April 18, 2013

Contents

JA-EHLEIS

Healthy Life Expectancies
in JapanToshiyuki OJIMA, MD, DrPH
Professor ofDepartment 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 lifeexpectancy 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 ofLiving 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

MenWomenLE

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:
LEHLE

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

Women73.6

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

6080

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 ofLiving 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)Men0510152025

Expected years

Contents• Governmental actions about healthy
life expectancies in Japan• Selected results of the ResearchGroup about Healthy Life Expectancyin 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)WithWithsevere 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 quantileof 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 ofDepartment 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 “interpersonalinteractions 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!