ䠍䠌᭶䠍䠐᪥ෆ㛶ᐁᡣ ೺ᗣ䞉་⒪ᡓ␎ᐊᑠ἟ኈ㑻䠍䠊ᅜ㝿ಖ೺እ஺ᡓ␎
UHC㐩ᡂ䛾ඛ䛻䚸᪥ᮏ䛿௒䚸೺ᗣⓗ䛺㛗ᑑ♫఍䛾ᐇ⌧䛻ྥ䛡䛶ᡓ␎䜢㐍䜑䛶䛔䜛䚹᪥ᮏ䛿䚸බⓗ௓ㆤಖ㝤ไᗘ䜢ᑟධ䛧䚸㧗㱋⪅䛜ᆅᇦ䛾୰䛷䜘䜚⮬❧䛧䛶⏕ά䛷䛝䜛䜘䛖ྲྀ⤌䜣䛷䛚䜚䚸㧗㱋⪅䛾♫఍ཧຍ䛜᥎㐍䛥䜜䛶䛔䜛䚹⚾䛿ᅜ䜢ᣲ䛢䛶䚸䛭䛧䛶ᚲせ䛻ᛂ䛨䛶つไ⦆࿴䜢㏻䛧䛶◊✲㛤Ⓨ䜢᥎㐍䛧䚸೺ᗣ㛗ᑑ⏘ᴗ䛾Ⓨᒎ䛻ྲྀ䜚⤌䜣䛷䛔䛟䚹䛣䛾䜘䛖䛻ᐁẸ䛜ᡭ䜢ྲྀ䜚ྜ䛔䚸ᑑ࿨䛾ఙ䜃䜢ୖᅇ䜛೺ᗣᑑ࿨䛾኱䛝䛺ఙ䜃䜢䜒䛯䜙䛩஦䛜䚸ᛴ㏿䛺㉸㧗㱋໬♫఍䜈䛾ฎ᪉⟢䛸䛺䜛䛷䛒䜝䛖䚹䝫䝇䝖2015䛻ྥ䛡䛯ᣢ⥆ྍ⬟䛺㛤Ⓨ䛾どⅬ䛛䜙䜒䚸ୡ⏺つᶍ䛾ᛴ㏿䛺㧗㱋໬䜢ぢ㐣䛤䛩஦䛿䛷䛝䛺䛔䚹- 68 -

䠎䠊䛂᪥ᮏ෌⯆ᡓ␎䛃 ᨵゞ2014 ᡓ␎ⓗᕷሙ๰㐀䝥䝷䞁䝔䞊䝬䠍䠖ᅜẸ䛾䛂೺ᗣᑑ࿨䛃䛾ᘏఙ
䠄䠍䠅KPI䛾୺䛺㐍ᤖ≧ἣ
䛀KPI䛁䛂2020ᖺ䜎䛷䛻ᅜẸ䛾೺ᗣᑑ࿨䜢䠍ṓ௨ୖᘏఙ䛆⏨ᛶ70.42ṓ䚸ዪᛶ73.62ṓ䠄2010ᖺ䠅䛇䛃эᖹᆒᑑ࿨䛻䛴䛔䛶䚸2012ᖺ䠖⏨ᛶ79.94ṓ䚸ዪᛶ86.41ṓ䛆⏨ᛶ
79.55ṓ䚸ዪᛶ86.30ṓ䠄2010ᖺ䠅䛇
䛀KPI䛁䛂2020ᖺ䜎䛷䛻䝯䝍䝪ேཱྀ䜢2008ᖺᗘẚ25䠂ῶ䛆1400୓ே
䠄2008ᖺᗘ䠅䛇䛃
э2011⸜⹎烉2008⸜⹎㭼9.7炴㷃
䛀KPI䛁䛂2020ᖺ䜎䛷䛻೺デཷデ⋡䠄40䡚74ṓ䠅䜢80䠂䠄≉ᐃ೺デ䜢ྵ䜐䠅䛆67.7䠂䠄2010ᖺ䠅䛇䛃э≉ᐃ೺デཷデ⋡䛻䛴䛔䛶䚸2011ᖺᗘ䠖44.7䠂䛆43.2䠂䠄2010ᖺᗘ䠅䛇䠏䠊೺ᗣ䞉་⒪ᡓ␎䛿䛨䜑䛻䕿 ୡ⏺䛻ඛ㥑䛡䛶㉸㧗㱋♫఍䜢㏄䛘䜛ᡃ䛜ᅜ䛻䛒䛳䛶䚸ㄢ㢟ゎỴඛ㐍ᅜ䛸䛧䛶䚸೺ᗣ㛗ᑑ♫఍䛾ᙧᡂ䛻ྥ䛡䚸ୡ⏺᭱ඛ➃䛾་⒪ᢏ⾡䞉䝃䞊䝡䝇䜢ᐇ⌧䛧䚸೺ᗣᑑ࿨䜢䛥䜙䛻ఙ䜀䛩䛣䛸䛜㔜せ䚹䕿 ೺ᗣ㛗ᑑ♫఍䛾ᙧᡂ䛻㈨䛩䜛᪂䛯䛺⏘ᴗάື䛾๰ฟ䜔䛣䜜䜙䛾⏘ᴗ䛾ᾏእ䛻䛚䛡䜛ᒎ㛤䜢ಁ㐍䛩䜛䛣䛸䛻䜘䜚䚸ᾏእ䛻䛚䛡䜛་⒪䛾㉁䛾ྥୖ䛻䜒ᐤ୚䛧䛴䛴䚸䛣䜜䜙䛾⏘ᴗ䜢ᡓ␎⏘ᴗ䛸䛧䛶⫱ᡂ䛧䚸ᡃ䛜ᅜ⤒῭䛾ᡂ㛗䛻ᐤ୚䛷䛝䜛䚸ୡ⏺䛷䜒㢮䜢ぢ䛺䛔Ᏻᚰ䛸Ᏻ඲䜢๓ᥦ䛸䛧䛯་⒪⚟♴ඛ㐍ᅜ䛸䛧䛶ୡ⏺䛻ᣑ䛢䛶䛔䛟䛣䛸䛜㔜せ䛷䛒䜛䚹䠍䠊⥲ㄽ䠍䠅 ೺ᗣ䞉་⒪ᡓ␎䛾఩⨨௜䛡䕿 䛂೺ᗣ䞉་⒪ᡓ␎᥎㐍ἲ䛃 ➨17᮲䛾つᐃ䛻ᇶ䛵䛝䚸➨2᮲䛻ᐃ䜑䜙䜜䜛ᇶᮏ⌮ᛕ䛻䛾䛳䛸䜚䚸➨10᮲䛛䜙➨16᮲䛻ᐃ䜑䜛ᇶᮏⓗ᪋⟇䠄◊✲㛤Ⓨ䛾᥎㐍䚸◊✲㛤Ⓨ䛾⎔ቃ䛾ᩚഛ䚸◊✲㛤Ⓨ䛾බṇ䛛䛴㐺ṇ䛺ᐇ᪋䛾☜ಖ䚸◊✲㛤Ⓨᡂᯝ䛾ᐇ⏝໬䛾䛯䜑䛾ᑂᰝయไ䛾ᩚഛ➼䚸᪂⏘ᴗ䛾๰ฟཬ䜃ᾏእᒎ㛤䛾ಁ㐍䚸ᩍ⫱䛾᣺⯆➼䚸ேᮦ䛾☜ಖ➼䠅䜢㋃䜎䛘⟇ᐃ䚹䠎䠅 ೺ᗣ䞉་⒪ᡓ␎䛾ᇶᮏ⌮ᛕ䠄᥎㐍ἲ➨䠎᮲䠅䕿 ୡ⏺᭱㧗Ỉ‽䛾ᢏ⾡䜢⏝䛔䛯་⒪䛾ᥦ౪
་⒪ศ㔝䛾◊✲㛤Ⓨ䛻䛚䛡䜛ᇶ♏ⓗ䛺◊✲㛤Ⓨ䛛䜙ᐇ⏝໬䛾䛯䜑䛾◊✲㛤Ⓨ䜎䛷䛾୍㈏䛧䛯◊✲㛤Ⓨ䛾᥎㐍ཬ䜃䛭䛾ᡂᯝ䛾෇⁥䛺ᐇ⏝໬䛻䜘䜚ୡ⏺᭱㧗Ỉ‽䛾་⒪䛾ᥦ౪䛻ᐤ୚䚹䕿 ⤒῭ᡂ㛗䜈䛾ᐤ୚೺ᗣ㛗ᑑ♫఍䛾ᙧᡂ䛻㈨䛩䜛⏘ᴗάື䛾๰ฟཬ䜃䛣䜜䜙䛾⏘ᴗ䛾ᾏእ䛻䛚䛡䜛ᒎ㛤䛾ಁ㐍䛭䛾௚䛾άᛶ໬䛻䜘䜚䚸ᾏእ䛻䛚䛡䜛་⒪䛾㉁䛾ྥୖ䛻䜒ᐤ୚䛧䛴䛴䚸ᡃ䛜ᅜ⤒῭䛾ᡂ㛗䛻ᐤ୚䚹䠏䠅 ೺ᗣ䞉་⒪ᡓ␎䛾ᑐ㇟ᮇ㛫䕿 ௒ᚋ䚸10ᖺ⛬ᗘ䜢ど㔝䛻ධ䜜䛯ᖹᡂ26ᖺᗘ䛛䜙䛾䠑ᖺ㛫䜢ᑐ㇟䚹⟇ᐃ䛛䜙䠑ᖺᚋ䜢┠㏵䛻඲య䛾ぢ┤䛧䜢⾜䛖䛣䛸䛸䛩䜛䛜䚸䝣䜷䝻䞊䜰䝑䝥䛾⤖ᯝ➼䜢㋃䜎䛘䚸ᚲせ䛻ᛂ䛨䛶㝶᫬ぢ┤䛧䜢ᐇ᪋䚹3- 69 -

㐩ᡂ䛩䜉䛝ᡂᯝ┠ᶆ䛆KPI䛇ͤ≉グ䛩䜛ሙྜ䜢㝖䛝2020ᖺ㡭䜎䛷䛾㐩ᡂ┠ᶆ䠍䠅 ୡ⏺᭱㧗Ỉ‽䛾་⒪䛾ᥦ౪䛻㈨䛩䜛་⒪ศ㔝䛾◊✲㛤Ⓨ➼䛻㛵䛩䜛᪋⟇
䞉

་⸆ရ๰ฟ

䜸䞊䝎䞊䝯䜲䝗䞉䝀䝜䝮་⒪䞉 ┦ㄯ䞉䝅䞊䝈ホ౯ 1500௳䞉 ᭷ᮃ䝅䞊䝈䜈䛾๰⸆ᨭ᥼ 200௳䞉 ௻ᴗ䜈䛾ᑟฟ䠄䝷䜲䝉䞁䝇䜰䜴䝖䠅 䠑௳䞉 ๰⸆䝍䞊䝀䝑䝖䛾ྠᐃ 10௳䞉 ⏕ά⩦័⑓䠄⢾ᒀ⑓䜔⬻༞୰䚸ᚰ➽᱾ሰ䛺䛹䠅䛾๻ⓗ䛺ᨵၿ䞉 Ⓨ䛜䜣ண デ᩿䚸ᢠ䛜䜣๣➼䛾἞⒪཯ᛂᛶ䜔๪స⏝䛾ண デ᩿䛾☜❧䞉 ㄆ▱⑕➼䛾䝀䝜䝮་⒪䛻ಀ䜛⮫ᗋ◊✲䛾㛤ጞ䞉 ⚄⤒䞉➽㞴⑓➼䛾㠉᪂ⓗ䛺デ᩿䞉἞⒪ἲ䛾㛤Ⓨͤ 2020-30ᖺ㡭䜎䛷䛾㐩ᡂ┠ᶆ་⒪ᶵჾ㛤Ⓨ䞉 ་⒪ᶵჾ䛾㍺ฟ㢠䜢ಸቑ䠄ᖹᡂ23ᖺ⣙䠑༓൨෇ĺ⣙䠍඙෇䠅䞉 䠑✀㢮௨ୖ䛾㠉᪂ⓗ་⒪ᶵჾ䛾ᐇ⏝໬䞉 ᅜෆ་⒪ᶵჾᕷሙつᶍ䛾ᣑ኱ 3.2඙෇

⑌ᝈ䛻ᑐᛂ䛧䛯◊✲䠘䛜䜣䠚䞉 䠑ᖺ௨ෆ䛻᪥ᮏⓎ䛾㠉᪂ⓗ䛺䛜䜣἞⒪⸆䛾๰ฟ䛻ྥ䛡䛯10✀㢮௨ୖ䛾἞㦂䜈䛾ᑟฟ䞉 ᑠඣ䛜䜣䚸㞴἞ᛶ䛜䜣䚸ᕼᑡ䛜䜣➼䛻㛵䛧䛶䚸ᮍᢎㄆ⸆䞉㐺ᛂእ⸆䜢ྵ䜐἞⒪⸆䛾ᐇ⏝໬䛻ྥ䛡䛯䠒✀㢮௨ୖ䛾἞㦂䜈䛾ᑟฟ䞉 ᑠඣ䛜䜣䚸ᕼᑡ䛜䜣➼䛾἞⒪⸆䛻㛵䛧䛶䠍✀㢮௨ୖ䛾⸆஦ᢎㄆ䞉ຠ⬟㏣ຍ䞉 䛔䜟䜖䜛䝗䝷䝑䜾䞉䝷䜾䚸䝕䝞䜲䝇䞉䝷䜾䛾ゎᾘ䞉 ᑠඣ䞉㧗㱋⪅䛾䛜䜣䚸ᕼᑡ䛜䜣䛻ᑐ䛩䜛ᶆ‽἞⒪䛾☜❧䠄䠏௳௨ୖ䛾䜺䜲䝗䝷䜲䞁䜢సᡂ䠅㠉᪂ⓗ䛺་⒪ᢏ⾡๰ฟᣐⅬ䞉 ་ᖌ୺ᑟ἞㦂ᒆฟᩘ ᖺ㛫40௳
䞉 First in Human䠄FIH䠅ヨ㦂䠄௻ᴗ἞㦂ྵ䜐䠅 ᖺ㛫40௳෌⏕་⒪䞉 iPS⣽⬊ᢏ⾡䜢ά⏝䛧䛶స〇䛧䛯᪂つ἞⒪⸆䛾⮫ᗋᛂ⏝䞉 ෌⏕་⒪➼〇ရ䛾⸆஦ᢎㄆᩘ䛾ቑຍ䞉 ⮫ᗋ◊✲ཪ䛿἞㦂䛻⛣⾜䛩䜛ᑐ㇟⑌ᝈ䛾ᣑ኱ ⣙15௳䞉 ෌⏕་⒪㛵ಀ䛾࿘㎶ᶵჾ䞉⿦⨨䛾ᐇ⏝໬䞉 iPS⣽⬊ᢏ⾡䜢ᛂ⏝䛧䛯་⸆ရᚰẘᛶホ౯ἲ䛾ᅜ㝿ᶆ‽໬䜈䛾ᥦゝ⑌ᝈ䛻ᑐᛂ䛧䛯◊✲䠘⢭⚄䞉⚄⤒⑌ᝈ䠚䞉 ᪥ᮏⓎ䛾ㄆ▱⑕䚸䛖䛴⑓䛺䛹䛾⢭⚄⑌ᝈ䛾᰿ᮏ἞⒪⸆ೃ⿵䛾἞㦂㛤ጞ䞉 ⢭⚄⑌ᝈ䛾ᐈほⓗデ᩿ἲ䛾☜❧䞉 ⢭⚄⑌ᝈ䛾㐺ṇ䛺⸆≀἞⒪ἲ䛾☜❧䞉 ⬻඲య䛾⚄⤒ᅇ㊰䛾ᵓ㐀䛸άື䛻㛵䛩䜛䝬䝑䝥䛾᏶ᡂ4㐩ᡂ䛩䜉䛝ᡂᯝ┠ᶆ䛆KPI䛇䠍䠅 ୡ⏺᭱㧗Ỉ‽䛾་⒪䛾ᥦ౪䛻㈨䛩䜛་⒪ศ㔝䛾◊✲㛤Ⓨ➼䛻㛵䛩䜛᪋⟇䠄䛴䛵䛝䠅ͤ≉グ䛩䜛ሙྜ䜢㝖䛝2020ᖺ㡭䜎䛷䛾㐩ᡂ┠ᶆ⑌ᝈ䛻ᑐᛂ䛧䛯◊✲䠘᪂⯆䞉෌⯆ឤᰁ⑕䠚䞉 ᚓ䜙䜜䛯⑓ཎయ䠄䜲䞁䝣䝹䜶䞁䝄䞉䝕䞁䜾⇕䞉ୗ⑩⑕ឤᰁ⑕䞉⸆๣⪏ᛶ⳦䠅䛾඲䝀䝜䝮䝕䞊䝍䝧䞊䝇➼䜢ᇶ䛻䛧䛯⸆๣䝍䞊䝀䝑䝖㒊఩䛾≉ᐃཬ䜃᪂䛯䛺㎿㏿デ᩿ἲ➼䛾㛤Ⓨ䞉ᐇ⏝໬䞉 䝜䝻䜴䜲䝹䝇䝽䜽䝏䞁ཬ䜃⤒㰯䜲䞁䝣䝹䜶䞁䝄䝽䜽䝏䞁䛻㛵䛩䜛㠀⮫ᗋヨ㦂䞉⮫ᗋヨ㦂䛾ᐇ᪋ཬ䜃⸆஦ᢎㄆ䛾⏦ㄳͤ 2030ᖺ䜎䛷䛾㐩ᡂ┠ᶆ ᪂䛯䛺䝽䜽䝏䞁䛾㛤Ⓨ䠄౛䠖䜲䞁䝣䝹䜶䞁䝄䛻ᑐ䛩䜛୓⬟䝽䜽䝏䞁䛺䛹䠅䚸᪂䛯䛺ᢠ⳦⸆䞉ᢠ䜴䜱䝹䝇⸆➼䛾㛤Ⓨ䚸WHO䚸ㅖእᅜ䛸㐃ᦠ䛧䛯䝫䝸䜸䚸㯞⑈➼䛾ឤᰁ⑕䛾᰿⤯䞉᤼㝖䛾㐩ᡂ䠄⤖᰾䛻䛴䛔䛶䛿2050ᖺ䜎䛷䛾㐩ᡂ┠ᶆ䠅⑌ᝈ䛻ᑐᛂ䛧䛯◊✲䠘㞴⑓䠚䞉䞉 ᪂つ⸆๣䛾⸆஦ᢎㄆ䜔᪤Ꮡ⸆๣䛾㐺ᛂᣑ኱䜢11௳௨ୖ㐩ᡂ䠄➽ⴎ⦰ᛶഃ⣴◳໬⑕䠄ALS䠅䚸㐲఩ᆺ䝭䜸䝟䝏䞊䛺䛹䠅䞉 Ḣ⡿➼䛾䝕䞊䝍䝧䞊䝇䛸㐃ᦠ䛧䛯ᅜ㝿ඹྠ⮫ᗋ◊✲ཬ䜃἞㦂䛾᥎㐍䠎䠅 ೺ᗣ䞉་⒪䛻㛵䛩䜛᪂⏘ᴗ๰ฟཬ䜃ᾏእᒎ㛤䛾ಁ㐍➼䛻㛵䛩䜛᪋⟇䞉 ೺ᗣቑ㐍䞉ண㜵䚸⏕άᨭ᥼㛵㐃⏘ᴗ䛾ᕷሙつᶍ䜢ᣑ኱䠄䠐඙෇ĺ10඙෇䠅䞉 ೺ᗣ䞉་⒪ศ㔝䛻䛚䛡䜛ᐁẸ䝣䜯䞁䝗䛸Ẹ㛫䛛䜙䛾༠ㄪฟ㈨䛜䛺䛥䜜䛯௳ᩘ䛾ẚ⋡䜢100%䞉 ᾏእ䛻᪥ᮏ䛾་⒪ᣐⅬ䜢๰タ䠄䠏䜹ᡤĺ10䜹ᡤ⛬ᗘ䠅䞉 ᪥ᮏ䛾་⒪ᢏ⾡䞉䝃䞊䝡䝇䛜⋓ᚓ䛩䜛ᾏእᕷሙつᶍ䜢䠑඙෇ 䈜2030ᖺ䜎䛷䛾㐩ᡂ┠ᶆ䠏䠅 ೺ᗣ䞉་⒪䛻㛵䛩䜛ඛ➃ⓗ◊✲㛤Ⓨཬ䜃᪂⏘ᴗ๰ฟ䛻㛵䛩䜛ᩍ⫱䛾᣺⯆䞉ேᮦ䛾☜ಖ➼䛻㛵䛩䜛᪋⟇䞉 ᅜẸ䛾೺ᗣᑑ࿨䜢䠍ṓ௨ୖᘏఙ䞉 䝯䝍䝪ேཱྀ䜢2008ᖺᗘẚ25䠂ῶ䞉 ೺デཷデ⋡䠄40ṓ䡚74ṓ䠅䜢80䠂䠄≉ᐃ೺デ䜢ྵ䜐䠅䠐䠅 ୡ⏺᭱ඛ➃䛾་⒪䛾ᐇ⌧䛾䛯䜑䛾་⒪䞉௓ㆤ䞉೺ᗣ䛻㛵䛩䜛䝕䝆䝍䝹໬䞉ICT໬䛻㛵䛩䜛᪋⟇䝺䝉䝥䝖䝕䞊䝍䛻ຍ䛘䚸䛣䜜䜎䛷฼ά⏝䛥䜜䛶䛔䛺䛔᳨ᰝ䝕䞊䝍➼䜢ྵ䜐་⒪䞉௓ㆤ䞉೺ᗣศ㔝䛾䝕䝆䝍䝹ᇶ┙䜢ᵓ⠏䛧䚸⮫ᗋ◊✲ཬ䜃἞㦂䚸䝁䝩䞊䝖◊✲➼䛾◊✲䛷䠄⌧ᅾ䛿฼⏝୙ྍ⬟䛺䠅་⒪➼᝟ሗ䜢฼⏝5- 70 -

೺ᗣᑑ࿨ᘏఙ⏘ᴗ䛾㔜せᛶ䛸ᯝ䛯䛩䜉䛝ᙺ๭䕿᪂⏘ᴗ๰ฟ䛸་⒪㈝๐ῶ
䞉៏ᛶᮇ་⒪䠄⏕ά⩦័⑓㛵㐃䠅䛻䛛䛛䜛་⒪㈝䜢䚸බⓗಖ㝤እ䛾䝃䞊䝡䝇䜢ά⏝䛧䛯ண㜵䞉೺ᗣ⟶⌮䛻䝅䝣䝖䛥䛫䜛䛣䛸䠄䝉䝹䝣䝯䝕䜱䜿䞊䝅䝵䞁䛾᥎㐍䠅䛻䜘䜚䚸䛂ᅜẸ䛾೺ᗣቑ㐍䛃䚸䛂་⒪㈝䛾๐ῶ䛃䚸䛂᪂⏘ᴗ䛾๰ฟ䛃䜢ྠ᫬䛻ᐇ⌧䚹䕿ᆅᇦ⤒῭䞉䝁䝭䝳䝙䝔䜱䛾άᛶ໬䞉ᆅᇦ䛻䛚䛔䛶ேཱྀῶᑡ䛸་⒪㈝ቑ኱䛜㐍䜐୰䚸೺ᗣᑑ࿨ᘏఙ⏘ᴗ䛾ᯝ䛯䛩䜉䛝ᙺ๭䛿䜎䛩䜎䛩ᣑ኱䚹䐟㧗㱋໬䛻క䛖ᆅᇦ䛾ከᵝ䛺೺ᗣ䝙䞊䝈䛾඘㊊䚸䐠㎰ᴗ䞉ほග➼䛾ᆅᇦ⏘ᴗ䛸䛾㐃ᦠ䛻䜘䜛᪂⏘ᴗ๰ฟ䠄་䞉㎰ၟᕤ㐃ᦠ䠅䛻䜘䜚䚸ᆅᇦ䛾䛂⤒῭άᛶ໬䛸་⒪㈝๐ῶ䛃䛻䛴䛺䛢䜛䛣䛸䛜㔜せ䚹䛆ᆅᇦ⤒῭䛻䛚䛡䜛ண㜵䞉೺ᗣ⟶⌮䝃䞊䝡䝇䛾ᙺ๭䛇䛆ண㜵䞉೺ᗣ⟶⌮䝃䞊䝡䝇䛾ά⏝䛇་⒪㈝බⓗಖ㝤䛻䜘䜛་⒪䝃䞊䝡䝇䛾౪⤥䝷䜲䞁බⓗಖ㝤እ䝃䞊䝡䝇䜢ే⏝䛧䛯౪⤥䝷䜲䞁㎰ᴗ䞉ほග➼䛾ᆅᇦ⏘ᴗ䛸䛾㐃ᦠ䠄་䞉㎰ၟᕤ㐃ᦠ➼䠅៏ᛶᮇ་⒪䠄⏕ά⩦័⑓㛵㐃䠅䛾
⣙9.8඙෇䚹ண㜵䞉೺ᗣ
་⒪㈝䛿⣙⟶⌮䝃䞊䝡䝇䛻䜘䜚๐ῶྍ⬟៏ᛶᮇ་⒪䛛䜙ண㜵䞉೺ᗣ⟶⌮䜈䛾኱⫹䛺䝅䝣䝖᪂⏘ᴗ๰ฟබⓗಖ㝤እ䛾
㐠ື䚸ᰤ㣴䚸ಖ೺䝃䞊䝡䝇➼

៏ᛶᮇ
་⒪

་⒪䞉௓ㆤ
䠄ᆅᇦໟᣓ䜿䜰䠅

ᆅᇦ་⒪䞉௓ㆤయไ䛾ᵓ⠏බⓗಖ㝤እ䛾ண㜵䞉೺ᗣ⟶⌮䝃䞊䝡䝇䛾ά⏝ᆅᇦ䛾⤒῭άᛶ໬䛸་⒪㈝๐ῶ

ಶே䛾ᖺ㱋- 71 -

6

InternationalWorkshoponHealthExpectancy:
HarmonizingSummaryMeasuresofPopulationHealthTokyo,October14Ͳ16,2014

FromREVES,internationalnetworkonhealth
expectancyandthedisabilityprocess…
…totheJAͲEHLEIS,EuropeanJointAction
onHealthyLifeYears- 72 -

• EuroͲREVES• AsiaͲREVES- 73 -

JA_EHLEIS(2011Ͳ2014)- 74 -

Timeline of EHLEIS projects
European Health
Status Module
2002-3Euro-REVES I
1995-7Euro-REVES II
1997-2002

1995

EHEMU
2004-7

1999

2003

2007

HLY
Indicator

Health Monitoring
Programme
1995-2002

JA EHLEIS
2011-14

EHLEIS
2007-10

2011

2013

EHIS
2008

EHIS
2014

Lisbon Strategy

Strategy Europe 2020

2000-20102010-2020

European context

Trends in life expectancy at age 65

24

24

22

22

20

20

18

18

16

16

14

14

12

12

10
1940

1950

1960

1970

1980

1990

Denmark

FranceJapan

Netherlands

2000
Spain

2010
Sweden

2020

10
1940

USA

- 75 -

1950

1960

1970

1980

Denmark

FranceJapan

Netherlands

1990

2000
Spain

2010
Sweden2020
USAHowlongcanweliveingoodhealth?

The Mini European Health Module (MEHM)
3 concepts:
Self perceived healthLong standing or chronic health problems
Functional heath / disability
3 global questions >>> The world smallest health survey
In EU-SILC since 2004/2005- 76 -

Self-perceived health

How is your health in general? Is it…
1.Very good
2.Good3.Fair
4.Bad
5.Very bad

Chronic morbidity

Do you have any chronic illness or condition?
1. Yes
2. No- 77 -

Global activity limitation (GALI)For at least the past 6 months, to what extent haveyou been limited because of a health problem in
activities people usually do?
Would you say you have been…
1.severely limited
2.limited but not severely, or
3.not limited at all

Health expectancies in Europe

Life expectancy in good perceived health
How is your health in general? Is it… Very good + GoodLife expectancy without chronic disease
Do you have any chronic illness or condition? No

Life expectancy without activity limitation
For at least the past 6 months, to what extent have you been limited
because of a health problem in activities people usually do? Not limited at all- 78 -

Healthy Life Years (HLY)(Life expectancy without activity limitation)

Selected as part of the Lisbon Strategy (2000-2010) to assess thequality of life and functional health status of Europeans
Set as the overarching target of the first partnership ofInnovation Union “Active Healthy Ageing”: an increase in HLY of
two years by 2020

Producingcountryprofiles- 79 -

21.3
17.8

Monitoringchangesovertime- 80 -

Howlongcanweliveingoodhealth?

3 main theories:
Compression of morbidity/disability
Dynamic equilibrium
Expansion of morbidity/disabilityLife and HLY at age 65, EU25, 2005-2012
21.4
20.2
16.7

8.5

+1.2

18.0

+1.3

8.85

8.5

+0.0

- 81 -

8.7-0.15

Prevalence of activity limitation (GALI), EU25, 2010-2012

0

20
2010

40
2011

60

80

100

2012

2012

80%
70%
60%
50%
40%
30%
20%
10%
0%
0

20
2010

40
2011

60

80

100

Prevalence in percentage

FemalesPrevalence in percentage

Prevalence in percentage

Males
80%
70%
60%
50%
40%
30%
20%
10%
0%

80%
70%
60%
50%
40%
30%
20%
10%
0%

2012

0

20

40

Males

60

HLYReleaseApril19,2012
FOREACHOFTHE27MEMBERSTATESAnnual countryreport- 82 -

80

Females100

www.eurohex.eu

InternationalWorkshoponHealthExpectancy:
HarmonizingSummaryMeasuresofPopulationHealthTokyo,October14Ͳ16,2014

Thankyouforyourattention!

- 83 -

The development of a blueprint for a
Summary Measure of Population Health
WP 7 JA: EHLEIS

H. Van Oyen, N. Berger and the JA:EHLEIS
14 October 2014

Historical overview
Necessity of measures summarizing population health and functioning:
Lois Verbrugge :Â REVES meeting ROME, 1996
Â A global indicator of disability, Journal of Aging Studies, 11:337-362, 1997
Euro-REVES projects:Â Complex instruments
 Functional limitation (physical, sensorial) Activity restrictions
 Mental health: psychological distress Mental health: positive mental healthÂ Global instruments: Minimum European Health Module (MEHM)
 Self-Perceived Health Chronic conditions
 Participation restrictions: GALI

- 84 -

Historical overview
GLOBAL ACTIVITY LIMITATION INDICATOR : GALI
Evolution from ICIDH to ICF : functional limitations / participation restriction
Survey to + 50 international expert
Systematic review +30 instruments

Robine et al:EJPH, 13 (3 suppl): 6-14, 2003

The Joint Action EHLEIS (2011-2014)
Aim: to consolidate existing information on life and health expectancy in the EU
Main Tasks:- To provide online information on LE and HE (www.eurohex.eu)- To analyse trends in HLY within the EU (Annual Country Report)- To identify determinants of the inequalities in HLY- To analyse socio-economic differences in HLY- To develop statistical tools for the analysis of HE- To validate the Global Activity Limitation Indicator (GALI)- To strengthen international harmonisation of Summary Measures of Population Health (SMPHs)- 85 -

Harmonisation of SMPHs
Overall objectives of the Work Package
To have a conceptual discussion on
the evaluation and possible improvement of SMPHs - in particular Health
Expectancies
the use of SMPH as a population health outcome measure of (health) policyand (health) policy interventions
the development of blueprint for an improved SMPH which has a higher
comparability at EU and OECD level

Harmonisation of SMPH
Outcome of the Work Package
A blueprint for a new SMPH (Health Expectancy) which is comparable at
EU/OECD level:
Selection of a health dimension for which a comparable measure isneeded at EU/OECD level to calculate Health Expectancies
Suggestion of protocols / guidelines in the creation of a global
survey instrument, testing, validation and implementation ininternational context- 86 -

Methods

Setting up a Working Group
Experts from various OECD countries and organizations were invited
to participate to a working group on international harmonization of
SMPHs (November 2011):
The JA: EHLEIS (14)The United States (2)Japan (1)Eurostat (2)OECD (1)
WHO Europe (1)European Commission (DG Sanco) (1)- 87 -

Activities of the Working Group
3 seminars organised in Paris
April 2012: “Concepts behind SMPH” (1 day)
Short experts survey, literature review, presentations of national uses of
SMPHs, group discussion on important health dimensions

April 2013: “Global Disability Indicator” (1 day)
Literature review, working document preparation, review, group discussions

April 2014: “Blueprint for a new SMPH” (1 ½ days)
Extended experts surveys (REVES members), critical evaluation of theworking document, final discussion

Results- 88 -

1st seminar: conclusions
Similar Health Expectancies used in the EU, the US and Japan
Health dimensions: Self-Rated Health; Chronic Morbidity; Activity Limitations…But different survey instruments => limited comparability=> Need for an internationally comparable global disability indicator (for the
calculation of DFLE)

2nd seminar: conclusions
Disability is too broad to be measured comprehensively with a global approach=> Selection of a dimension of disability: participation restriction

Supplement measure: global measure of functional limitation- 89 -

3rd seminar: the Blueprint
1.
2.

Rationale: main objectives of Health Expectancies
Measurement priority: DFLE and global measure of disability
1.
2.

3.

Desired conceptual characteristics of the global indicators
1.
2.

4.
5.
6.
7.
8.

Conceptual perspective on disability
Rationale for a global measure of disability
Participation restriction(Functional limitation)

Technical characteristics of a global indicator
Instrument selection and design
Translation, testing and validation
Recommendation for implementation
Conclusion

Disability dimensions
Priority measure = participation restriction
Supplement measure = functional limitation
Rationale
1. Participation summarises disability – Reflects best ICF
2.

The 2 dimensions are useful for public policies
A. Disability and Health policies
e.g. United Nation Convention on the Rights of People with Disabilities
cf. Washington Group and Budapest Initiative rationales
B. Ageing Policies – Active and Healthy Ageing- 90 -

3. Conceptual characteristics:
Participation restriction
1. Measure of participation => performance
2. With assistive devices and/or personal assistance
3. Health-relatedness [survey: 83% relevant]
4. Long-term duration of limitations [survey: 80% relevant]
5. Comprehensive content [survey: 74% relevant]
6. Normative comparison [survey: 67% relevant]
7. Severity of limitations [survey: 87% relevant]

3. Conceptual characteristics:
Functional limitation
1. Measure of functional limitation => capacity
2. Without assistive devices and/or personal assistance
3. Long-term duration of limitations [survey: 80% relevant]
4. Comprehensive content
5. Severity of limitations [survey: 96% relevant]- 91 -

4. Technical characteristics ofa global indicator
1. Conciseness of the instrument
2. Usability for general population
3. Simplicity of the question(s)4. Amenability to multi-modes of collection

5. Instrument design
Non-systematic review of the literature & experts survey results:
1. Participation restriction: no generally accepted global measure outside EU(although the GALI is conceptually close)=> To design
GALI:‘For at least the past 6 months, to what extent have you been limited
because of a health problem in activities people usually do? Would
you say you have been; 1. severely limited, 2. limited but not
severely, or 3. not limited at all?

- 92 -

5. Instrument design
Non-systematic review of the literature & experts survey results:

2. Functional limitation: 4 items of the Washington Group short set as astarting point=> Evaluate whether the dimensions of the instrument are the most relevant for
EU/OECD countries
e.g. # of teeth as a measure of functional limitation (proposed by Japan)

Conclusion
The suggested global measures – participation restriction (in priority) andfunctional limitation (as a supplement) – would allow to calculateinternationally comparable Health Expectancies which are highly policy
relevant.
Further work is needed!
Next step: to design and test a global measure of participation
Recommendation for further work: to share the leadership between the EU,
the US and Japan and to invite additional OECD countries to take part to theinitiative- 93 -

Thank you for your attention!
hvanoyen@wiv-isp.bewww.eurohex.eu
The JA-EHLEIS group
Jean-Marie Robine Project Leader, Institut national de la santé et de la recherche médicale (France)
Herman Van Oyen Scientific Institute of Public Health (Belgium)
Nicolas Berger Scientific Institute of Public Health (Belgium)
Jan-Willem Bruggink Statistical Office - CBS (Netherlands)
Chris White Office for National Statistics (United Kingdom)
Henrik Bronnum Hansen University of Copenhagen (Denmark)Bernard Jeune University of Southern Denmark - Institute of Public Health, Epidemiology (Denmark)Emmanuelle Cambois Institut National d'Etudes Démographiques (France)
Jurgen Thelen Robert Koch Institute (Germany)
Giorgos Ntouros Hellenic Statistical Authority (Greece)
Viviana Egidi University la Sapienza (Italy)
Wilma Nusselder Erasmus Medical Center (Netherlands)
Marten Lagergren National Board of Health and Welfare (Sweden)
Carol Jagger Newcastle University (United Kingdom)- 94 -

Washington Group on Disability
Statistics
Mitchell Loeb
National Center for Health Statistics /Washington Group on Disability Statistics

2/26/2015

1

The Washington Group on Disability
Statistics (WG)••

June 2001: UN International Seminar on the
Measurement of Disability
WG established as a City Group under the aegis
of the UN Statistical Commission to:••••address the need for population based measures of
disability
foster international cooperation in the area of healthand disability statistics
produce internationally tested measures to monitor
status of persons with disability
incorporate disability into national statistical systems

2/26/20152- 95 -

The WG is Country driven
•
•
•

•

•

Countries have ownership
The Secretariat for the WG is located at the
National Center for Health Statistics
A rotating Steering Committee oversees the work
plan of the WG and preparations for the annual
meetings
Workgroups lead the development of specific tasks:
currently child disability, the environment andparticipation, and analysis & dissemination
Emphasis on evidence and transparency – extensive
testing of questions in multiple countries

2/26/20153

Membership of the WG•••

Current representatives from national statisticalauthorities include 118 countries and territories
Past and present representatives ofinternational and national organizations
representing persons with disabilities, andseveral national government and nongovernment organizations
Other international organizations including
among others: EUROSTAT, ILO, OECD, World
Bank, WHO, UNICEF, UNESCAP, etc.

2/26/20154- 96 -

WG Milestones:
1. Agreement to develop short and long sets ofinternationally comparable disability measures using the
ICF as a framework; census questions a priority
2. Equalization of opportunities selected as purpose of shortmeasure3. Developed a comparable testing methodology
4. Tested and revised questions
5. Short set adopted 2006
6. Extended set on functioning adopted 2010
7. Module on Child Functioning and Disability developedwith UNICEF – testing underway
8. Extended set on the environment for children and adults
currently under development.
2/26/2015

5

Summary of annual meetings
1. Washington, DC
2. Ottawa, Canada
3. Brussels, Belgium
4. Bangkok, Thailand
5. Rio de Janeiro, Brazil
6. Kampala, Uganda
7. Dublin, Ireland
8. Manila, Philippines
9. Dar es Salaam, Tanzania
10. Luxembourg
11. Southampton, Bermuda
12. Bangkok, Thailand
13. Amman, Jordan
14. Buenos Aires

February
January
February
September
September
October
September
October
OctoberNovemberNovember
October
October
October

2/26/2015

2002
2003
2004
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
6

- 97 -

Disability Statistics to Monitor
Development Goals and the UN
Convention on the Rights of Persons
with Disabilities…

2/26/20157

Need for National Data to Support
Monitoring
National Data on population with disabilities isnecessary to both implement and monitor
post-2015 SDGs and the UN CRPD.
The International Classification of Functioning,
Disability and Health (ICF) provides acommonly accepted model to support national
data collection.
The Washington Group work seeks to provide
internationally comparable data based on the
ICF Model to fulfill the monitoring function.
2/26/20158- 98 -

Locating Risk in the ICF Model
Health Condition(disorder/disease)?

Body Function &Structure (Impairment)

Personal
Factors

2/26/2015

Participation(Restriction)

Environmental
Factors

Source: World Health Organization, 2001

9

WG Short Set of Questions
Because of a Health problem:
1) Do you have difficulty seeing even if wearing glasses?
2) Do you have difficulty hearing even if using a hearing aid?
3) Do you have difficulty walking or climbing stairs?
4) Do you have difficulty remembering or concentrating?
5) Do you have difficulty with (self-care such as) washing allover or dressing?
6) Using your usual language, do you have difficultycommunicating (for example understanding or being
understood by others)?
Response categories:
No - no difficulty; Yes - some difficulty;
Yes - a lot of difficulty; Cannot do at all
2/26/201510- 99 -

Standardized Approach to Monitoring••

By standardizing these questions it will bepossible to provide comparable data crossnationally for populations living in a varietyof cultures with varying economic
resources;
Data can be used to assess a country’s
compliance with development goals theConvention and, over time, theirimprovement in meeting requirement

2/26/2015

11

The Road Ahead•

We will continue to work on question
development for sub-populations (children),
specific areas (mental health, environment &participation), and applications (registry data)•

We will discuss:
•
•
•
•
•

2/26/2015

Capacity building,Training & Technical assistance,
Analysis,
Implementation, andDissemination.
WG-14 Buenos Aires, Argentina- 100 -

12

For more information…
The WG reports to the UN Statistical Commission.
The WG annual report to the Commission isavailable at:
http://unstats.un.org/unsd/statcom/doc14/2014-10WashingtonGroup-E.pdf•

Executive summary of past meetings posted on
the WG website along with presentations &papers from the meetings:
http://www.cdc.gov/nchs/washington_group.htm•

2/26/201513- 101 -

Oct 14, 2014
International Workshop

Overview of healthy life
expectancy research in Japan
Toshiyuki OJIMA, MD, DrPH
Professor of
Department of Community Health and Preventive Medicine,
Hamamatsu University School of Medicine, JAPANContents• History of HLE research inJapan• Researches by the HLE researchgroup• International comparison between
Japan and EU- 102 -

History of Healthy Life Expectancy (HLE) researchin Japan and worldwide
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

1971 Sullivan DF published the method
1974 HLE in Japan (The Council of National Living)1982 HLE in Japan (Koizumi A ᑠἨ᫂)1989 REVES network was set up (Robine JM)
1991 Disease-free LE (Gunji T, Hayashi R 㒆ྖ⠜᫭䚸ᯘ⋹Ꮚ)
1993 DALY was published by World Bank (Murray CJ)
1995 Active LE using cohort data (Tsuji I ㎷୍㑻䠅1997 Health indicator research group (PI: Hashimoto S ᶫᮏಟ஧)1998 QOL and HLE research group (PI: Kondo T ㏆⸨೺ᩥ䠅1999 HLE by prefectures was calculated (Miyashita & Hashimoto ᐑୗග௧)1999 DALY in Japan was calculated (Fukuda Y ⚟⏣ྜྷ἞)
2000 Concept of HLE was described in the Health Japan 21
2007 HLE without care need (Hashimoto S)
2011 HLE without activity limitation (Hashimoto S)
2012 Health Japan 21 (the 2nd term ) adopt HLE as a main target

Calculation of HLE was the top news (1999)- 103 -

HLE in Health Japan 21 (the 2nd term) (2012)9.22 years

Contents• History of HLE research in Japan• Researches by the HLE
research group• International comparison between
Japan and EU- 104 -

Japanese website of the HLE research grouphttp://toukei.umin.jp/kenkoujyumyou/

English website of the research grouphttp://life.umin.jp- 105 -

Healthy Life Expectancies
calculated by the research group(1) Disability free life expectancy (without activity limitation)᪥ᖖ⏕ά䛻ไ㝈䛾䛺䛔ᮇ㛫䛾ᖹᆒ– Used for the Health Japan 21 (2nd edition)– Using self-administered questionnaire data

(2) Life expectancy with self-perceived health⮬ศ䛷೺ᗣ䛷䛒䜛䛸⮬ぬ䛧䛶䛔䜛ᮇ㛫䛾ᖹᆒ– Using self-administered questionnaire data

(3) Disability free life expectancy (without care need)᪥ᖖ⏕άືస䛜⮬❧䛧䛶䛔䜛ᮇ㛫䛾ᖹᆒ– 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

Comprehensive Surveyof Living Conditions

Technical Report

Questionaire- 106 -

Healthy Life Expectancy Calculation Guidelines(tentative translation)

Calculation of HLE• Prepare data
– Mortality rate by sex and age group– Proportion of unhealthy people by sex
and age group• Use Life Table (⏕࿨⾲) and Sullivan
method– EXCEL sheet for calculation can be
downloaded from the website– For local officers to calculate themselves- 107 -

Provided EXCEL file:
to input mortality and health status data

Life expectancy and healthy life expectancy
are calculated automatically- 108 -

Contents• History of HLE research in Japan• Researches by the HLE researchgroup• International comparison
between Japan and EU

Background• Joint Action European Health and Life
Expectancies Information System (JA
EHLEIS) annually calculates healthy life
expectancies (HLE) of EU member states.

Objectives• To calculate HLE in Japan for the same
indicators as EU• And to compare with EU- 109 -

Methods of conversion• Supplemental mail survey• Subjects: 2,700 randomly selected residents of 20+ years
old in 6 municipalities in Shizuoka prefecture, Japan• Questionnaire:– Activity limitation, the same as the Japanese national survey– Activity limitation by Global Activity Limitation Indicator (GALI)– Chronic morbidity, the same as EU– Self-perceived health, the same as the Japanese national survey• Response: 1,774 (66.0%)• Conversion tables were 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
Survey of Living
Age
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.

- 110 -

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

ബƷ෇ѣСᨂƴǑǔͤࡍ‫ݤ‬ԡƻƲƍ
GlobalActivityLimitationIndicator(GALI)atage65෇ѣСᨂ

‫ڡ‬
Women

ଐஜ

෇ѣСᨂ໯Ơ

ǍǍСᨂஊǓ

13.4

6.3

Japan

ȕȩȳǹ

FranceǹǦǧȸȇȳ

Sweden
EU27

7.5

9.2

6.5
3.5

14.6

Ȩȸȭȃȑᚘ

ஊǓ
4.2

7.2

8.8

3.0
5.0

ଐஜ

ဏ
Men

Japan

4.8

11.4

ȕȩȳǹ

FranceǹǦǧȸȇȳ

8.8

Sweden
EU27

5.4
5.6

8.6
0

4.6
2.6

13.6

Ȩȸȭȃȑᚘ

2.7

5

10

2.0

3.4
15

20

Expected years
Withoutactivitylimitation

Withmoderateactivitylimitation

WithsevereactivitylimitationബƷɼᚇႎƳͤࡍƴǑǔͤࡍ‫ݤ‬ԡ
‫ڡ‬

ଐஜ

ͤࡍᑣƍ

୍ᡫ

ȕȩȳǹ
ǹǦǧȸȇȳ
ȨȸȭȃȑᚘଐஜဏȕȩȳǹǹǦǧȸȇȳ
Ȩȸȭȃȑᚘ

- 111 -

ͤࡍफƍ25

Conclusions• Healthy Life Expectancies (HLE) in
Japan were calculated using thesame indicators as EU.
• International comparison of HLE
provides useful information to assess
health status of each country.

- 112 -

Thank you for your kindattention!

- 113 -

- 114 -- 115 -