Extension of healthy life expectancy and reduction of health disparities
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” an individual spends 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 by1

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 advance 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
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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 the 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” should also be taken into
account.
“Average period of time spent without limitation in daily activities” was calculated using the
Sullivan method, with basic data taken from the Comprehensive Survey of Living Conditions andLife Table (see below 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 those 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 the Population Projection of Japan (January 2012 estimates) by the National
Institute of Population and Social Security Research, life expectancy in the years from 2013 to2022 is predicted to rise from 80.09 years to 81.15 years in men, an increase of 1.06 years, andfrom 86.80 years to 87.87 years in women, an increase of 1.07 years (Figure 3).

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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

2010

2001

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 of4

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 extension in the period of time individuals consider
themselves as healthy together with extension in the period of time spent without limitation indaily 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.
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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

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

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”)
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<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 the Comprehensive Survey of Living Conditions and Life Table as basic data. Thus, a
response of “No” to the question, “Do health problems currently have some effect on your daily
activities?” in the Comprehensive Survey of Living Conditions is taken to indicate limitation-freedaily activities, and the percentages of people without limitation in daily activities were obtainedfor each sex and age group. The stationary population and number of survivors were obtained
from Life Table. The percentage of people without limitation in daily activities was thenmultiplied by the stationary population for each sex and age group to obtain the stationary
population without limitation in daily 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.

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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 the 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 that consider themselves
as healthy by sex and age group from the survey, the municipal population, and the number ofdeaths as basic data. In municipalities with small populations, the addition of a certain handling
method needs 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 their 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”)

8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/)9

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, publicly available 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

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