Last month, the Office for National Statistics (ONS) released its latest Healthy Life Expectancy (HLE) figures. Unlike traditional life expectancy, which measures how long people are living for, HLE attempts to measure how many years people can expect to live in good health.
The latest figures are eye-catching. According to the ONS, men in the UK can now expect to spend 60.7 years in good health, while women can expect 60.9 years. That’s a drop of 1.8 years for men and 2.5 years for women over three years. The decline in HLE seems to have begun in 2019 – a phenomenon that World Health Organization (WHO) data shows to be echoed around the world.
Some of the other headline figures include:
- HLE at birth is now at its lowest level since records began over a decade ago
- The gap in HLE at birth across different regions of the UK has grown to around 15 years
With numbers like these, it’s no surprise the release has attracted a lot of attention. But what are the numbers really showing?
As well as tracking changes in the nation’s health, HLE is often drawn into debates about how long people can, or should, remain in work. If people are spending fewer years in good health, it seems reasonable to ask whether it is realistic to expect them to work to even later ages. As a result, one of the common questions we are hearing on these figures is whether they should influence future decisions about the State Pension age.
But there are several reasons why HLE isn’t a particularly good guide to when people can no longer work, something that was discussed in Club Vita’s response to the State Pension age review.
How is HLE measured?
HLE is calculated using data from the ONS Annual Population Survey, which covers around 80,000 UK households and 175,000 people each year1. People are asked a simple question about their general health and asked to rate it on a five-point scale from “very good” to “very bad”. There’s no guidance about what those scores mean – it’s entirely down to personal judgement.
For the HLE calculation:
- “Very good” or “good” responses are treated as good health
- “Fair”, “bad” or “very bad” responses are treated as poor health
These responses are then combined with mortality data to estimate how many years people are likely to live in good health.
How useful is HLE as a measure?
HLE is useful for understanding how people feel about their health, but that doesn’t mean it’s a particularly good way to judge whether people can work.
One big issue is that it’s based on self-reported health from a relatively small survey sample. Because there’s no clear benchmark included in the survey, people answer based on their own personal experiences and expectations. Someone living in a more deprived area might say their health is “good” even if they have serious health problems, because they compare themselves to others around them. Meanwhile, someone more affluent might rate relatively minor issues more negatively.
People’s answers are also influenced by what’s going on around them. Economic pressures, a pandemic, worries about access to healthcare, or even how someone is feeling on the day of the survey can all affect how they rate their health. As we’ve shown in one of our Top Charts, there’s even some link between reported health and mood or happiness.
Another limitation is how the ONS defines “good” and “poor” health. Anyone who answers “fair” is counted as being in poor health, although this doesn’t necessarily mean they are unable to work. Many people in “fair” health are still in employment, especially if they have flexible roles or reasonable workplace adjustments. In fact, “fair” is a very common response among older people in the survey, so simply changing how it’s classified could make a big difference to the headline figures.
It’s also worth remembering that HLE is just an average. It doesn’t tell us whether there’s a clear age where health suddenly drops off, or whether changes are gradual. For example, although HLE at birth for men and women is around 61 years, the ONS data shows that most people in their early 60s are still in good health – around two-thirds of men and women aged 60 to 64 say their health is “good” or “very good”.
What else could we look at?
There’s no perfect way to measure people’s ability to work, but there are other approaches that could give a more balanced picture. For example, looking at the proportion of people in each health category (within different age groups) and tracking how that changes over time could provide a more rounded basis for assessment. In addition, placing greater weight on objective health data (such as GP records or clinical assessments) may be beneficial, as these are based on professional judgement rather than self‑perception.
Our paper explores different ideas in more detail, particularly in the context of reviewing the State Pension age.
Key takeaways
- HLE is a useful measure of how people perceive their health.
- But it isn’t an objective measure. It could be affected by many non-health related factors such as how people compare themselves to others or even the general mood of the nation.
- It also wasn’t designed to show when people are no longer able to work.
- Using HLE as a proxy for working capacity is risky and potentially misleading.
- Big policy decisions, like changes to State Pension age, need a broader evidence base.
What do you think?
Do you think HLE is a good measure of people’s ability to work? What other approaches do you think policymakers should consider?