Health-Adjusted Life Expectancy (HALE)

Sex and Gender-based Analysis of this topic

Definition

Health-adjusted life expectancy (HALE) is a measurement developed by the World Health Organization that attempts to capture a more complete estimate of health than standard life expectancy rates (note that HALE was previously referred to as Disability-Adjusted Life Expectancy or DALE). HALE estimates the number of healthy years an individual is expected to live at birth by subtracting the years of ill health – weighted according to severity – from overall life expectancy [1]. HALE is also calculated at age 65 to provide a measurement of the quality of life of seniors. By moving beyond mortality data, HALE is meant to measure not just how long people live, but the quality of their health through their lives.

 
 
Sex Issues

Though Canadian women live longer on average than men (82.7 years vs. 78.0 years), Canadian men tend to live healthier lives. In 2001, Canadian men lived 88.8% (68.3 years) of their lives in good health, compared to 86.3% (70.8 years) of women [2].

Individuals with chronic conditions such as arthritis, chronic pain, and mental illness, have lower HALE as these health issues can affect mobility or ability to easily complete daily tasks. Each of these conditions is more prevalent for women and contributes to lowering HALE for women. For example, research has shown that men have a genetic protection against arthritis of the knee [3], and Canadian women report a higher prevalence of disability related to arthritis at nearly all age level [4]. There is also a sex-related difference in chronic pain; 18% of Canadian women report chronic pain as opposed to 14% of Canadian men [5]. 

Chronic conditions are one of the main causes of lowered HALE and for many chronic conditions, women are at a higher risk than men Depression is the worldwide leading cause of years lived with disabilities, and women experience depression nearly twice as often as men [6]. Women are more affected by stress-related disorders, such as post-traumatic stress disorder, than men [7]. Women are also more likely than men to have two or more chronic conditions (or co-morbidities), as well as to report having disabilities that affect daily functioning [8].

 
 
Gender Issues

Gender plays a significant role in a range of situations that either create or exacerbate causes of disability for Canadian women. For example, a recent study found that physicians were more likely to recommend total knee arthroplasty for male patients when both men and women present with similar levels of disability [9], meaning that women will experience disability for a longer period before surgery. Another example is in benefit gained from social support. Spouses provide a large amount of social support, which for men has led to a 40% lower risk of death [10]. However, there have been no demonstrated benefits for women from spousal social support. In general, women tend to put off caring for their own health in order to look after the health of their families, resulting in long-term negative health consequences and associated disability [11-12].

 
 
Diversity

Geographically, HALE varies significantly across Canada. In 1996, the Nunavik region of Quebec had the lowest HALE of 61 years, compared to the Richmond region of British Columbia, which had a HALE of 73 years [13]. This difference mirrors differences in life expectancy rates for the two regions (high in BC and low in Nunavik), an association which generally holds true for all regions of Canada as calculation of HALE is based partially on life expectancy. There is also a strong association between high HALE and urban populations. The populations in the lowest quartile of HALE, ranging from 61.0-66.3 years, are generally in northern or rural regions, while the populations in the highest quartile, ranging from 68.9-72.8 years, are generally in or adjacent to urban areas [13]. HALE is also strongly associated with socioeconomic status (SES). A high proportion (46%) of the variation of HALE by health region observed across Canada can be explained by differences in SES [13].

 
 
Critique

HALE is a relatively new measure of population health, but it has already illustrated a number of gendered health inequities. Overall, HALE has shown that while women are living longer than men, these additional years of life are not necessarily associated with good health. The reasons for this finding are only now being determined, but they are partially related to women’s roles in society (such as caregiving responsibilities) and partially associated with women’s genetics (such as a lower lack of protection against knee arthritis). Further investigation of these factors can help to quantify not only the length of the lives of Canadians, but also the quality of those lives as well. In this analysis, specific attention should be paid to using HALE calculated at age 65 to better understand the needs of elderly women and adjust health and social services accordingly.

*NOTE: HALE is affected by morbidity associated with any disease, condition, or other health-impacting factor. Thus, data sources from nearly all other indicators on The Source have some relevance to HALE statistics.

 
 
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