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General Health Status
Measures of general health status provide information on the health of a population. Throughout the decade, Healthy People 2020 will assess the general health status of the U.S. population by monitoring:
Life expectancy is a summary mortality measure often used to describe the overall health status of a population. Life expectancy is defined as the average number of years a population of a certain age would be expected to live, given a set of age-specific death rates in a given year.
Healthy People 2020 monitors 2 life expectancy measures:
Life expectancy at birth
Life expectancy at age 65
International Comparison of Life Expectancy Life expectancies are 1 of the most commonly used measures for international health comparison. In 2007, the United States ranked 27th and 26th out of 33 countries within its peer group of Organization for Economic Co-operation and Development (OECD) countries, for life expectancy at birth for females and males, respectively.
Healthy life expectancy is the average number of healthy years a person can expect to live if age-specific death rates and age-specific morbidity rates remain the same throughout his or her lifetime. Thus, healthy life expectancy is a snapshot of current death and illness patterns and can illustrate the long-range implications of the prevailing age-specific death and illness rates. The measure allows for easy comparisons across populations and over long periods of time.
Healthy People 2020 tracks healthy life expectancy using 3 measures:
Expected years of life in good or better health
Expected years of life free of limitation of activity
Expected years of life free of selected chronic diseases
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YPLL is a summary measure of premature mortality (early death). It represents the total number of years not lived by people who die before reaching a given age. Deaths among younger persons contribute more to the YPLL measure than deaths among older persons.
YPLL is based on the number of deaths at each age up to some limit. For example, in the United States, the age limit is often placed at 75. People who die before age 75 are defined as having lost some potential years of life. YPLL has declined in the United States over the past decades.
International Comparison of Years of Potential Life Lost Although YPLL statistics have improved in the United States, they are often higher than those of comparable countries and even some less wealthy nations. For the 31 OECD countries for which recent data were available, the United States ranked 29th for females and 27th for males.
Years of Potential Life Lost by Cause of Death YPLL can be calculated from deaths from all causes or as a cause-specific measure. In the United States, cancer is the second leading cause of death but accounts for the largest YPLL per 100,000 for both males and females. Deaths from motor vehicle accidents are the second leading cause of YPLL for both sexes.
Physically and mentally unhealthy days measure the number of days in the past 30 days that individuals rated their physical or mental health as not good. In 2008, individuals in the United States reported on average 3.6 physically unhealthy days and 3.4 mentally unhealthy days in the past 30 days.
Physically unhealthy days increased with age. In 2008, adults ages 18 to 24 reported an average of 2.1 physically unhealthy days, while adults age 75 and older reported 6.0 days.
Mentally unhealthy days decreased with age in the older groups. In 2008, adults ages 18 to 24 reported an average of 4.0 mentally unhealthy days in the past 30 days, while adults age 75 and older reported 2.0 days.
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Self-assessed health status is a measure of how an individual perceives his or her health—rating it as excellent, very good, good, fair, or poor. Self-assessed health status has been validated as a useful indicator of health for a variety of populations and allows for broad comparisons across different conditions and populations.1 In 2007, 9.5 percent of individuals in the United States reported their health to be fair or poor.
Self-assessed health status varies by age, with 26.8 percent of individuals age 65 and older reporting fair or poor health.
Limitation of activity refers to a long-term reduction in a person’s ability to do his or her usual activities. Since 1997, in the National Health Interview Survey, limitation of activity has been assessed by asking people about their limitations in:
Activities of daily living (such as bathing/showering, dressing, eating, getting in and out of bed, walking, using the toilet)
Instrumental activities of daily living (such as using the telephone, doing light housework, doing heavy housework, preparing meals, shopping for personal items, managing money)
Play, school, or work
Remembering
Any other activity that they cannot do because of limitations caused by physical, mental, or emotional problems
In 2006, 5.5 percent of adults ages 18 to 44 had a limitation of activity, while 7.3 percent of children under age 18 and 32.6 percent of noninstitutionalized adults age 65 and older had a limitation of activity.
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Chronic diseases are the leading cause of death and disability in the United States. They cause 7 out of 10 deaths each year. Heart disease, cancer, and stroke alone cause more than 50 percent of all deaths each year.2
In 2008, 107 million Americans—almost 1 out of every 2 adults age 18 or older—had at least 1 of 6 reported chronic illnesses:
Cardiovascular disease
Arthritis
Diabetes
Asthma
Cancer
Chronic obstructive pulmonary disease (COPD)
References
1 Idler E, Benyamini Y. Self-rated health and mortality: A review of 28 studies. J Health Soc Behav. 1997;38(1):21-37.
2 Heron MP, Hoyert DL, Murphy SL, et al. Deaths: Final data for 2006. Natl Vital Stat Rep. 2009;57(14). Hyattsville, MD: National Center for Health Statistics.
Life Expectancy Xu JQ, Kochanek KD, Murphy SL, et al. Deaths: Final data for 2007. Natl Vital Stat Rep. 2010;58(10). Hyattsville, MD: National Center for Health Statistics.
Healthy Life Expectancy Anderson RN. Method for constructing complete annual U.S. life tables. Vital Health Stat. 1999;2(129):1-28. Hyattsville, MD: National Center for Health Statistics.
Idler E, Benyamini Y. Self-rated health and mortality: A review of 28 studies. J Health Soc Behav. 1997;38(1):21-37.
Molla MT, Madans JH, Wagener DK, et al. Summary measures of population health: Report of findings on methodologic and data issues. Hyattsville, MD: National Center for Health Statistics; 2003.
Sullivan DF. A single index of mortality and morbidity. HSMHA Health Rep. 1971;86:347-54.
Sullivan DF. Disability components for an index of health. Vital Health Stat. 1971;2(42). Hyattsville, MD: National Center for Health Statistics.
Years of Potential Life Lost Centers for Disease Control and Prevention. Premature mortality in the United States: Public health issues in the use of years of potential life lost. MMWR. 1986;35(2S):1s-11s. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/00001773.htm
Physically and Mentally Unhealthy Days Centers for Disease Control and Prevention. Measuring healthy days: Population assessment of health-related quality of life. Atlanta: U.S. Department of Health and Human Services; 2000.
Dominick KL, Ahern FM, Gold CH, et al. Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging Clin Exp Res. 2002;14:499-508.
Institute of Medicine (IOM). State of the USA health indicators: Letter report. Washington: IOM; 2008 Dec 9. Available from: http://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspx
Jia H, Lubetkin EI. Estimating EuroQol EQ-5D scores from population Healthy Days data. Med Decis Making 2008;28:491-9.
Moriarty DG, Kobau R, Zack M, et al. Tracking Healthy Days—a window on the health of older adults. Prev Chronic Dis. 2005;2(3):A16.
Self-Assessed Health Status Idler E, Benyamini Y. Self-rated health and mortality: A review of 28 studies. J Health Soc Behav. 1997;38(1):21-37.
Limitation of Activity Altman B, Bernstein A. Disability and health in the United States, 2001–2005. Hyattsville, MD: National Center for Health Statistics; 2008.
Brandt EN, Pope AM. Enabling America: Assessing the role of rehabilitation science and engineering. Washington, DC: National Academies Press; 1997.
Pastor PN, Reuben CA, Loeb M. Functional difficulties among school-aged children: United States, 2001–2007. Natl Health Stat Rep. 2009;(19):1-23. Hyattsville, MD: National Center for Health Statistics.
World Health Organization (WHO). International classification of functioning, disability and health. Geneva: WHO; 2001.
Chronic Disease Prevalence Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System (BRFSS) prevalence and trends data [Internet]. Atlanta: CDC; 2008. Available from: http://apps.nccd.cdc.gov/brfss/page.asp?cat=AC&yr=2007&state=US#AC
Heron MP, Hoyert DL, Murphy SL, et al. Deaths: Final data for 2006. Natl Vital Stat Rep. 2009;57(14). Hyattsville, MD: National Center for Health Statistics.
Institute of Medicine (IOM). State of the USA health indicators: Letter report. Washington: IOM; 2008 Dec 9. Available from: http://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspx
National Center for Health Statistics. Health, United States, 2009. With special feature on medical technology. Hyattsville, MD: National Center for Health Statistics; 2009. Available from: http://www.cdc.gov/nchs/data/hus/hus09.pdf [PDF - 10.3 MB]
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