Living longer but spending more of our lives in ill health. That is the rather shocking picture presented by the figures for ‘healthy life expectancy’ published by the Office for National Statistics (ONS) yesterday. They show that while life expectancy continues to rise modestly, the proportion of our lives lived in ‘good’ health is falling sharply. Between 2022 and 2024 men enjoyed 60.7 years of good health and women 60.9 years. This was, respectively, 1.8 years and 2.5 years down on the previous period for which data was collected, 2019 to 2020. We now appear to spend less of our lives in good health than we did at any time since the data began to be collected in this form between 2011 and 2013.
There will be no shortage of people proffering explanations for apparent declining health: ‘austerity’, no doubt; obesity, lack of exercise, long Covid, the stress of having to work a full five days a week, ultra-processed food (the current bogeyman, which gets blamed for just about anything). Then again, as with anything like this, it is necessary to step back and ask: what are these statistics actually measuring, and are they telling us anything useful at all?
Can I say I’m in good health when I have an ingrown toenail?
The data is collected via something called the ‘Sullivan method’, devised by US statistician Daniel Sullivan in the 1960s. It is easy to see the rationale behind wanting to have such a measure: what is the point of increasing life expectancy if people are living their extra years in pain and suffering? If government is going to have a role in improving people’s lives, it should focus on the quality of those years, not just the quantity. The trouble is, though, while it is easy to derive data on life expectancy – being alive or not being alive is pretty binary – it is much harder to establish whether people are in ‘good’ health or not. It is purely subjective.
The data is obtained simply by interviewing members of the public and asking them whether they are in good health. This has obvious problems in that what we define as good health will vary from individual to individual and also over time and place. Can I say I’m in good health when I have an ingrown toenail? Would I still be in good health if I added to that a bad knee, arthritis, bone cancer or gangrene? Somewhere along the line I would surely change my answer from ‘good’ to ‘bad’ health, but at what point? Are people healthy when they have a serious but well-controlled health condition?
The guide quoted by the ONS in its methodology, which was drawn up by the University of Newcastle for an EU project in 2013, adds a further layer of complication: it admits that the answers that people give are ‘very sensitive to the way the data are collected (e.g., face-to-face interview, telephone interview, postal questionnaire)’. The ONS index is really as much a measure of health expectations as it is actual health, and these have surely changed over time. Asking someone whether they enjoy good health now means something different from what it did in the 1970s, when elderly people had lived through two world wars, the Great Depression and other sources of privation.
The idea of publishing healthy life expectancy dates from the Cameron-era, when the ONS also started publishing a happiness index to run alongside GDP – is that quality of life cannot be reduced to a single economic figure. Fair enough, but neither can it be reduced to a happiness index either. No one really takes it seriously any more – although we do keep our eyes very carefully on GDP. Figures for healthy life expectancy similarly need to be treated with extreme caution. And no, it won’t be austerity wot is making us ill.
