Wolfgang - ClinicaIn August, a worldwide study was published in the Medical Journal Lancet about life expectancy and ill health.

The tabloids did not hesitate to spread the news, although with the usual gloom and self-pity, summarizing it like “life expectancy for both sexes has risen by 6.2 years in the last two decades, but people are living for longer with illness and disability.”

To be fair, the prestigious German paper Der Spiegel wallowed far more in gloomy scenarios than the Daily Mail, but this only shows the decline in quality.

Truth is, we don’t live longer, but we just don’t die earlier as we did before and walking through London’s cemeteries shows that I am right.

This is due to DALY & HALE and to the fact that life expectancy at birth is far away from being an accurate and sensitive measure: calculating the life expectancy for example only from the age of the Queen Mother and Aylan Kurdi would give us a lifespan of 52 years.

The problem is that when a disproportionate number of young people die, the life expectancy drops disproportionately. Dying younger mostly signifies dying needlessly: think of the absence of wars, or vaccine preventable deaths (the number of deaths in under 5’s through measles dropped by 700,000 each year after implementing broad-based vaccination programs), of access to antibiotics, of accident prevention and functioning health systems (although in our opinion none of them is worth the money).

A life expectancy in Northern Europe of less to sanitation, dry housing, safe food and contraception, apart from what the yearly UK statistics still show: socio-economic background: it predicts how long you will live and in what sort of state of health! Healthy life expectancy at birth for a man
is over 70 years in Richmond upon Thames – but just over 55 in Tower Hamlets.

DALY is exactly the tool which measures this phenomenon. It stands for ‘disability adjusted life year’ a measure which assesses the sum of potentially lost years of life through unnecessary early death or years spent with a disability through birth, illness or accidents. DALYs have been calculated for each individual disease and reflect the impact of the disease on the entire population in terms of death or quality of life, economically speaking also of impact on productivity.

This allows comparisons of countries or geographic areas within countries and facilitates decision making on which health measures are having the highest impact for all. HALE, health adjusted life expectancy, by contrast measures the number of years a person of a certain age is expected to live without disability, enabling advanced health systems focusing their resources on the challenges of an aging population.

QALY, quality adjusted life year, is the purely economic cousin, which merely calculates the cost effectiveness of health interventions and although DALY and HALE can be used in a similar manner they primarily focus on wellbeing.

By the way, the 6 main risk factors for poor health in England which
impact on disability free life years are diet, smoking, obesity, high blood pressure, alcohol, drugs and diabetes. Tackling those problems would improve DALY, whereas finding solutions to arthritis and depression would benefit HALE greatly, but in the end everything boils down to one point; that our potential live span has remained unchanged, we only have to avoid premature death and suffering.

(Feature: Medical)

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