Healthy life expectancy: international comparisons

Life expectancy (LE)

Historical trends from 1910 to 1995 in male and female LE at birth in Scotland and other Western European countries are published in the 2003 report Understanding the health of Scotland's population in an international context  (1.71MB). Figure 3.4 in the report shows that Scotland’s position has slipped relative to the other countries over time. In 1930, for example, out of 17 European countries Scottish males were ranked 9th worst, while females were ranked 11th worst. However, with most other countries having a steeper rate of improvement in LE at birth from 1950, Scotland’s relative position deteriorated, and by 1995 males were ranked the 2nd worst (behind Portugal), and females the worst.

More recent LE data are included in the Scotland and European Health for All (HfA) Database. This presents data for life expectancy at birth and at ages 1, 15, 45 and 65 years, and allows quick comparisons between Scotland and any/all of the 53 member states in the WHO European Region, including the UK. Time trends are given, with the Scottish data starting in 1981 for LE for males and for females, but only 2004 for persons. The graphs and tables from the database show that despite the general pattern of an increase in LE over time in Scotland and many other Western European countries, Scotland’s LE is one of the lowest.

Using the database to compare male LE at birth with the 27 member states of the European Union (EU), in recent years Scotland has ranked worse than 16 countries: Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Greece, the Republic of Ireland, Italy, Luxembourg, Malta, the Netherlands, Spain, Sweden and the United Kingdom. Scotland has had a broadly similar male LE to Portugal, and a better LE than Bulgaria, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia and Slovenia.

For female LE at birth, there is a broadly similar picture, with Scotland ranking worse than 18 of the 27 member states of the European Union: Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Greece, the Republic of Ireland, Italy, Luxembourg, Malta (in recent years), the Netherlands, Portugal, Slovenia, Spain, Sweden and the United Kingdom. Scotland’s female LE has been similar to the Czech Republic and Poland in recent years, and better than Bulgaria, Estonia, Hungary, Latvia, Lithuania, Romania and Slovakia.

Health expectancy

There do not appear to be suitable data to draw comparisons of healthy life expectancy (HLE) between Scotland and countries other than the UK, and therefore other measures of health expectancy must be considered. For example, Jagger et al (2008) investigated inequalities in LE and healthy life years (years free of activity limitation) at 50 years of age for the 25 countries in the EU in 2005, including the UK as a whole, but not Scotland separately.

The Scotland and European Health for All (HfA) Database includes indicators for disability-adjusted life expectancy (DALE) based on estimates made by the WHO. These are available for the 27 member states of the EU, including the UK, but not Scotland separately.

For a broader picture world-wide than just Europe, Mathers (1999) compared DALE at birth for persons in 191 countries. While again Scotland was not included, it is of interest that the UK ranked 14th best of the 191 countries.

Macdonald et al (2006) compared Scotland to 14 EU (pre-accession) countries, including the UK, with respect to disability-free life expectancy (DFLE) at birth, in various years between 1995 and 2000. They concluded that because different definitions of health were used in different countries, a great deal of caution was required, but the Scottish estimates fell “very near the bottom of the European league for men, and in the bottom half for women”.