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 were published by Leon et al (2003) in 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 Slovenia, and a better LE than Bulgaria, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania and Slovakia.

For female LE at birth, there is a broadly similar picture, with Scotland, in recent years, ranking worse than 18 of the 27 member states of the EU: Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Greece, the Republic of Ireland, Italy, Luxembourg, Malta, 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.

Male and female LE at birth in 2005 is also included in I2SARE Regional Health Profiles. For these indicators, Scotland ranked lowest of the 12 UK 'regions' for both males and females; and 134/189 EU regions for males and 162/189 EU regions for females.

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.

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".

A more recent comparison of HLY (DFLE) at birth was undertaken by ScotPHO using data for 2008-10 for European Union countries from the Eurostat Statistics Database; Joint Action European Health and Life Expectancy Information System (JA EHLEIS), and data for the UK and its constituent countries from the Office for National Statistics (ONS).

Caution is needed when comparing the data for HLY as the figures for the United Kingdom differ between the Eurostat and ONS sources, due to the use of different surveys: Eurostat data are based on the European Union Statistics on Income and Living Conditions (EU-SILC) Survey; ONS data are based on the General Lifestyle Survey (GLS), formerly known as the General Household Survey (GHS).

Chart 1 and the accompanying Table 1 (84KB) show that for males in 2008-10, the UK as a whole ranked lower for HLY than 3 of the 27 member states of the EU: Greece, Malta, and Sweden, and also lower than Iceland, Norway and Switzerland. Scotland had a significantly lower HLY at birth than the UK (and England). Although it is difficult to compare Scotland directly with the EU countries, it would appear that Scotland would be in the lower half of the ranking for HLY in males.

Chart 2 and the accompanying Table 2 (84KB) show that for females in 2008-10, the UK as a whole ranked lower for HLY than 4 of the 27 member states of the EU: Bulgaria, Greece, Malta and Sweden, and also lower than Iceland and Norway. Scotland had one of the highest HLY estimates within the UK, and although comparisons with the EU countries are again hampered by the use of different surveys, it would appear that Scotland would be in the upper third of the ranking for HLY in females.

Again, some caution is needed in drawing conclusions, as the data are based on just one 3-year period, there are no confidence intervals for the EU data, and there are differences arising from the use of different surveys in the two sets of UK data. It would appear, however, that for HLY, in comparison with many European countries, Scotland fares badly for males but compares better for females.