ABOUT THE INDEX

The Healthy Ageing and Prevention Index offers a unique and holistic perspective to understanding population health, not just through health metrics but also through an economic and environmental lens.

We want this programme of work to sit at the heart of global policy and political engagement on prevention and healthy ageing.

We will use the Healthy Ageing and Prevention Index as a tool to:
1. Hold Governments to account by tracking progress on prevention and healthy ageing.
2. Engage leading global health leaders including at the G7 and G20 to move from commitment to action on preventative health.
3. Support the Healthy Ageing and Prevention Coalition’s calls to action.

The Index gives us a comprehensive picture of how well countries perform against key healthy ageing metrics. These are the issues that matter to policy makers most. The Healthy Ageing and Prevention Index measures and ranks 121 countries against six metrics: life span, health span, work span, income, environmental performance, and happiness.

These indicators give us a comprehensive picture of the extent to which different governments are investing in efforts to prevent ill health and support healthy ageing. We take a broad view of healthy ageing, based on evidence from wider literature and global policy developments that includes the UN Decade of Healthy Ageing.

Healthy ageing isn’t just about the number of additional years people live, but: how many of those years are spent in good health; the opportunities for individuals to work and have an income that helps them meet their needs; the opportunity to live in an environment where they can live dignified and healthy lives; and the opportunity to do the things they value and to live fulfilled and enriched lives.

By combining these metrics, we can compare countries that are doing well and are on a sustainable path, with others that may be less so. We can also pinpoint key action areas by country and best practice.

Over time, we will compare each country’s ranking in the Index to specific policy interventions and country-by-country progress, to identify which interventions are linked to improvements in the Index.

WHY DEVELOP THIS INDEX?

This Index brings together health, wealth and societal metrics for the first time, to give us a comprehensive picture of sustainable longevity in different countries, and whether they’re investing in interventions that will help people live well for longer in the long term. The Index builds on existing indices, such as the Yale Environmental Performance Index (EPI). It includes metrics like happiness and environmental conditions, which hasn’t been done before. It also presents data in an accessible and easy to understand format, saving users from having to retrieve data from individual sources.

Most importantly, in addition to ranking individual countries on their performance, the Index also ranks political and economic country blocs, such as the G20, EU and OECD. This information gives stakeholders another way of demanding action on sustainable longevity from their governments. The Index can function as a roadmap for ministers to set their national priorities and measure their success.

THE INDEX METRICS

The Index uses pre-COVID baseline data from 2019, which is the latest, most complete dataset currently available. However, as new data becomes available, the Index will track progress over time.

The six metrics are:

LIFE SPAN

This is the number of years an individual can expect to live. This is measured at birth in years, using life expectancy measures obtained from WHO.

The top five countries in 2019 were Japan (84.3), Switzerland (83.4), South Korea (83.3), Spain and Singapore (83.2).

HEALTH SPAN

This is the number of years an individual can expect to spend in good health. This is measured at birth in years, using health expectancy measures obtained from WHO.

The top five countries in 2019 were Japan (74.1), Singapore (73.6), South Korea (73.1), Switzerland (72.5), and Israel (72.4).

WORK SPAN

This is defined as the expected number of years spent being economically active. For this metric we use the labour force participation rate. We use 15 as our lower age limit and 65 as our upper age limit. The upper age limit is the average effective age of retirement in countries in the Index.

We translate this percentage figure into a number of years. For instance, if everyone in a given population were to be in work between the ages of 15 and 65, that country’s average work span would be 50 years across the life course. However, if only half of that population were to be in work (50%), the average work span would be only 25 years across the life course.

Data are obtained from the World Bank and the International Labour Organisation.

The top five countries in 2019 were Cambodia (43.7), Ethiopia (40.7), Eritrea (40.6), Burundi, (39.5) and Laos (39.4).

INCOME

This is measured by GDP per capita, using purchasing power parity (ppp), with data obtained from the World Bank.

We use GDP per capita as a measure of economic wellbeing and standard of living. GDP is a measure of the size and health of a country’s economy over a period of time (usually one year) and is based on the total value of all finished goods and services.

GDP is also used to compare the size of different economies at different points in time. We use ppp to ensure comparability between countries. This takes into account the relative cost of local goods, services and inflation rates of the country, rather than using international market exchange rates, which may distort the real differences in per capita income.

The top five countries in 2019 were Luxembourg (120.96), Singapore (101.94), Ireland (89.43), Switzerland (73.11), and Norway (68.35).

ENVIRONMENTAL PERFORMANCE

This is measured using the Yale Environmental Performance Index (EPI) which positions countries on a scale of 0 to 100 (100=best).

The EPI ranks countries against 40 performance indicators across 11 issue categories and three themes: climate change performance, environmental health and ecosystem vitality.

The global average EPI rating is 48.8; the top five countries in 2020 were Denmark (82.5), Luxembourg (82.3), Switzerland (81.5), the UK (81.3), and France (80).

We use 2020 data in our Index because the EPI is released only every two years, making 2019 data unavailable, with the most recent release in 2022.

HAPPINESS

Happiness positions countries on a scale of 0-10. Scores of 0-4 are interpreted as “suffering”, 5-7 as “struggling”, and 8-10 as “thriving”.

Data are taken from the annual Gallup World Poll, which asks respondents to think of a ladder and rate their current lives on the 0-10 scale. Rankings are from nationally representative samples. The UN creates reports from these polls, from which we obtain the data.

The top five countries in 2019 were Finland (7.8), followed by Switzerland (7.694), Denmark (7.693), Iceland (7.5), and Norway (7.4).

HOW WE DEVELOPED
THE INDEX

We sought a simple way of combining information on living standards, health and life span, working lives, the quality of the environment, and life satisfaction. We found that simply ranking countries against the individual indicators from ‘best’ to ‘worst’ performing and then ranking their performance against all the indicators combined was the most straightforward and fair way to compare countries’ performance.

STEP 1

Countries are categorised from ‘best’ to ‘worst’ for each individual metric. We use the original values from the relevant data source for each metric except work span (for further details on this metric, see above section “work span”).

STEP 2

We assign each country a numerical rank for that metric.

Below is a visual representation of steps one and two, using the life span metric as an example. Country Y and country X are the two best-performing countries in the Index. In this example, we can see that despite being the best-performing countries across all metrics, they are ranked 2nd and 14th on life expectancy. This is because we are looking at one metric in isolation. When we take their performance across all six metrics, their average performance pushes them to the top of the Index.

Example: ranking the life span metric for the top two countries in the Index

Country

Step 1: categorising values from ‘best’ to ‘worst’

Step 2: numerical rank

Country Y

83.4

2

Country X

82.3

14

We repeat steps one and two for all six indicators for all 121 countries.

STEP 3

We then take the sum of these numerical ranks for each country to generate an overall score for each country.

Example: Generating a country score for the top two performing countries on the Index.

 

Country

Life span

Health span

Work span

Income

Environmental performance

Happiness

COUNTRY SCORE

Country Y

2

4

25

4

3

2

40

Country X

14

9

11

9

17

4

64

STEP 4

Aggregated country scores are then assigned a further and final numerical rank. The smaller the total score, the higher the rank.

Example: final ranking assigned from aggregated country scores for the top two countries in the Index

Country

Life span

Health span

Work span

Income

Environmental performance

Happiness

Country score

RANK

Country Y

2

4

25

4

3

2

40

1

Country X

14

9

11

9

17

4

64

2

 

In our Index, life span is always higher than health span which in turn is higher than work span. Life and health span are highly correlated and work span is more strongly correlated with health span than life span. Across the Index, life span outcomes vary considerably more than health and work span outcomes.

Countries that achieve the same combined score hold the same position in the global ranking, such as Australia, Luxembourg, and Netherlands, which are all ranked 6th.

In deriving the Index we chose not to weight each metric for importance, as there’s no ‘right’ way to do this. Some will argue that income is the most important, while others happiness or health. Instead we give all indicators equal weight as contributors to global health and well-being. When developing the political and economic bloc rankings, we apply population weights.

Countries included in the Index are selected primarily on the basis of their population size – the cut-off for minimum population size is two million. Of our 121 countries, 114 (95%) have populations in excess of this figure. But to ensure the Index is representative of the global economy we also include seven countries with a smaller population, but where the average per capita income is $30,000 a year or more. This includes countries such as Luxembourg and Malta.

There are 11 countries with incomplete data on one or more of the metrics. Where this occurs, the countries concerned are given a value of zero and are ranked accordingly. If only one country is missing a value, the country concerned would be ranked 121, the lowest possible value for that metric. In the case of environmental performance data, four countries have missing values each of which is therefore ranked 118 making this the lowest possible value. Missing values are also reflected in the combined score based on all measures and therefore fall near the bottom of the Index. The Index will be updated as data becomes available.

Metrics with missing country data include: Income (six countries), Environmental performance (four countries), and Happiness (seven countries)

Countries with missing data include: Angola (Happiness), Brunei (Happiness), Central African Republic (Happiness), Cuba (Income), Eritrea (Income), North Korea (Income, Environmental performance, and Happiness), Libya (Environmental performance), Sudan (Happiness), Syria (Income, Environmental performance, and Happiness), Venezuela (Income) and Yemen (Income and Environmental performance).

For further information on the methods and developing the Index, you can read our publication: Introducing the Healthy Ageing and Prevention Index

 

The programme so far:
2019-2022

ILC has established itself at the forefront of the global prevention debate. We have engaged with political leaders, policymakers and experts from across the globe to understand not only “why” we ought to prioritise prevention across the life course but “how” we can deliver it. As a result:

  • We helped convince G20 Ministers in Japan to commit to a joint focus on the prevention of ill health across the life course in 2019.
  • We informed the WHO’s and UN’s joint Decade of Healthy Ageing (2020-2030), as well as the WHO Immunisation Agenda 2030, which led to a new chapter on life course and adult immunisation being added.
  • We fed into the Department of International Trade’s White Paper on Healthy Ageing. 
  • We were selected to write a policy paper that informed the G20 in Italy on the role of prevention in global health and the management of the COVID-19 pandemic.
  • ILC’s policy recommendation was adopted in the 2022 changes to the NICE guidelines, recommending that an adult’s waist should be less than half their height to reduce health risks.

Explore our News and resources section to see all of our previous and upcoming publications and activities.