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Udgivelsesdato: 2009-Aug AIMS: A newly published study showed that the life expectancy for Danes was below the European Union (EU) average. Furthermore, the study showed that healthy life years (HLYs) at 50 years of age were much higher in Denmark than in the other EU countries in 2005. However, the results of this study should be interpreted with caution. METHODS: The analyses regarding HLYs were based on the global long-term activity limitation index as a measure of disability and were included in the EU Survey on Income and Living Condition (EU-SILC). In Denmark two response categories were used to asses long-term activity limitation (yes; no) compared to three levels in all other countries (severely limited; limited but not severely; none). In addition, the wording of the question in Denmark makes cross-national comparisons even more inadequate. The questions and the response categories were revised in the Danish SILC-2008. RESULTS: A comparison of the previous and the revised indicator shows that the estimated number of HLYs at 50 years of age is approximately three years lower for both men and women in 2008 than in 2005. Furthermore, in Denmark data was collected via telephone interviews or postal questionnaires. However, in almost all other countries data was collected via face-to-face interviews. It is well known that the mode of data collection may affect response distributions. CONCLUSIONS: Results based on non-harmonized indicators should always be interpreted cautiously to avoid policy-makers and others reaching erroneous conclusions.

The goal of this elaboration is to point out changes in mortality that were responsible for longer life expectancy and lower infant mortality. The trend of basic indicators that contributed to changes in mortality was assessed based on the time series data available on the website of Czech Statistical Office. The life expectancy paradox and the necessary level of birth rate and life expectancy to maintain level of simple reproduction was calculated based on the trend of life expectancy in selected age groups of men and women, infant mortality coefficient and actual birth rate in the Czech Republic during 1920-2008. The elaboration describes in detail the indicators and methods of calculating mortality and pays special attention to life tables and possible ways of flattening mortality rate curves. It also compares life expectancy and healthy life years in the Czech Republic and European countries and describes the term of healthy life years and the most common way of their calculation. In all monitored countries, women's expectation of life at birth is longer than that of men. In the Czech Republic, the difference is now about six years. Life expectancy in all countries keeps going up, with the exception of e.g. the countries of the former Soviet Union where life expectancy has been fluctuating for the past 20 years. Individual countries are compared based on data from the Eurostat database and Human Mortality Database. The annex shows methods of calculating life tables and possible ways of flattening mortality rate curves and provides an overview of the most common models of flattening and extrapolating mortality rate curves. The elaboration also has an index of used terms and a Czech-English vocabulary.

Although life expectancy in the European Union (EU) is increasing, whether most of these extra years are spent in good health is unclear. This information would be crucial to both contain health-care costs and increase labour-force participation for older people. We investigated inequalities in life expectancies and healthy life years (HLYs) at 50 years of age for the 25 countries in the EU in 2005 and the potential for increasing the proportion of older people in the labour force.We calculated life expectancies and HLYs at 50 years of age by sex and country by the Sullivan method, which was applied to Eurostat life tables and age-specific prevalence of activity limitation from the 2005 statistics of living and income conditions survey. We investigated differences between countries through meta-regression techniques, with structural and sustainable indicators for every country.In 2005, an average 50-year-old man in the 25 EU countries could expect to live until 67.3 years free of activity limitation, and a woman to 68.1 years. HLYs at 50 years for both men and women varied more between countries than did life expectancy (HLY range for men: from 9.1 years in Estonia to 23.6 years in Denmark; for women: from 10.4 years in Estonia to 24.1 years in Denmark). Gross domestic product and expenditure on elderly care were both positively associated with HLYs at 50 years in men and women (p0.039 for both indicators and sexes); however, in men alone, long-term unemployment was negatively associated (p=0.023) and life-long learning positively associated (p=0.021) with HLYs at 50 years of age.Substantial inequalities in HLYs at 50 years exist within EU countries. Our findings suggest that, without major improvements in population health, the target of increasing participation of older people into the labour force will be difficult to meet in all 25 EU countries.EU Public Health Programme.

Investing wisely in health is vital if we are to ensure that future populations do not spend their increased lifespan burdened with disabilities that diminish their contribution to society and quality of life. In order to guide these investments and monitor health as an economic and societal welfare factor, the European Commission developed the Healthy Life Years indicator, which is part of the European Structural Indicators set.

We aimed to estimate the economic losses currently caused by coal workers' pneumoconiosis (CWP) and, on the basis of these measurements, confirm the economic benefit of preventive measures. Our cohort study included 1,847 patients with CWP and 43,742 coal workers without CWP who were registered in the employment records of the Datong Coal Mine Group. We calculated the cumulative incidence rate of pneumoconiosis using the life-table method. We used the dose-response relationship between cumulative incidence density and cumulative dust exposure to predict the future trend in the incidence of CWP. We calculate the economic loss caused by CWP and economic effectiveness of CWP prevention by a step-wise model. The cumulative incidence rates of CWP in the tunneling, mining, combining, and helping cohorts were 58.7%, 28.1%, 21.7%, and 4.0%, respectively. The cumulative incidence rates increased gradually with increasing cumulative dust exposure (CDE). We predicted 4,300 new CWP cases, assuming the dust concentrations remained at the levels of 2011. If advanced dustproof equipment was adopted, 537 fewer people would be diagnosed with CWP. In all, losses of 1.207 billion Renminbi (RMB, official currency of China) would be prevented and 4,698.8 healthy life years would be gained. Investments in advanced dustproof equipment would be total 843 million RMB, according to our study; the ratio of investment to restored economic losses was 1:1.43. Controlling workplace dust concentrations is critical to reduce the onset of pneumoconiosis and to achieve economic benefits.

Noise is pervasive in everyday life and induces both auditory and non-auditory health effects. Noise-induced hearing loss remains the most common occupational disease in the United States, but is also increasingly caused by social noise exposure (e.g., through music players). Simultaneously, evidence on the public health impact of non-auditory effects of environmental noise exposure is growing. According to the World Health Organization (WHO), ca. 1.6 Million healthy life years (DALYs) are lost annually in the western member states of the European Union due to exposure to environmental noise. The majority (>90%) of these effects can be attributed to noise-induced sleep disturbance and community annoyance, but noise may also interfere with communication and lead to cognitive impairment of children. Epidemiological studies increasingly support an association of long-term noise exposure with the incidence of hypertension and cardiovascular disease. Up-to-date exposure-response relationships are needed for health impact assessments, to reassess the validity of current noise policy and to better mitigate the negative health consequences of noise. The International Commission on Biological Effects of Noise (ICBEN) is a non-profit organization constituted 1978 that promotes all aspects of noise effects research and its application through International Noise Teams and an International Congress every three years.

Summary Objective This study highlights the burden of urban road traffic injuries (RTIs) in children and young adults in South Asia and Sub-Saharan Africa to heighten awareness of current limitations in child health policies, and to direct future research and intervention development. Methods Comparative analysis of recent Sub-Saharan Africa and South Asia reviews of RTIs, World Health Organization (WHO) Global Burden of Disease statistics, and the Bangladesh Health and Injury Survey. Participants Children aged 0–18 years in South Asia and Sub-Saharan Africa reviews, aged 0–14 years in the WHO data, and aged 1–17 years in the Bangladeshi data. Results Child pedestrians comprise the largest proportion of urban RTI victims. More healthy life years were lost per 1000 children aged 0–18 years in South Asia than Sub-Saharan Africa. Disability-adjusted life years lost per 1000 children aged 0–14 years was greater in Africa than South-east Asia. South-east Asia has the greatest overall incidence of RTIs; however, Africa has poorer reported outcomes for children aged 0–14 years. Conclusion These data sources point to the salience of intervening in RTIs in children to prevent a predicted boom in the RTI burden in children, particularly in the poorest regions of the world. However, child health policies in these regions have not yet embraced RTI, either in research or programmes.

Background Occupational back pain exacts a toll on society with concomitant economic losses; it is imperative to evaluate the cost-effectiveness of interventions to reduce the relevant ergonomic stressors at work. This study estimates and evaluates the average and incremental cost-effectiveness ratios (CERs) of specific interventions for the prevention of occupationally induced back pain for the World Health Organization (WHO) defined subregions of the world. Methods Four back-pain interventions were selected from the literature: training (T), engineering controls (EC), engineering controls and training (EC&T), and a comprehensive full ergonomics program (EP) for evaluation. A simulation model for a 100-year time horizon, developed by the WHO CHOICE initiative project was used to estimate the effectiveness of the interventions in healthy year equivalents. The intervention costs were adjusted for all WHO subregions. Results In all of the subregions, training was the most cost-effective with CERs varying from $74 per healthy life years gained in the subregion comprising of Egypt, Iraq, Morocco, Yemen (EMROD) to approximately $567 in the subregion covering Canada and the United States (AMROA). Training is considered to be very cost-effective and would be the first choice option where resources are scarce. However, the overall effectiveness of training is low. Although other interventions such as engineering controls and total ergonomic interventions are relatively more expensive, the addition to health outcome through these interventions is much higher. The difference in the CERs for training and other engineering controls and full ergonomic interventions is relatively small for most of the industrialized regions of the world. It is clear from the ranked CERs and incremental CERs over the different subregions that in most of the industrialized regions of the world additional resources, if they become available, should go straight to the full ergonomics program. Conclusions The model results based on CERs show that worker training is a low cost, feasible first step toward reducing back pain/injury incidence. However, all of the average CERs for the different interventions, for each of the regions, fall well within their GDP per capita estimates [World Bank, 2001]. According to the WHO Commission on Macroeconomics and Health any intervention that costs less than three times GDP per capita for saving a healthy year equivalent should be considered worthwhile and good value for money [WHO, 2002]. Given this criterion, the engineering controls interventions as well as the full ergonomics program look very cost effective for all of the WHO subregions. Am. J. Ind. Med. 48:515–529, 2005. © 2005 Wiley-Liss, Inc.

Background: Haemophilia is a rare hereditary haemorrhagic disease that requires regular intravenous injections of clotting factor (CF) concentrates. This study sought to estimate the health and economic burden of haemophilia in Belgium. This is the first study of its type to be conducted, and reflects the Belgian authorities' growing interest for haemophilia as part of their priority planning for rare and chronic diseases. Methods: A probabilistic model was developed in order to estimate the lifetime haemophilia burden for the 2011 birth-year Belgian cohort. The health burden was initially expressed in terms of disability-adjusted life years (DALYs), the number of healthy life years lost due to living with disability and dying prematurely. An incidence perspective was used in line with World Health Organization recommendations. The economic burden calculated from direct and indirect haemophilia-related costs was expressed in euros. Data were drawn from the literature if none were available from federal institutions or health insurance. Disability weights for DALY calculation were derived using generic quality-of-life tools such as SF-6D from the SF-36 (36-item Short-Form Health Survey; for adults) and KINDL (generic quality-of-life instrument; for children) compared to population norms. Analyses were stratified according to haemophilia type and severity. Results: In Belgium, haemophilia resulted in 145 undiscounted and unweighted DALYs in total (95% credible interval [CrI] = 90-222), which represents an average of 11 DALYs per incident case with haemophilia (95% CrI = 8-15) during his life, varying according to haemophilia severity (17 DALYs for severe haemophilia, 12 DALYs for moderate, and 4 DALYs for mild). Mean total lifetime costs reached (sic)7.8 million per people with haemophilia, 94.3% being direct costs and 5.7% indirect costs. Clotting factors accounted for 82.5% of direct costs. Conclusions: Haemophilia represents both an economic and health burden, especially regarding individual health on an individual patient level. Initiatives to counteract this burden should be clearly identified and given full support, as this burden is likely to increase in the future, especially from an economic perspective. Our study may also contribute towards a better global evaluation of haemophilia in the future.

Alcohol consumption is a public health problem in Latin America, being responsible for thousands of annual deaths and millions of healthy life years lost to acute and chronic conditions caused by alcohol. Consumption is higher and more prevalent among men, but women and adolescent girls are increasing their consumption more rapidly than men and adolescent boys. Beer is the alcoholic beverage most consumed, followed by distilled spirits; however, there are countries differences as some countries drink mostly wine. The industry which produces, distributes and sells alcoholic beverages is powerful, mostly globalized and with great political influence, so the current situation favors commercial interests at the expense of public health. Public policies in Latin America are insufficient to respond to the situation at national level, with little o no regulatory control of the availability of alcoholic beverages, prices and taxation policies or government control of marketing and promotion. There is limited research which can inform policy actions. Gaps in prevention and treatment of alcohol consumption and related problems are discussed as well as some perspectives for the future.

Stroke is a prototype disorder that disables as well as kills people. The disability-adjusted life years (DALY) metric developed by the World Health Organization to measure the global burden of disease integrates healthy life years lost due to both premature mortality and living with disability. Accordingly, it is well suited to stroke research. The DALY has previously been applied only to large but relatively crude population-level data analyses, but now it is possible to calculate the DALY lost in individual stroke patients. Measuring each patient's stroke outcome with DALY lost has expanded its application to the analysis of treatment effect in acute stroke trials, delineating the poststroke complication impact, the differential weighting of discrete vascular events, and estimating a more refined stroke burden in a specific population. The DALY metric has several advantages over conventional stroke outcome measures: 1) Since the DALY measures the burden of diverse health conditions with a common metric of life years lost, stroke burden and benefits of stroke interventions can be directly compared to other health conditions and their treatments. 2) Quantifying stroke burden or interventional benefits as the life years lost or gained makes the DALY metric more intuitively accessible for public and health system planners. 3) As a continuous, equal-interval scale, the DALY analysis might be statistically more powerful than either binary or ordinal rank outcome analyses in detecting the treatment effects of clinical trials. 4) While currently employed stroke outcome measures take one-time snapshots of disability or mortality and implicitly indicate long-term health impact, the DALY explicitly indicates the burdens of living with disability for an individual's remaining life.

Twenty four risk factors are responsible for 44% of the estimated 60 million global deaths that occur each year and cause 34% of the loss of healthy life years worldwide, says a World Health Organization report. The five leading global risks for mortality are high blood pressure, which is responsible for 12.8% of all deaths globally; tobacco use (8.7%); high blood glucose (5.8%); physical inactivity (5.5%), and overweight and obesity (5%), it says. Other key global risk factors among the top 10 causes of death include high cholesterol (4.5%), unsafe sex (4%), alcohol use (3.8%), childhood underweight (3.8%), and indoor smoke from solid fuels (3.3%). The report concludes that these leading risks are responsible for raising the risk of chronic diseases such as heart disease, diabetes, and cancers. For instance, 57% of cardiovascular deaths, it says, can be traced back to three risk factors—high blood pressure, high body mass index, and physical inactivity. Similarly, it says that raised blood pressure changes the structure of arteries and increases …

Michael Adler, Susan Foster, John Richens, Hazel Slavin Overseas Development Administration, £6.95, pp 136 ISBN 0 902 500 902 Sexually transmitted infections are highly prevalent in poor countries and are a major cause of loss of healthy life years in women of childbearing age. Recently, they have assumed even greater importance because they are the main reducible risk factor for transmission of HIV. Previously largely ignored, they have become high priority targets for prevention and control. Unfortunately few policy makers and planners, or aid and donor organisations, have a wide general background in this complex subject—a problem which has important consequences for the advocacy and implementation of effective …

Health systems worldwide struggle to meet increasing demands for health care, and Norway is no exception. This paper discusses the new, comprehensive framework for priority setting recently laid out by the third Norwegian Committee on Priority Setting in the Health Sector. The framework posits that priority setting should pursue the goal of “the greatest number of healthy life years for all, fairly distributed” and centres on three criteria: 1) The health-benefit criterion: The priority of an intervention increases with the expected health benefit (and other relevant welfare benefits) from the intervention; 2) The resource criterion: The priority of an intervention increases, the less resources it requires; and 3) The health-loss criterion: The priority of an intervention increases with the expected lifetime health loss of the beneficiary in the absence of such an intervention. Cost-effectiveness plays a central role in this framework, but only alongside the health-loss criterion which incorporates a special concern for the worse off and promotes fairness. In line with this, cost-effectiveness thresholds are differentiated according to health loss. Concrete implementation tools and open processes with user participation complement the three criteria. Informed by the proposal, the Ministry of Health and Care Services is preparing a report to the Parliament, with the aim of reaching political consensus on a new priority-setting framework for Norway.

Background Studies state profound cross-country differences in healthy life years and its time trends, suggesting either the health scenario of expansion or compression of morbidity. A much-discussed question in public health research is whether the health scenarios are heterogeneous or homogeneous on the subnational level as well. Furthermore, the question arises whether the morbidity trends or the mortality trends are the decisive drivers of the care need-free life years (CFLY), the life years with care need (CLY), and, ultimately, the health scenarios. Methods This study uses administrative census data of all beneficiaries in Germany from the Statutory Long-Term Care Insurance 2001–2009. We compute the CFLY and CLY at age 65+ for 412 counties. The CFLY and CLY gains are decomposed into the effects of survival and of the prevalence of care need, and we investigate their linkages with the health scenarios by applying multinomial regression models. Results We show an overall increase in CFLY, which is higher for men than for women and higher for severe than for any care need. However, spatial variation in CFLY and in CLY has increased. In terms of the health scenarios, a majority of counties show an expansion of any care need but a compression of severe care need. There is high spatial heterogeneity, with expansion-counties surrounding compression-counties and vice versa, which is mainly caused by divergent trends in the prevalence of care need. We show that mortality is responsible for the absolute changes in CFLY and CLY, while morbidity is the decisive driver that determines the health scenario of a county. Conclusion Combining regionalized administrative data and advanced statistical methods permits a deeper insight into the complex relationship between health and mortality. Our findings demonstrate a compression of life years with severe care need, which however, depends on the region of residence. To attenuate regional inequalities, more efforts are needed that improve health by medical and infrastructural interventions and by the exchange of insights in the efficiency of small- and large-area policy measures between the vanguard and the rearguard counties. In future research, the underlying latent mechanisms should be investigated in more detail. Electronic supplementary material The online version of this article (doi:10.1186/s12963-016-0093-1) contains supplementary material, which is available to authorized users.

Individuals with low socioeconomic status (SES) are disproportionally affected by depressive disorders which are among the main causes for loss in healthy life years in adults worldwide. The main objective of the research presented here was to identify a psychological mindset of individuals with low SES and to investigate whether this mindset mediates the relationship between low SES and symptoms of depression. Towards these goals, a series of four studies was conducted: Study 1 identified a set of ten statements reflecting a psychological mindset associated with low SES using a population-based sample from Germany (N = 1,969). Study 2 cross-validated a psychometric scale (S-Scale) that was created based on these statements in a population-based sample from Germany (N = 3,907). Study 3 introduced a longitudinal perspective and showed that the S-Scale mediated the relationship between low SES and symptoms of depression assessed one year later in a German student sample (N = 1,275). Study 4 supported unidimensionality and construct validity of a unified version of the S-Scale and confirmed the mediation effect of the S-Scale for SES and depression while controlling for confounding variables (e.g., socially desirable responding) in a U.S. American convenience sample (N = 1,000). Evidence from four studies supported the reliability and validity of the S-Scale. Controlling for a psychological mindset as measured with this scale, low SES was no longer a predictor of depressive symptoms. The S-Scale can be used in clinical and research settings to assess a psychological mindset that puts individuals at risk for depression. Overall strengths of this series of studies include the use of population-based and longitudinal datasets and the application of findings to different operationalizations of SES. Future studies should investigate whether this mindset can be modified by psychological interventions and whether changes in this mindset predict improvements in depressive symptoms.

ObjectivesPoor psychosocial working conditions increase the likelihood of various types of morbidity and may substantially limit quality of life and possibilities to remain in paid work. To date, however, no studies to our knowledge have quantified the extent to which poor psychosocial working conditions reduce healthy or chronic disease-free life expectancy, which was the focus of this study.MethodsData were derived from four cohorts with repeat data: the Finnish Public Sector Study (Finland), GAZEL (France), the Swedish Longitudinal Occupational Survey of Health (Sweden) and Whitehall II (UK). Healthy (in good self-rated health) life expectancy (HLE) and chronic disease-free (free from cardiovascular disease, cancer, respiratory disease and diabetes) life expectancy (CDFLE) was calculated from age 50 to 75 based on 64 394 individuals with data on job strain (high demands in combination with low control) at baseline and health at baseline and follow-up.ResultsMultistate life table models showed that job strain was consistently related to shorter HLE (overall 1.7 years difference). The difference in HLE was more pronounced among men (2.0 years compared with 1.5 years for women) and participants in lower occupational positions (2.5 years among low-grade men compared with 1.7 years among high-grade men). Similar differences in HLE, although smaller, were observed among those in intermediate or high occupational positions. Job strain was additionally associated with shorter CDFLE, although this association was weaker and somewhat inconsistent.ConclusionsThese findings suggest that individuals with job strain have a shorter health expectancy compared with those without job strain.

Evidence of the cost and effects of interventions for reducing the global burden of migraine remains scarce. Our objective was to estimate the population-level cost-effectiveness of evidence-based migraine interventions and their contributions towards reducing current burden in low- and middle-income countries. Using a standard WHO approach to cost-effectiveness analysis (CHOICE), we modelled core set intervention strategies for migraine, taking account of coverage and efficacy as well as non-adherence. The setting was primary health care including pharmacies. We modelled 26 intervention strategies implemented during 10 years. These included first-line acute and prophylactic drugs, and the expected consequences of adding consumer-education and provider-training. Total population-level costs and effectiveness (healthy life years [HLY] gained) were combined to form average and incremental cost-effectiveness ratios. We executed runs of the model for the general populations of China, India, Russia and Zambia. Of the strategies considered, acute treatment of attacks with acetylsalicylic acid (ASA) was by far the most cost-effective and generated a HLY for less than US$ 100. Adding educational actions increased annual costs by 1–2 US cents per capita of the population. Cost-effectiveness ratios then became slightly less favourable but still less than US$ 100 per HLY gained for ASA. An incremental cost of > US$ 10,000 would have to be paid per extra HLY by adding a triptan in a stepped-care treatment paradigm. For prophylaxis, amitriptyline was more cost-effective than propranolol or topiramate. Self-management with simple analgesics was by far the most cost-effective strategy for migraine treatment in low- and middle-income countries and represents a highly efficient use of health resources. Consumer education and provider training are expected to accelerate progress towards desired levels of coverage and adherence, cost relatively little to implement, and can therefore be considered also economically attractive. Evidence-based interventions for migraine should have as much a claim on scarce health resources as those for other chronic, non-communicable conditions that impose a significant burden on societies.

Background: While many studies have examined differences between body mass index (BMI) categories in terms of mortality risk and health-related quality of life (HRQL), little is known about the effect of body weight on health expectancy. We examined life expectancy (LE), health-adjusted life expectancy (HALE), and proportion of LE spent in nonoptimal (or poor) health by BMI category for the Canadian adult population (age ≥ 20). Methods: Respondents to the National Population Health Survey (NPHS) were followed for mortality outcomes from 1994 to 2009. Our study population at baseline (n=12,478) was 20 to 100 years old with an average age of 47. LE was produced by building abridged life tables by sex and BMI category using data from the NPHS and the Canadian Chronic Disease Surveillance System. HALE was estimated using the Health Utilities Index from the Canadian Community Health Survey as a measure of HRQL. The contribution of HRQL to loss of healthy life years for each BMI category was also assessed using two methods: by calculating differences between LE and HALE proportional to LE and by using a decomposition technique to separate out mortality and HRQL contributions to loss of HALE. Results: At age 20, for both sexes, LE is significantly lower in the underweight and obesity class 2+ categories, but significantly higher in the overweight category when compared to normal weight (obesity class 1 was nonsignificant). HALE at age 20 follows these same associations and is significantly lower for class 1 obesity in women. Proportion of life spent in nonoptimal health and decomposition of HALE demonstrate progressively higher losses of healthy life associated with lowered HRQL for BMI categories in excess of normal weight. Conclusions: Although being in the overweight category for adults may be associated with a gain in life expectancy as compared to normal weight adults, overweight individuals also experience a higher proportion of these years of life in poorer health. Due to the descriptive nature of this study, further research is needed to explore the causal mechanisms which explain these results, including the important differences we observed between sexes and within obesity subcategories.

A CONTINUING interest of the National Center for Health Statistics is the development and evaluation of new health indices suited to diverse specific purposes. No one index can reflect all aspects of health, but there is considerable agreement that an index which measures some aspects of nonfatal illness as well as mortality would be desirable. A rationale for using both mortality and disability rates as the components of such an index has already been published (1). One technique for combining mortality and morbidity rates into a single index was devised and reported by Chiang in conjunction with his development of mathematical models of illness frequency, illness duration, and mortality (2). Moriyama has discussed criteria desired in an index of health and, in view of these, reviewed some approaches proposed in the literature (3). A deseription and evaluation of disability concepts and measures being considered as the basis of the morbidity component of a mortality-morbidity index appeared in a recent report (4). Another technique for merging death rates with illness rates, and some illustrative results are described in this paper. A primary objective of these studies is development of a summary measure which reflects changes over time in the health status of the nation's population. Too little is known as yet about these techniques, and in some cases about the data they employ, to permit thorough evaluation of alternative approaches to the construction of such indices. Results of studies of such measures are presented as they become available by the Center to stimulate consideration of the issues and, possibly, to stimulate further studies by those in a position to conduct related research. Some preliminary index values based upon the techniques presented in this paper have already been published for fiscal years 1958-66 (5). The estimates in this article are also preliminary. Although they relate to only a single year, they provide previously unpublished information on whites and other persons and on sex differences. These estimates are considered more accurate than earlier computations of such values.

Healthy Life Years (HLY) is a prominent summary indicator for evaluating and comparing the levels of population health status across Europe. Variations in HLY, however, do not necessarily reflect underlying differences in health and mortality levels among countries and the indicator is particularly sensitive when broken down by subpopulations. For instance, despite European countries showing large HLY inequalities by educational level, these countries are also heterogenous regarding their population composition by educational attainment, which most likely affects their HLY levels. We demonstrate how this compositional effect shapes HLY levels by providing estimates for HLY by educational attainment and gender for 16 European countries using the Sullivan method. We use prevalence data about limitations in daily activities from the European Union Statistics on Income and Living Conditions (EU-SILC) and mortality data from the Eurostat database. Finally, we adjust for compositional effects by means of standardization. The education-adjusted HLY estimates do not differ much from conventional HLY. Yet, we find that in some countries HLY levels are indeed affected by the population composition by educational attainment. For example, low-, medium-, and high educated individuals in Portugal show more HLY than their counterparts in Poland. Still, Poland's total HLY value slightly exceeds that of Portugal, indicating favorable health and mortality conditions in Poland. It is Poland's lower relative number of low educated individuals in its population that is responsible for producing this higher total HLY value. We conclude that differentials in HLY due to differences in the relative size of educational subpopulations are generally small in HLY across Europe but they can play an important role for countries that experienced large differences in their educational expansion., Highlights • Providing Healthy Life Years estimates by educational attainment for 16 European countries. • Revealing large educational inequalities in Healthy Life Years across Europe. • Illustrating the impact of population's educational composition on Healthy Life Years in Europe.