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Background Analysis of demographic trends indicates that there is an increasing proportion of people who can be described as elderly. In Poland, the population aged >60 years is expected to increase to 10.8 million in 2030 and to 13.7 million in 2050, i.e., around 40% of total population. In line with the general trend, the issue of the aging of the professionally active population is becoming more relevant. Material and Methods The average age of the world’s working population is steadily increasing. In the European Union, workers aged 55–64 years accounted for 50% of the total workforce in 2013, and already 59% in 2018. In Poland, in 2018, people aged 55–64 years accounted for 49% of the employed population. The low percentage of people working at this age is due, among other things, to employers’ attitudes towards employing older people, perceiving them as employees who are more difficult to manage and have health problems. Moreover, working conditions of seniors are not adapted to their age capabilities. Results It is necessary to reduce the burden of physical work, especially in awkward positions, carrying loads, monotonous work and piecework. It is important to create work organization in which it is possible to refer to the experience of older people, who should have freedom of action, without time pressure and the need to perform many tasks at the same time. The ever-increasing social dependence on information technology tools creates new problems for seniors. Taking into account age-related difficulties in acquiring new knowledge, it is important to provide them with simplified tools that are easier to use. Conclusions The scope of necessary actions to enable the aging population to work is very wide, ranging from legislative, technological and organizational changes, ending with education addressed both to people responsible for employee safety (including occupational health services) and to current and potential employees. Med Pr Work Health Saf. 2024;75(3):293–302

The recently presented CroHaM hypothesis says (1) that longitudinal health domain-specific expansion and compression effects depend primarily on the health domains’ mortality risk and (2) that these effects exist equivalently in the cross-sectional context, affecting differences in healthy life years (HLY) between populations and subpopulations with different levels of life expectancy (LE). We test this hypothesis by analysing the association between LE and unhealthy life years (ULY) at age 50 for a large number of subpopulations. The analyses are carried out for three health domains which are differently related to mortality: poor self-perceived health and strong activity limitation with comparatively high mortality, and chronic morbidity with comparatively low risk of dying. Data on gender- and subpopulation-specific prevalence of these health conditions are taken from the Actual German Health Study 2012 (GEDA). LEs are estimated with the “Longitudinal Survival Method”, using data of the German Life Expectancy Survey. ULY are estimated with the “Sullivan Method”. Differences in ULY between each subpopulation and the total population and between women and men for each subpopulation are decomposed into the effects caused by differences in health (“health effect”) and mortality (“mortality effect”) with the “Nusselder/Looman Method”. The results confirm the CroHaM hypothesis: we find a positive relationship between LE and ULY only for chronic morbidity, whereas this relationship is negative for poor self-perceived health and strong activity limitation. However, when the mortality effect is controlled for, we find a negative relationship between LE and ULY for all three health domains. The practical relevance of these findings is discussed using the example of the so-called “gender paradox” in health and mortality. We conclude that the CroHaM hypothesis may describe an important determinant of life years spent with and without health impairment, and it may help to better understand and interpret trends and differentials in HLY or ULY based on cross-sectional data. * This article belongs to a special issue on “Levels and Trends of Health Expectancy: Understanding its Measurement and Estimation Sensitivity”.

The Healthy Life Years (HLY) indicator is the official European Union indicator and a cornerstone of many health policies used in over 15 countries in the EU region to set national health plans and monitor targets. It is also used to investigate trends over time in the proportion of total life years spent in good or poor health, socioeconomic inequalities in health and mortality and the male-female health survival paradox. Based on the Global Activity Limitation Indicator (GALI) included in the European Union Statistics on Income and Living Conditions (EU-SILC), a great amount of effort has been directed at harmonising and making HLY comparable across countries. Nonetheless, the characteristics of the age-specific prevalence distribution are still rarely accounted for, regardless of the fact that patterns of prevalence often fluctuate considerably by age. In addition, the impact of assumptions used at very young ages on HLY estimates are seldom discussed, despite the fact that the majority of policies and initiatives at the EU level use HLY at birth, while data on health is only available after age 16. In this paper, we assess whether smoothing the age-specific prevalence distributions by different methods, extrapolating to older ages and changing assumptions at younger ages affect HLY estimates. Overall, assumptions made before age 15 are the most important and affect women and men differently, thus affecting HLY at birth for some countries. Estimates at age 65 are very slightly impacted. Generalised linear models (GAMs) seem promising for harmonising and extrapolating to older ages, while using polynomials or aggregating into 5-year age groups seem best for younger ages. As most EU policies use HLY at birth and by sex for developing and monitoring health policies, caution is needed when estimating HLY at birth. * This article belongs to a special issue on “Levels and Trends of Health Expectancy: Understanding its Measurement and Estimation Sensitivity”.

Abstract Background Type 2 diabetes (T2D) causes substantial disease burden and is projected to affect an increasing number of people in coming decades. This study provides projected estimates of life years free of type 2 diabetes (T2D) and years of life lost ( $${\mathrm{YLL}}$$ YLL ) associated with T2D for Germany in the years 2015 and 2040. Methods Based on an illness-death model and the associated mathematical relation between prevalence, incidence and mortality, we projected the prevalence of diagnosed T2D using currently available data on the incidence rate of diagnosed T2D and mortality rates of people with and without diagnosed T2D. Projection of prevalence was achieved by integration of a partial differential equation, which governs the illness-death model. These projected parameters were used as input values to calculate life years free of T2D and $${\mathrm{YLL}}$$ YLL associated with T2D for the German population aged 40 to 100 years in the years 2015 and 2040, while accounting for different assumptions on future trends in T2D incidence and mortality. Results Assuming a constant incidence rate, women and men at age 40 years in 2015 will live approximately 38 years and 33 years free of T2D, respectively. Up to the year 2040, these numbers are projected to increase by 1.0 years and 1.3 years. Assuming a decrease in T2D-associated excess mortality of 2% per year, women and men aged 40 years with T2D in 2015 will be expected to lose 1.6 and 2.7 years of life, respectively, compared to a same aged person without T2D. In 2040, these numbers would reduce by approximately 0.9 years and 1.6 years. This translates to 10.8 million and 6.4 million $${\mathrm{YLL}}$$ YLL in the German population aged 40–100 years with prevalent T2D in 2015 and 2040, respectively. Conclusions Given expected trends in mortality and no increase in T2D incidence, the burden due to premature mortality associated with T2D will decrease on the individual as well as on the population level. In addition, the expected lifetime without T2D is likely to increase. However, these trends strongly depend on future improvements of excess mortality associated with T2D and future incidence of T2D, which should motivate increased efforts of primary and tertiary prevention.

In addition to life expectancy, the length of time a person can expect to remain free of health-related functional impairments is becoming increasingly important both for the individuals concerned and for society at large. The indicator healthy life years used for this purpose is a key figure for mapping mortality and morbidity. Diabetes is one of the most common chronic diseases and can be associated with health-related functional impairments. In 2014, women and men with diabetes could expect to have significantly fewer healthy life years than people without diabetes; this particularly applies to younger and middle-aged groups. Among 30- to 34-year-olds, for example, women and men with diabetes could expect eleven and twelve fewer healthy life years respectively than people without diabetes. These differences narrow with increasing age. Ensuring that people with and without diabetes have a similar length of lifetime free of health impairments is an important task for public health.

Abstract Background Healthy life years have superseded life expectancy (LE) as the most important indicator for population health. The most common approach to separate the total number of life years into those spent in good and poor health is the Sullivan method which incorporates the health dimension to the classic period life table, thus transforming the LE indicator into the health expectancy (HE) indicator. However, life years derived from a period life table and health prevalence derived from survey data are based on different conceptual frameworks. Method We modify the Sullivan method by combining the health prevalence data with the conceptually better fitting cross-sectional average length of life (CAL). We refer to this alternative HE indicator as the “cross-sectional average length of healthy life” (HCAL). We compare results from this alternative indicator with the conventional Sullivan approach for nine European countries. The analyses are based on EU-SILC data in three empirical applications, including the absolute and relative level of healthy life years, changes between 2008 and 2014, and the extent of the gender gap. Results HCAL and conventional HE differ in each of these empirical applications. In general, HCAL provides larger gains in healthy life years in recent years, but at the same time greater declines in the proportion of healthy life years. Regarding the gender gap, HCAL provides a more favourable picture for women compared to conventional HE. Nonetheless, the extent of these differences between the indicators is only of minor extent. Conclusions Albeit the differences between HE and HCAL are small, we found some empirical examples in which the two indicators led to different conclusions. It is important to note, however, that the measurement of health and the data quality are much more important for the healthy life years indicator than the choice of the variant of the Sullivan method. Nonetheless, we suggest to use HCAL in addition to HE whenever possible because it widens the spectrum of empirical analyses and serves for verification of results based on the highly sensitive HE indicator.

Abstract Background Prevention aiming at smoking, alcohol consumption, and BMI could potentially bring large gains in life expectancy (LE) and health expectancy measures such as Healthy Life Years (HLY) and Life Expectancy in Good Perceived Health (LEGPH) in the European Union. However, the potential gains might differ by region. Methods A Sullivan life table model was applied for 27 European countries to calculate the impact of alternative scenarios of lifestyle behavior on life and health expectancy. Results were then pooled over countries to present the potential gains in HLY and LEGPH for four European regions. Results Simulations show that up to 4 years of extra health expectancy can be gained by getting all countries to the healthiest levels of lifestyle observed in EU countries. This is more than the 2 years to be gained in life expectancy. Generally, Eastern Europe has the lowest LE, HLY, and LEGPH. Even though the largest gains in LEPGH and HLY can also be made in Eastern Europe, the gap in LE, HLY, and LEGPH can only in a small part be closed by changing smoking, alcohol consumption, and BMI. Conclusion Based on the current data, up to 4 years of good health could be gained by adopting lifestyle as seen in the best-performing countries. Only a part of the lagging health expectancy of Eastern Europe can potentially be solved by improvements in lifestyle involving smoking and BMI. Before it is definitely concluded that lifestyle policy for alcohol use is of relatively little importance compared to smoking or BMI, as our findings suggest, better data should be gathered in all European countries concerning alcohol use and the odds ratios of overconsumption of alcohol.

Abstract Background In 2005, the European Union (EU) started to use a disability-free life expectancy, known as Healthy Life Years (HLY), to monitor progress in the strategic European policies such as the 2000 Lisbon strategy. HLY are based on the underlying measure: the Global Activity Limitation Indicator (GALI). Twelve years after its implementation, this study aims to assess its current use in EU Member States and the European Commission. Methods In March 2017, a questionnaire was sent to 28 Member states and the European Commission. The questionnaire inquired how the GALI and HLY are used to set policy targets, in which surveys the GALI has been introduced since 2005, how the GALI and HLY are presented, and what the capacity in each country is to investigate the GALI and HLY. Results The survey was answered by 22 Member States and by the Commission. HLY are often used to set targets and develop strategies in health such as national health plans. Analysis of HLY has even led to policy change. In some countries, HLY have become the main indicator for health, gaining more importance than life expectancy. More recently, the GALI and HLY have also been used for policy targets outside the health sector such as in the area of pension and retirement age or in the context of sustainable development. Regarding surveys, the GALI is mostly obtained from the EU-SILC, SHARE and EHIS, but is also increasingly introduced in national surveys. National health reporting systems usually present HLY on their national statistics websites. Most countries have up to three specialists working on the GALI and HLY, which has been consistent through time. Others have increased their capacity over various institutions. Conclusion HLY is an indicator that is systematically used to monitor health developments in most EU countries. The SHARE, EU-SILC and EHIS are commonly used to assess HLY through the GALI. The results are then described in reports and presented on national statistics websites and used in different policy settings. Expertise to analyse the GALI and HLY is available in most countries.

Abstract Background GALI or Global Activity Limitation Indicator is a global survey instrument measuring participation restriction. GALI is the measure underlying the European indicator Healthy Life Years (HLY). Gali has a substantial policy use within the EU and its Member States. The objective of current paper is to bring together what is known from published manuscripts on the validity and the reliability of GALI. Methods Following the PRISMA guidelines, two search strategies (PUBMED, Google Scholar) were combined to identify manuscripts published in English with publication date 2000 or beyond. Articles were classified as reliability studies, concurrent or predictive validity studies, in national or international populations. Results Four cross-sectional studies (of which 2 international) studied how GALI relates to other health measures (concurrent validity). A dose-response effect by GALI severity level on the association with the other health status measures was observed in the national studies. The 2 international studies (SHARE, EHIS) concluded that the odds of reporting participation restriction was higher in subjects with self-reported or observed functional limitations. In SHARE, the size of the Odds Ratio’s (ORs) in the different countries was homogeneous, while in EHIS the size of the ORs varied more strongly. For the predictive validity, subjects were followed over time (4 studies of which one international). GALI proved, both in national and international data, to be a consistent predictor of future health outcomes both in terms of mortality and health care expenditure. As predictors of mortality, the two distinct health concepts, self-rated health and GALI, acted independently and complementary of each other. The one reliability study identified reported a sufficient reliability of GALI. Conclusion GALI as inclusive one question instrument fits all conceptual characteristics specified for a global measure on participation restriction. In none of the studies, included in the review, there was evidence of a failing validity. The review shows that GALI has a good and sufficient concurrent and predictive validity, and reliability.

Limitations to usual activities due to health problems impact quality of life and well-being. The Global Activity Limitation Indicator (GALI) was developed to assess the trends in limitations to usual activities. The GALI question is applied in a single or routed, multi-question version. GEDA 2014/2015-EHIS for the first time applied a three-question version. Three quarters of respondents reported that they did not experience any limitations to their usual activities. 18.7% of women and 17.0% of men said they had experienced moderate limitations. 6.4% of women and 6.8% of men reported severe limitations. The share of respondents experiencing limitations increases with age and shows a clear education gradient. Changes in methodology, however, mean that current results based on the GALI question cannot be compared to the results from earlier survey waves of the same study.

The paper investigates the impact of the selected factors on the healthy life years of men and women in the EU countries. The multiple quantile spatial autoregression models are used in order to account for substantial differences in the healthy life years and life quality across the EU members. Quantile regression allows studying dependencies between variables in different quantiles of the response distribution. Moreover, this statistical tool is robust against violations of the classical regression assumption about the distribution of the error term. Parameters of the models were estimated using instrumental variable method (Kim, Muller 2004), whereas the confidence intervals and p-values were bootstrapped.

This concept paper intends to define four new paradigms for improving nutrition research. First, the consequences of applying a reductionist versus a holistic approach to nutrition science will be discussed. The need for a more focused preventive nutrition approach, as opposed to a curative one, will then be presented on the basis of the ‘healthy core metabolism’ concept. This will lead us to propose a new classification of food products based on processing for future epidemiological studies. As a result of applying the holistic approach, health food potential will be redefined based on both food structure and nutrient density. These new paradigms should help define a more ethical preventive nutrition for humans to improve public recommendations while preserving the environment.

Social security system currently face a number of difficulties arising of changes in the demographic structure of societies, like the decrease in fertility, lengthening of life expectancy and unfavorable change in the proportion of the population receiving retirement benefits to the population in working age. In result social security systems are being subjects to transition aimed ad securing their financial stability, part of which is a tendency to rise the retirement age and eliminate all the incentives to prematurely exit the labor market. On the other hand, this process of transition, as observed in Poland, is being driven mainly by political processes and due to economic reasons, while lacking public health evidence. This rises a danger that in final result the financial savings will be illusory only, and that the final configuration of the system will be inconsistent with the actual social needs of the population and will not efficiently protect against the social risks. In the article we present arguments for using the Healthy Life Years indicator in analyzes relating to the performance of social security systems, so that its construction will reflect differences in health status of different professional groups and system’s solutions in terms of both risk protection and prevention might be adjusted to conditions characterizing these groups.