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Objectives: To explore various methods to quantity the burden of mortality, with a special interest for the more recent method at the core of calculations of disability adjusted life years [...]

Abstract Objectives--In the standard economic model of evaluation, constant discount rates devalue the long term health benefits of prevention strongly. This study shows that it is unlikely that this reflects [...]

Health expectancy is an increasingly used indicator of population health status. It collapses both mortality and morbidity into a single indicator, and is therefore preferred to the total life expectancy index for populations with low mortality but high morbidity rates. Three methods of calculation exist: the Sullivan, double decrement, and multi-state methods. This report aims to describe their relative advantages and limitations when used to monitor changes in population health status over time.

To estimate the prevalence of hypertension in The Netherlands and to quantify the influence of methodological variables on the reported prevalences.

OBJECTIVES: To examine whether elimination of fatal diseases will increase healthcare costs. DESIGN: Mortality data from vital statistics combined with healthcare spending in a cause elimination life table. Costs were allocated to specific diseases through the various healthcare registers. SETTING AND SUBJECTS: The population of the Netherlands, 1988. MAIN OUTCOME MEASURES: Healthcare costs of a synthetic life table cohort, expressed as life time expected costs. RESULTS: The life time expected healthcare costs for 1988 in the Netherlands were 56,600 Pounds for men and 80,900 Pounds for women. Elimination of fatal diseases--such as coronary heart disease, cancer, or chronic obstructive lung disease--increases healthcare costs. Major savings will be achieved only by elimination of non-fatal disease--such as musculoskeletal diseases and mental disorders. CONCLUSION: The aim of prevention is to spare people from avoidable misery and death not to save money on the healthcare system. In countries with low mortality, elimination of fatal diseases by successful prevention increases healthcare spending because of the medical expenses during added life years.

In industrialised countries, mortality and morbidity are dominated by age related chronic degenerative diseases. The health and health care needs of future populations will be heavily determined by these conditions of old age. Two opposite scenarios of future morbidity exist: morbidity might decrease ("compress"), because life span is limited, and the incidence of disease is postponed. Or morbidity might increase ("expand"), because death is delayed more than disease incidence. Optimality theory in evolutionary biology explains senescence as a by product of an optimised life history. The theory clarifies how senescence is timed by the competing needs for reproduction and survival, and why this leads to a generalised deterioration of many functions at many levels. As death and disease are not independent, future morbidity will depend on duration and severity of the process of senescence, partly determined by health care, palliating the disease severity but increasing the disease duration by postponing death. Even if morbidity might be compressed, health care needs will surely expand.