MONITORING THE HEALTH GOAL INDICATORS OF OVERALL PROGRESS Thus far, the SDg indicator and monitoring framework contribute to it. Despite large gaps in the coverage of global developed by the United Nations Statistical Commission has mortality data systems, mortality is more amenable to focused on finding indicators for the 169 targets. Monitoring accurate measurement than disease or disability of the 17 goals themselves and cross-cutting themes has not yet been discussed, but will certainly be required to Globally, life expectancy has been improving at a rate help produce easily legible summaries of situations and of more than 3 years per decade since 1950, with the trends at national, regional and global levels. Framed in very exception of the 1990s. During that period, progress on general terms, the overall health SDG is: "Ensure healthy life expectancy stalled in Africa because of the rising HIV lives and promote well-being for all at all ages"WHO has epidemic; and in Europe because of increased mortality considered several overarching indicators that might serve in many ex-Soviet countries following the collapse of the to monitor this goal, including: "life expectancy","healthy Soviet Union. Life expectancy increases accelerated in most life expectancy" and"number of deaths before age 70".As regions from 2000 onwards, and overall there was a globa such indicators are not only affected by progress towards increase of 5.0 years in life expectancy between 2000 and the targets under the health Sdg but also by advances 2015, with an even larger increase of 9. 4 years observed in made towards the health-related targets in other goals, the WHO African Region(Fig. 3.1) hey truly reflect the multisectoral nature of health. This section presents the current situation with regard to these the global average increase in life expectancy at birth since indicators, including data gaps 2000 exceeds the overall average rate of life expectancy increase achieved by the best-performing countries over the past century The world as a whole is catching up with 3. 1 Life expectancy-major gains but still those countries and improvements in outcomes for all major large differences causes of deaths have contributed to these huge gains Life expectancy is a summary measure of mortality rates at all ages, and all health and health-related programmes 2 World Population wDs in the WHo anual life tables for 1985-2015based Mortality Database and on Hi mortality 3 Deppen J, Vaupel JW. Demography. Broken limits to life expectancy. Science MONITORING HEALTH FOR THE SDGs
MONITORING HEALTH FOR THE SDGs 7 3 Thus far, the SDG indicator and monitoring framework developed by the United Nations Statistical Commission has focused on finding indicators for the 169 targets. Monitoring of the 17 goals themselves and cross-cutting themes has not yet been discussed, but will certainly be required to help produce easily legible summaries of situations and trends at national, regional and global levels. Framed in very general terms, the overall health SDG is: “Ensure healthy lives and promote well-being for all at all ages”. WHO has considered several overarching indicators that might serve to monitor this goal, including: “life expectancy”; “healthy life expectancy”; and “number of deaths before age 70”.1 As such indicators are not only affected by progress towards the targets under the health SDG but also by advances made towards the health-related targets in other goals, they truly reflect the multisectoral nature of health. This section presents the current situation with regard to these indicators, including data gaps. 3.1 Life expectancy – major gains but still large differences Life expectancy is a summary measure of mortality rates at all ages, and all health and health-related programmes 1 For reports of WHO technical meetings, see: http://www.who.int/healthinfo/sage/ meeting_reports/en/ (accessed 9 April 2016). contribute to it. Despite large gaps in the coverage of global mortality data systems, mortality is more amenable to accurate measurement than disease or disability. Globally, life expectancy has been improving at a rate of more than 3 years per decade since 1950, with the exception of the 1990s.2 During that period, progress on life expectancy stalled in Africa because of the rising HIV epidemic; and in Europe because of increased mortality in many ex-Soviet countries following the collapse of the Soviet Union. Life expectancy increases accelerated in most regions from 2000 onwards, and overall there was a global increase of 5.0 years in life expectancy between 2000 and 2015, with an even larger increase of 9.4 years observed in the WHO African Region (Fig. 3.1). The global average increase in life expectancy at birth since 2000 exceeds the overall average rate of life expectancy increase achieved by the best-performing countries over the past century.3 The world as a whole is catching up with those countries and improvements in outcomes for all major causes of deaths have contributed to these huge gains. 2 World Population Prospects, the 2015 revision (WPP2015). New York (NY): United Nations DESA, Population Division; and WHO annual life tables for 1985–2015 based on the WPP2015, on the data held in the WHO Mortality Database and on HIV mortality estimates prepared by UNAIDS. 3 Oeppen J, Vaupel JW. Demography. Broken limits to life expectancy. Science 2002;296(5570):1029–31. MONITORING THE HEALTH GOAL – INDICATORS OF OVERALL PROGRESS
The gap between African life expectancy and European life Regional and global gains in life expectancy per decade, 1970-2015 expectancy has narrowed by 4.9 years since the year 2000 ■1970-1990■1990-2000■20002015MDG)■2015-2030D6 Life expectancy at age 60 has also been increasing globally from 18.7 years in 2000 to 20.4 years in 2015. Regional increases ranged from 0.7 years in the WHO Eastern Mediterranean Region to 2.5 years in the WHO European Region Several cause-specific mortality targets are proposed for the post-2015 agenda, with many focusing on reducing or ending"preventable"deaths According to provisional estimates, achievement of the major Sdg child, maternal EMR WPR Global 1 For instance, SDG Target 3. 1(maternal mortality), Target 3. 2 (neonatal and child mortality), Target 3.4 NCD mortality(due to four leading causes of death) and Target 3.6(road traffic injuries). tancy at birth and healthy life expectancy at birth (years), both sexes, 2015 AFR Iran Islamic鼠eph Honduras ed Repul of Tanzania icent and the Gre Poland Zimbabwe WPR 60 目n s9 sLs M 52 SEAR su2 Thailand Camerons. Bangladesh amnesia(Federated states of Republ af Modena Democratic Peegle's Republik of Kore Uzbekistan a Values shown refer to life expectancy at birth. Light blue bars represent provisional estimates of healthy life expectancy at birth. Dark blue bars represent lost health expectancy, defined as the difference between life expectancy WORLD HEALTH STATISTS: 2016
8 WORLD HEALTH STATISTICS: 2016 The gap between African life expectancy and European life expectancy has narrowed by 4.9 years since the year 2000. Life expectancy at age 60 has also been increasing globally – from 18.7 years in 2000 to 20.4 years in 2015. Regional increases ranged from 0.7 years in the WHO Eastern Mediterranean Region to 2.5 years in the WHO European Region. Several cause-specific mortality targets are proposed for the post-2015 agenda, with many focusing on reducing or ending “preventable” deaths.1 According to provisional estimates, achievement of the major SDG child, maternal, 1 For instance, SDG Target 3.1 (maternal mortality), Target 3.2 (neonatal and child mortality), Target 3.4 NCD mortality (due to four leading causes of death) and Target 3.6 (road traffic injuries). Figure 3.2 Life expectancy at birth and healthy life expectancy at birth (years),a both sexes, 2015 Algeria Mauritius Cabo Verde Seychelles Sao Tome and Principe Senegal Rwanda Gabon Namibia Botswana Madagascar Ethiopia Eritrea Congo Comoros Kenya Mauritania South Africa Ghana Uganda United Republic of Tanzania Zambia Niger Liberia Gambia Zimbabwe Benin Burkina Faso Togo Democratic Republic of the Congo Burundi Guinea Swaziland Guinea-Bissau Malawi Mali Equatorial Guinea Mozambique South Sudan Cameroon Nigeria Lesotho Côte d'Ivoire Chad Central African Republic Angola Sierra Leone 75.6 74.6 73.3 73.2 67.5 66.7 66.1 66.0 65.8 65.7 65.5 64.8 64.7 64.7 63.5 63.4 63.1 62.9 62.4 62.3 61.8 61.8 61.8 61.4 61.1 60.7 60.0 59.9 59.9 59.8 59.6 59.0 58.9 58.9 58.3 58.2 58.2 57.6 57.3 57.3 54.5 53.7 53.3 53.1 52.5 52.4 50.1 AFR Qatar United Arab Emirates Bahrain Oman Iran (Islamic Republic of) Tunisia Lebanon Kuwait Saudi Arabia Morocco Jordan Libya Egypt Iraq Pakistan Yemen Syrian Arab Republic Sudan Djibouti Afghanistan Somalia 78.2 77.1 76.9 76.6 75.5 75.3 74.9 74.7 74.5 74.3 74.1 72.7 70.9 68.9 66.4 65.7 64.5 64.1 63.5 60.5 55.0 EMR Japan Singapore Australia Republic of Korea New Zealand Brunei Darussalam China Viet Nam Malaysia Samoa Tonga Vanuatu Fiji Micronesia (Federated States of) Solomon Islands Mongolia Cambodia Philippines Kiribati Lao People's Democratic Republic Papua New Guinea 83.7 83.1 82.8 82.3 81.6 77.7 76.1 76.0 75.0 74.0 73.5 72.0 69.9 69.4 69.2 68.8 68.7 68.5 66.3 65.7 62.9 WPR Canada Chile Costa Rica United States of America Cuba Panama Uruguay Mexico Antigua and Barbuda Argentina Jamaica Ecuador Bahamas Peru Barbados Saint Lucia Brazil Nicaragua Colombia Honduras Venezuela (Bolivarian Republic of) Paraguay Dominican Republic Grenada El Salvador Saint Vincent and the Grenadines Guatemala Suriname Trinidad and Tobago Bolivia (Plurinational State of) Belize Guyana Haiti 82.2 80.5 79.6 79.3 79.1 77.8 77.0 76.7 76.4 76.3 76.2 76.2 76.1 75.5 75.5 75.2 75.0 74.8 74.8 74.6 74.1 74.0 73.9 73.6 73.5 73.2 71.9 71.6 71.2 70.7 70.1 66.2 63.5 AMR Maldives Sri Lanka Thailand Bangladesh Democratic People's Republic of .. Bhutan Nepal Indonesia Timor-Leste India Myanmar 78.5 74.9 74.9 71.8 70.6 69.8 69.2 69.1 68.3 68.3 66.6 SEAR Switzerland Spain Italy Iceland Israel France Sweden Luxembourg Netherlands Norway Malta Austria Ireland United Kingdom Portugal Finland Belgium Germany Greece Slovenia Denmark Cyprus Czech Republic Croatia Albania Estonia Poland Bosnia and Herzegovina Slovakia Montenegro Hungary Turkey The former Yugoslav Republic of .. Serbia Romania Armenia Latvia Bulgaria Georgia Lithuania Azerbaijan Belarus Republic of Moldova Ukraine Kyrgyzstan Russian Federation Kazakhstan Tajikistan Uzbekistan Turkmenistan 83.4 82.8 82.7 82.7 82.5 82.4 82.4 82.0 81.9 81.8 81.7 81.5 81.4 81.2 81.1 81.1 81.1 81.0 81.0 80.8 80.6 80.5 78.8 78.0 77.8 77.6 77.5 77.4 76.7 76.1 75.9 75.8 75.7 75.6 75.0 74.8 74.6 74.5 74.4 73.6 72.7 72.3 72.1 71.3 71.1 70.5 70.2 69.7 69.4 66.3 EUR Figure 3.2 Democratic People’s Republic of Korea The Former Yugoslav Republic of Macedonia a Values shown refer to life expectancy at birth. Light blue bars represent provisional estimates of healthy life expectancy at birth. Dark blue bars represent lost health expectancy, defined as the difference between life expectancy and healthy life expectancy. 3 2 1 4 Figure 3.1 Regional and global gains in average life expectancy per decade, 1970–2015 5 Gain per decade (years) 6 AFR 7 1970–1990 1990–2000 2000–2015 (MDG) 2015–2030 (SDG) AMR SEAR EUR EMR WPR Global 0
infectious diseases and NCd targets would result in an Japan, Singapore, Australia, and the republic of Korea in increase in global average life expectancy of around 4 years the who Western Pacific Region; and Canada in the WHo by 2030. The gap between high-and low-income countries Region of the Americas. At the lower end of the range there would narrow from around 17.5 years in 2015 to around 13 are still 22 countries with life expectancies below 60 years to 14 years in 2030. all of them in sub-Saharan africa Global life expectancy in 2015 was 71.4 years. Life expectancy On average, women live longer than men in every country estimates by country for 2015(both sexes combined) are of the world and in every WHo region(Fig. 3.3). Overall shown in Fig. 3.2. Twenty-nine countries have an average life female life expectancy is 73.8 years and male life expectancy expectancy of 80 years or higher. Life expectancy exceeds is 69.1 years. Globally, female life expectancy at birth passed 82 years in 12 countries: Switzerland, Spain, Italy, Iceland, male life expectancy at birth in the 1970s and the difference Israel, France and Sweden in the WHO European Region; reached 4.6 in 2015. Among high-income OECD countries, the male-female gap peaked at 6.9 years in the health indicator for the post-2015 development agenda. Brief summary 1990s and has been declining since to reach 5.2 years in 014.geneVa:WorldHealthOrganization2014(http:/www.who.2015.Countrieswiththehighestandlowestlifeexpectancy /healthinfo/indicators/hsi indicators SDG- TechnicalMeeting_ December2015 BackgroundPaper pdf?ua=l, accessed 9 April 2016). Figure 3.3 ife expectancy by sex, by WHo region, 2015 SEAR Female 75 e88 e89ee88 6 Each cirde represents a country value; numbers and horizontal lines indicate the median value (middle point]for each subgroup, light grey bands indicate the interquartile range(middle 50%)for each subgroup. MONITORING HEALTH FOR THE SDGs
MONITORING HEALTH FOR THE SDGs 9 infectious diseases and NCD targets would result in an increase in global average life expectancy of around 4 years by 2030. The gap between high- and low-income countries would narrow from around 17.5 years in 2015 to around 13 to 14 years in 2030.1 Global life expectancy in 2015 was 71.4 years. Life expectancy estimates by country for 2015 (both sexes combined) are shown in Fig. 3.2. Twenty-nine countries have an average life expectancy of 80 years or higher. Life expectancy exceeds 82 years in 12 countries: Switzerland, Spain, Italy, Iceland, Israel, France and Sweden in the WHO European Region; 1 An overarching health indicator for the post-2015 development agenda. Brief summary of some proposed candidate indicators. Background paper for expert consultation, 11–12 December 2014. Geneva: World Health Organization; 2014 (http://www.who. int/healthinfo/indicators/hsi_indicators_SDG_TechnicalMeeting_December2015_ BackgroundPaper.pdf?ua=1, accessed 9 April 2016). Figure 3.3 Life expectancy by sex, by WHO region, 2015a AFR Female Male AMR Female Male SEAR Female Male EUR Female Male EMR Female Male WPR Female Male 50 55 60 65 70 75 80 85 Years 63 59 78 72 71 68 81 75 75 72 76 71 a Each circle represents a country value; numbers and horizontal lines indicate the median value (middle point) for each subgroup; light grey bands indicate the interquartile range (middle 50%) for each subgroup. Japan, Singapore, Australia, and the Republic of Korea in the WHO Western Pacific Region; and Canada in the WHO Region of the Americas. At the lower end of the range there are still 22 countries with life expectancies below 60 years – all of them in sub-Saharan Africa. On average, women live longer than men in every country of the world and in every WHO region (Fig. 3.3). Overall, female life expectancy is 73.8 years and male life expectancy is 69.1 years. Globally, female life expectancy at birth passed male life expectancy at birth in the 1970s and the difference reached 4.6 years in 2015. Among high-income OECD countries, the male-female gap peaked at 6.9 years in the 1990s and has been declining since to reach 5.2 years in 2015. Countries with the highest and lowest life expectancy
by sex are shown in Table 3. 1. In developed countries, Estimates have now been updated for the year 2015 Scandinavian countries have among the lowest male-female using the who life tables for year 2015 and updated YLD life expectancy gaps(iceland 3.0 years; Sweden 3. 4 years) estimates drawing on WHO statistical inputs and the global ith some former Soviet countries having among the burden of disease 2013 analyses using the same methods highest(Russian Federation 11.6 years: Ukraine 9.8 years). as previously applied. 4 5 Globally, hle in 2015 is estimated at 63.1 years for both sexes combined. In general, HLE Table 3.1 varies between countries in line with life expectancy(see Countries with the highest and lowest life expectancy at birth (in years), by sex, 2015 ig. 3. 2)but is on average 11.7% shorter than life expectancy Male Female (ranging from 9.3% to 14.7% between countries) Country Regional and global average life expectancies and hle at 86.8 birth for 2015 are shown in Fig. 3.4. The total height of the Iceland 81.2 Singapore bar represents life expectancy at birth and the bottom part as5 of the bar represents HLE at birth. The gap between life 80.7 Republic of Korea 806Fa as,4 expectancy and HLE are the equivalent healthy years lost Switzerland 853 through morbidity and disability. The contributions of each Australia of the causes of this loss of healthy years are also Canada 802a 84.8 shown. The main contributors are musculoskeletal disorders 84.3 (with back and neck pain being a major contributor),mental and substance-use disorders(particularly depression and anxiety disorders), neurological disorders, vision and 51.7 51.cOte d'Ivoire 54 hearing loss, and cardiovascular diseases and diabetes African Republic entral African Republic The prevalence of most of these conditions rises with age Angola and, for most conditions, the age-standardized rates are not Sierra Leone 49.3 Sierra leone declining. As life expectancy increases, the proportion of the ife span spent with these conditions increases -HlE thus increases more slowly than life expectancy. 3.2 Healthy life expectancy -gaining healthy life years Healthy life expectancy(HLE) provides an indication of overall health for a population, representing the average Injuries Other NCD Musculoskeletal disorders a vision and hearing loss ological disorders Mental disorders equivalent number of years of full health that a newborn a Group 1(MDG) causes Healthy life expectancy uld expect to live if they were to pass through life subject to the age-specific death rates and average age-specific 80 levels of health states for a given period.' If it could be measured reliably, hle would be an ideal 270 indicator that captures both mortality and years of life lived in less than good health-that is, in the case of a g disability "years lost due to disability"(YLD). There is 260 increasing interest in the accurate measurement of health, 2 disability and well-being, particularly given the context of i ageing populations and the growing prominence of chronic 2 50 diseases as causes of disability and premature mortality. 45 WHO has reported on HLE for Member States in recent 40 years based on Global Burden of Disease analyses. 2,3 SEAR EUR EMR WPR a Lost health expectancy is calculated as life expectancy minus heal indicates global health life expectancy. 1 An overarching health indicator for the post-2015 development agenda. I mary nealthinfo/indicators/hsi indicators so icalMeeting_ December2015 ackground Paperpdt?ua=1, accessed 9 April 2016) 4 WHo methods and data source estimates 2000-2011 vailableathttp://www.who.int/gho/publications/worldhealthstatistics/en/, tics cessed 9 April 2016). GlobalDALYmethods_ 2000-2011.pdfua=l, acces Study 2013 Col http://www.who.int/healthinfa/statistics/t_method-pdf?ua=1&ua=1,accessed9April diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the lobal Burden of Disease Study 2013. Lancet. 2015, 386(9995 743-800. WORLD HEALTH STATISTS: 2016
10 WORLD HEALTH STATISTICS: 2016 by sex are shown in Table 3.1. In developed countries, Scandinavian countries have among the lowest male-female life expectancy gaps (Iceland 3.0 years; Sweden 3.4 years) with some former Soviet countries having among the highest (Russian Federation 11.6 years; Ukraine 9.8 years). Male Female Country Years Country Years Highest Highest Switzerland 81.3 Japan 86.8 Iceland 81.2 Singapore 86.1 Australia 80.9 Spain 85.5 Sweden 80.7 Republic of Korea 85.5 Israel 80.6 France 85.4 Japan 80.5 Switzerland 85.3 Italy 80.5 Australia 84.8 Canada 80.2 Italy 84.8 Spain 80.1 Israel 84.3 Singapore 80.0 Iceland 84.1 Lowest Lowest Lesotho 51.7 Chad 54.5 Chad 51.7 Côte d’Ivoire 54.4 Central African Republic 50.9 Central African Republic 54.1 Angola 50.9 Angola 54.0 Sierra Leone 49.3 Sierra Leone 50.8 Table 3.1 Countries with the highest and lowest life expectancy at birth (in years), by sex, 2015 3.2 Healthy life expectancy – gaining healthy life years Healthy life expectancy (HLE) provides an indication of overall health for a population, representing the average equivalent number of years of full health that a newborn could expect to live if they were to pass through life subject to the age-specific death rates and average age-specific levels of health states for a given period.1 If it could be measured reliably, HLE would be an ideal indicator that captures both mortality and years of life lived in less than good health – that is, in the case of a disability, “years lost due to disability” (YLD). There is increasing interest in the accurate measurement of health, disability and well-being, particularly given the context of ageing populations and the growing prominence of chronic diseases as causes of disability and premature mortality. WHO has reported on HLE for Member States in recent years based on Global Burden of Disease analyses.2,3 1 An overarching health indicator for the post-2015 development agenda. Brief summary of some proposed candidate indicators. Background paper for expert consultation, 11–12 December 2014. Geneva: World Health Organization; 2014 (http://www.who. int/healthinfo/indicators/hsi_indicators_SDG_TechnicalMeeting_December2015_ BackgroundPaper.pdf?ua=1, accessed 9 April 2016). 2 World Health Statistics [2005–2015]. Geneva: World Health Organization (series available at: http://www.who.int/gho/publications/world_health_statistics/en/, accessed 9 April 2016). 3 WHO methods for life expectancy and healthy life expectancy. Global Health Estimates Technical Paper WHO/HIS/HSI/GHE/2014.5. Geneva: World Health Organization; 2014 (http://www.who.int/healthinfo/statistics/LT_method.pdf?ua=1&ua=1, accessed 9 April 2016). Estimates have now been updated for the year 2015 using the WHO life tables for year 2015 and updated YLD estimates drawing on WHO statistical inputs and the Global Burden of Disease 2013 analyses using the same methods as previously applied.4,5 Globally, HLE in 2015 is estimated at 63.1 years for both sexes combined. In general, HLE varies between countries in line with life expectancy (see Fig. 3.2) but is on average 11.7% shorter than life expectancy (ranging from 9.3% to 14.7% between countries). Regional and global average life expectancies and HLE at birth for 2015 are shown in Fig. 3.4. The total height of the bar represents life expectancy at birth and the bottom part of the bar represents HLE at birth. The gap between life expectancy and HLE are the equivalent healthy years lost through morbidity and disability. The contributions of each of the major causes of this loss of healthy years are also shown. The main contributors are musculoskeletal disorders (with back and neck pain being a major contributor), mental and substance-use disorders (particularly depression and anxiety disorders), neurological disorders, vision and hearing loss, and cardiovascular diseases and diabetes. The prevalence of most of these conditions rises with age, and, for most conditions, the age-standardized rates are not declining. As life expectancy increases, the proportion of the life span spent with these conditions increases – HLE thus increases more slowly than life expectancy. 4 WHO methods and data sources for global burden of disease estimates 2000–2011. Global Health Estimates Technical Paper WHO/HIS/HSI/GHE/2013.4. Geneva: World Health Organization; 2013 (http://www.who.int/healthinfo/statistics/ GlobalDALYmethods_2000_2011.pdf?ua=1, accessed 4 March 2016). 5 Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800. Figure 3.4 Regional and global life expectancy and healthy life expectancy at birth, with cause decomposition of lost health expectancy,a 2015 a Lost health expectancy is calculated as life expectancy minus healthy life expectancy. Horizontal dotted line indicates global health life expectancy. Injuries Other NCD Musculoskeletal disorders Vision and hearing loss CVD and diabetes Neurological disorders Mental disorders Group 1 (MDG) causes Healthy life expectancy 65 55 50 45 60 70 80 75 Life expectany or healthy life expectancy (years) AFR AMR SEAR EUR EMR WPR Global 40
Figure 3.5 Healthy life expectancy at birth, by sex and wHO regio' AFR AMR SEAR Female 70 67 65 886 86s 8自 只 55 543 Each cirde represents a country value; numbers and horizontal lines indicate the median value (middle point] for each subgroup light grey bands indicate the interquartile range(middle 50%)for each subgroup. Globally, male and female HLes are 61.5 and 64.6 years expectancy at birth in 2015, with considerable statistical respectively with substantial differences between male uncertainty associated with the estimates, especially at and female HLE in all WHO regions( Fig. 3.5). The largest country level difference is observed in the WHo European Region where omen can expect 5 more healthy life years than men. Other methods for measuring population health status, The smallest difference is found in the WHO South-East such as monitoring of the european Union target of gaining Asia Region, where women have only one extra year of 2 healthy life years by 2020, also present challenges healthy life in terms of the availability of data on population-level functional status that are comparable over time and In terms of SDG monitoring purposes, determining the across populations, and that are collected through regular usefulness of HLE estimates is complex. The YLD-based surveys L2 To date there is no generally accepted standard approach to calculating HLE relies on extensive modelling survey instrument and methodology that allows for the of disease and injury sequelae prevalence and distribution, comparable measurement of health-state distributions in and on aggregating these to population levels in order to populations. 4.5 alculate the healthy proportion of years lived at each age Because the approach relies heavily on statistical modelling and the use of predictive variables to produce estimates of disease incidence and prevalence, it is less suitable for detecting short-term changes and monitoring progress, especially at the country level. Additionally, the YLD-based eurohex mber 2015. Indudes the Joint Action: European Health component is dominated by causes such as musculoskeletal conditions, depression and neurological conditions for 3 Romieu l, Robine JM. World atlas of health expectancy calculations. In: Mathers CD, ne JM, editors. Advances in health expectancies. Canberra: Australian which country-specific data are sparse and infrequent. Such statute of Health and welfare: 1994. data are also often based on self-reporting, and there are significant comparability problems across countries. There are also substantial data gaps on severity distributions 5 An overarching health indicator for the post-2015 develop within populations. In addition, there was only limited int/healthinfo/indicators/hsi indicators SDG Technical Mee variation (<2 years) across the Who regions in lost health MONITORING HEALTH FOR THE SDGs
MONITORING HEALTH FOR THE SDGs 11 Globally, male and female HLEs are 61.5 and 64.6 years respectively with substantial differences between male and female HLE in all WHO regions (Fig. 3.5). The largest difference is observed in the WHO European Region where women can expect 5 more healthy life years than men. The smallest difference is found in the WHO South-East Asia Region, where women have only one extra year of healthy life. In terms of SDG monitoring purposes, determining the usefulness of HLE estimates is complex. The YLD-based approach to calculating HLE relies on extensive modelling of disease and injury sequelae prevalence and distribution, and on aggregating these to population levels in order to calculate the healthy proportion of years lived at each age. Because the approach relies heavily on statistical modelling and the use of predictive variables to produce estimates of disease incidence and prevalence, it is less suitable for detecting short-term changes and monitoring progress, especially at the country level. Additionally, the YLD-based component is dominated by causes such as musculoskeletal conditions, depression and neurological conditions for which country-specific data are sparse and infrequent. Such data are also often based on self-reporting, and there are significant comparability problems across countries. There are also substantial data gaps on severity distributions within populations. In addition, there was only limited variation (<2 years) across the WHO regions in lost health expectancy at birth in 2015, with considerable statistical uncertainty associated with the estimates, especially at country level. Other methods for measuring population health status, such as monitoring of the European Union target of gaining 2 healthy life years by 2020, also present challenges in terms of the availability of data on population-level functional status that are comparable over time and across populations, and that are collected through regular surveys.1,2 To date there is no generally accepted standard survey instrument and methodology that allows for the comparable measurement of health-state distributions in populations.3,4,5 1 Europe 2020 – for a healthier EU [website]. Brussels: European Commission (http:// ec.europa.eu/health/europe_2020_en.htm, accessed 16 September 2015). 2 Advanced research on European health expectancies [website]. EurOhex (http://www. eurohex.eu/, accessed 16 September 2015). Includes the Joint Action: European Health & Life Expectancy Information System (JA:EHLEIS). 3 Romieu I, Robine JM. World atlas of health expectancy calculations. In: Mathers CD, McCallum J, Robine JM, editors. Advances in health expectancies. Canberra: Australian Institute of Health and Welfare; 1994. 4 King G, Murray CJL, Salomon JA, Tandon A. Enhancing the validity and cross-cultural comparability of measurement in survey research. American Political Science Review. 2003;97(4):567–83. 5 An overarching health indicator for the post-2015 development agenda. Brief summary of some proposed candidate indicators. Background paper for expert consultation, 11–12 December 2014. Geneva: World Health Organization; 2014 (http://www.who. int/healthinfo/indicators/hsi_indicators_SDG_TechnicalMeeting_December2015_ BackgroundPaper.pdf?ua=1, accessed 9 April 2016). Figure 3.5 Healthy life expectancy at birth, by sex and WHO regiona AFR Female Male AMR Female Male SEAR Female Male EUR Female Male EMR Female Male WPR Female Male 45 50 55 60 65 70 75 Years 54 52 68 64 63 61 72 67 65 63 68 63 a Each circle represents a country value; numbers and horizontal lines indicate the median value (middle point) for each subgroup; light grey bands indicate the interquartile range (middle 50%) for each subgroup