Health Health Article

HEALTH INDICATORS

The health of potential military recruits and applicants for life insurance is assessed by their past history of illness and harmful behavior (e.g., smoking), and by a physical examination that includes blood pressure, tests of exercise tolerance, and other measures. Similar methods can be used to assess the health of a nation. The physical examinations of military conscripts early in the twentieth century provided evidence of the poor health of the British working classes, and which in turn motivated the government to introduce the first tax-supported medical services. In the United States, the National Health Surveys provide information about the health status of Americans (such as the increasingly prevalent obesity among young people). But this is a costly way to assess a nation's health. Traditionally, health care professionals have relied on summary statistics, especially life expectancy, which is derived from the age distribution of the population as determined by a national census. Life expectancy at birth is particularly sensitive to infant mortality, which is another widely used indicator of a nation's level of health.

More sensitive indicators take into account the available evidence on commonly occurring disabling diseases to derive summary statistics such as disability-adjusted life years. Health measurement scales are more elaborate derivatives of disability-based health indicators. These require the use of questionnaires, interviews, and sometimes physical examination of individuals to derive a numerical score for particular aspects of health such as an ability to climb stairs, shop for food, prepare meals, get dressed unaided, or drive a car. Standardized interviews can also be used to derive a numerical score for aspects of mental health, social interaction with others, and employability. When all available health indicators are complied, various conclusions can be drawn. They show, for example, that Japan, Australia, Sweden, the Netherlands, and Canada are among the world's healthiest nations; while Sierra Leone, Mozambique, and Malawi are in many respects the least healthy. The United States is among the top twenty nations according to some indicators, and among the top twenty-five according to others. But no nation has a monopoly on indicators of good health. If athletic prowess is an indicator, African Americans consistently outperform all others in sprints, while Africans from Kenya outperform all others in middle- and long-distance running. Some small nations in the mountainous Caucasus region between the Caspian Sea and the Black Sea, in the

Table 1

foothills of Mount Ararat, are famous for many authenticated cases of extreme longevity, and they may have the world's highest proportion of persons surviving to ages over one hundred. Yet these same nations have relatively high infant and childhood mortality rates, as well as high death rates from causes associated with violence.

Determining which nations are healthy depends on which health indicators are looked at. The Netherlands, for example, ranks at the top using indicators of health quality—literacy levels, low incidence of abortion and unwanted pregnancy, low incidence rates of impairments, disabilities, and handicaps—though other countries may rank higher in terms of longevity and other indicators.

Table 1 shows the ranking of various nations based on years of healthy life expectancy or disability-adjusted life years, the age to which on average people are expected to live in good health. This number is reached by subtracting the average years of ill health from the overall life expectancy. The top nations are Japan, Australia, and France; the bottom three are Malawi, Niger, and Sierra Leone. The United States is twenty-fourth on this list, though it is the richest nation on earth in terms of economic indicators. The poorest fifth of residents in the United States have a healthy life expectancy of just fifty-five years, compared to seventy years for the nation as a whole. Clearly there is room for considerable improvement.