Population Health

Research Area

Health Expectancies and Disability Dynamics

Keywords: Ageing, Mortality and Longevity; Health Care, Public Health, Medicine, and Epidemiology; Culture

Length of life has been increasing almost linearly in many countries; thus the question of whether the extra years of life are spent in good or in poor health has become a key policy concern. As supplements to estimates of total life expectancy, healthy life-expectancy and unhealthy life-expectancy measures provide insights into the aggregate burdens of disease, disability, and impaired cognitive functioning in demographically aging populations. We seek to document the levels and forecast trends in healthy and unhealthy life expectancy, to analyze whether the improvements in health and survival are equally distributed across sociodemographic groups, and to understand what the driving factors are behind the trends and differentials in healthy and unhealthy life expectancies within and across populations. We also develop methodological approaches that allow analyzing the disability dynamics, not just the aggregate time spent in healthy and unhealthy states.

To understand the factors driving the patterns in health and disability, we analyze the independent and interacting impacts of behavioral determinants, structural conditions, and sociodemographic factors. The developed world is witnessing a major shift in the distribution of risky health behaviors, as cigarette smoking, previously the dominant damaging health behavior, is being replaced by obesity and potentially also by other risky behaviors. We focus on understanding the implications of this population-level replacement of health behaviors on health expectancies and disability dynamics. To get a full picture of health, we use multidimensional health measures, based on information on physical and cognitive functioning, diagnosed conditions, medication use, and other factors.

Our analyses cover a large number of developed and less developed countries, and a wide range of institutional contexts, birth cohorts and time periods. This allows us to learn how changes in population health interact not just with individual characteristics but also with the policy environment and broader socioepidemiological environment. We employ regression techniques and decomposition methods to analyze differentials in disability dynamics across contexts, covering environments exposing individuals to specific conditions and contexts – defined by living conditions, economic development, and access to health care – that strongly affect health throughout the life course.

The anticipated outcomes in this research area have strong policy relevance as we document the current and project the future disability burden as well as the individual and contextual factors that are the key determinants of health and disability. Uncovering the relevant factors of both healthy and unhealthy life courses can help to improve the quality of life of older individuals, to reduce health inequalities in populations, and to finally reduce the costs for social welfare regimes.

Projects of this Research Area: