Healthy Life Expectancy Analysis

Author

Public Health Evidence & Intelligence, Hertfordshire County Council

Published

31 Jan 2024

Abstract
This briefing provides small area estimates of 2018 to 2022 healthy life expectancy (HLE) within Hertfordshire & West Essex. Current life expectancy values for male Hertfordshire residents at birth are 80.7 years of which 66.3 years are spent in good health whilst the equivalent figures for females are 84.1 and 66.3; both males and females are statistically significantly higher than the England average. However, in both metrics there is significant variation within the ICS and some areas are statistically significantly lower than the England average. This analysis explores the variation at a granular geographic level to guide interventions.

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Introduction

Life expectancy is an extremely important summary of the health of a population and can be used to track the effect of policies over a long period of time as well in distinct cohorts of the population, such as those living in more deprived areas. However, making an impact on life expectancy can be difficult; multiple factors influence the measure and changes need to be measured over multiple years. One solution to track progress in a more timely fashion is to break life expectancy down. For instance measuring premature mortality, exploring the composition of deaths, and measuring the age at which changes in health states occur are typically more directly amenable to interventions and can be expected to result in improvements to life expectancy in the longer term. This briefing explored variation in healthy life expectancy and forms part of work to provide these breakdown and aid services in measuring their impact on population health. Other products can be found here including a tool providing information on the causes of death and age groups that are driving inequalities in life expectancy.

About Healthy Life Expectancy

Healthy life expectancy (HLE) aims to define how long an individual experiences life expectancy as a period of good health. This is an important supplementary measure to life expectancy itself as those living with poor health tend to have poorer well being and have higher care needs (ONS.), 2023).

Here, healthy is based on the responses to the 2021 census, which asked respondents their general health status on a five-point scale: “Very good”, “Good”, “Fair”, “Bad”, or “Very bad”. Good health is defined as “Very Good” and “Good”, and poor health defined as the “Fair”, “Bad” or “Very bad”. These figures, for a specific geographical area are aggregated and weighted by age groups, sex, and/or other demographic variables to work out the proportion how much of that area’s average life expectancy is spent in good health.

National figures for Hertfordshire and Essex have been published however this does not provide the level of granularity services need to target their work. This work therefore provides estimates at MSOA (middle super output area) level, which typically comprise around 2,000 and 6,000 households and have a usual resident population between 5,000 and 15,000 persons. To do this however, five years worth of data has been required to ensure robust estimates. This work was carried out in collaboration with Essex County Council to create West Essex values.

Life expectancy is influenced by multiple factors. Primarily, it is influenced by mortality rates within a population. However, exogenous influences, such as the Covid-19 pandemic, health inequalities, deprivation, chronic disease prevalence and incidence, migration status are also known to affect life expectancy figures.

Healthy life expectancy on the other hand, incorporates the prevalence of self-reported good health as an additional function. For HLE, changes in self-reported good health prevalence have a larger impact on HLE than changes in mortality rates. Evidence suggests that chronic health conditions, and multimorbidity (having 2+ long term health conditions) are the main drivers of self-reported poor health. Behavioural and socioeconomic risk factors are also intertwined with HLE.

Analysis

We extracted all deaths for residents within Hertfordshire from 2018 to 2022, comprising five years of deaths data. We then joined total population level data from APS, along with general health status data from the 2021 Census. These data are then passed into a function which calculates healthy life expectancy using the Sullivan method.

One MSOA (E02004893) did not have healthy expectancy values due to small number of respondents on the census survey, thus no HLE calculation for this MSOA was performed, though a LE value was still calculated.

Results

The below plot shows the healthy life expectancy and life expectancy for each MSOA within each district of Hertfordshire and West Essex. The MSOAs within each plot are ordered from the most deprived at the top, to the least deprived at the bottom and for most areas there is a clear trend where more deprived areas have both lower life expectancy and healthy life expectancy as well as a bigger gap between the two. This means that on average someone living in a more deprived area of the ICS is likely to enter a state of poor health at a younger age, spend longer in this state, and die younger than someone in a less deprived area.

Local Authority MSOA Code Female LE Female HLE Female Gap Male LE Male HLE Male Gap
Broxbourne E02004843 83.7 71.2 12.5 80.8 68.9 11.9
Broxbourne E02004844 84.0 65.9 18.1 77.4 64.7 12.8
Broxbourne E02004845 84.9 68.6 16.3 81.3 67.5 13.8
Broxbourne E02004846 85.8 74.5 11.3 81.9 71.9 10.0
Broxbourne E02004847 82.4 66.5 15.8 81.2 67.6 13.6
Broxbourne E02004848 86.7 70.5 16.2 80.3 68.4 11.9
Broxbourne E02004849 86.5 73.1 13.4 82.8 71.5 11.3
Broxbourne E02004850 85.7 68.6 17.1 79.5 65.9 13.6
Broxbourne E02004851 82.7 65.9 16.8 79.1 63.7 15.4
Broxbourne E02004852 84.5 67.9 16.5 79.2 65.3 13.9
Broxbourne E02004853 82.3 64.7 17.6 78.0 63.8 14.1
Broxbourne E02004854 84.3 67.5 16.8 79.1 65.6 13.6
Broxbourne E02004855 81.3 62.6 18.7 74.9 59.5 15.4
Dacorum E02004856 85.2 72.4 12.8 80.8 70.1 10.7
Dacorum E02004857 87.7 74.8 12.9 81.6 71.1 10.5
Dacorum E02004858 84.0 70.3 13.7 80.1 69.0 11.1
Dacorum E02004859 87.4 76.0 11.4 82.3 72.8 9.5
Dacorum E02004860 77.9 64.5 13.3 80.5 67.3 13.2
Dacorum E02004861 87.0 74.8 12.2 83.1 73.4 9.7
Dacorum E02004862 84.4 64.8 19.5 79.1 62.4 16.7
Dacorum E02004863 80.2 61.5 18.7 74.1 59.0 15.0
Dacorum E02004864 90.9 77.1 13.7 84.1 73.6 10.5
Dacorum E02004865 86.2 68.3 17.9 81.9 67.5 14.4
Dacorum E02004866 81.5 65.3 16.3 78.2 63.8 14.4
Dacorum E02004867 84.0 72.1 11.9 81.6 71.4 10.2
Dacorum E02004868 80.8 64.6 16.2 78.0 64.0 14.0
Dacorum E02004869 85.4 74.4 11.1 80.4 71.0 9.4
Dacorum E02004870 80.8 66.3 14.5 80.4 66.2 14.3
Dacorum E02004871 86.9 69.3 17.6 82.0 67.9 14.2
Dacorum E02004872 85.8 70.7 15.1 84.0 70.7 13.4
Dacorum E02004873 86.1 72.0 14.0 82.8 71.1 11.7
Dacorum E02004874 80.9 66.0 14.9 79.1 65.7 13.4
Dacorum E02004875 82.4 65.9 16.5 78.8 65.6 13.2
Dacorum E02004876 86.8 73.0 13.8 83.7 69.9 13.8
Dacorum E02004877 87.4 72.9 14.5 81.7 71.5 10.2
East Hertfordshire E02004878 86.0 72.6 13.5 83.2 70.6 12.6
East Hertfordshire E02004879 86.0 72.3 13.7 82.3 70.3 12.0
East Hertfordshire E02004880 85.0 74.5 10.5 81.9 72.3 9.6
East Hertfordshire E02004881 85.6 72.7 13.0 83.2 72.0 11.1
East Hertfordshire E02004882 84.6 71.2 13.4 81.0 69.6 11.4
East Hertfordshire E02004883 85.7 72.5 13.2 82.1 70.8 11.3
East Hertfordshire E02004884 84.4 68.1 16.2 80.6 67.0 13.6
East Hertfordshire E02004885 84.3 71.6 12.7 83.8 72.8 11.0
East Hertfordshire E02004886 83.8 70.0 13.8 81.1 69.6 11.6
East Hertfordshire E02004887 87.7 73.7 14.1 81.9 70.9 11.1
East Hertfordshire E02004888 85.8 71.3 14.4 79.8 67.7 12.1
East Hertfordshire E02004889 82.1 68.7 13.4 79.4 67.3 12.1
East Hertfordshire E02004890 84.2 72.4 11.9 80.1 69.0 11.1
East Hertfordshire E02004891 86.2 72.3 13.9 82.7 71.2 11.5
East Hertfordshire E02004892 82.5 67.0 15.5 79.9 67.5 12.4
East Hertfordshire E02004893 84.3 NA NA 78.0 NA NA
East Hertfordshire E02004894 85.9 71.6 14.3 81.4 69.8 11.6
East Hertfordshire E02004895 85.8 71.8 13.9 81.4 70.2 11.2
Hertsmere E02004896 85.8 72.8 13.0 82.1 71.0 11.1
Hertsmere E02004897 85.6 70.8 14.8 81.5 69.6 12.0
Hertsmere E02004898 84.9 68.3 16.7 78.2 64.9 13.3
Hertsmere E02004899 81.4 68.7 12.7 78.4 66.7 11.7
Hertsmere E02004900 87.8 75.9 11.9 83.8 73.9 9.9
Hertsmere E02004901 80.4 62.8 17.6 76.7 62.2 14.4
Hertsmere E02004902 83.8 66.7 17.1 78.6 65.4 13.2
Hertsmere E02004903 86.0 70.3 15.8 79.0 66.5 12.5
Hertsmere E02004904 84.8 68.8 16.0 77.2 64.8 12.4
Hertsmere E02004905 84.2 72.3 12.0 80.2 69.7 10.4
Hertsmere E02004906 80.9 65.6 15.3 78.0 65.2 12.8
Hertsmere E02004907 86.4 72.2 14.1 80.0 69.1 10.9
Hertsmere E02004908 84.4 72.7 11.7 81.8 71.1 10.7
North Hertfordshire E02004909 84.2 67.4 16.8 80.3 67.1 13.2
North Hertfordshire E02004910 86.8 73.2 13.6 83.6 71.8 11.8
North Hertfordshire E02004911 83.0 65.0 18.0 80.5 64.9 15.6
North Hertfordshire E02004912 81.3 68.1 13.2 77.9 66.2 11.7
North Hertfordshire E02004913 84.8 71.5 13.3 82.6 70.8 11.7
North Hertfordshire E02004914 82.8 66.1 16.8 79.1 66.1 13.0
North Hertfordshire E02004915 84.1 65.2 18.9 78.2 63.9 14.3
North Hertfordshire E02004916 86.4 70.7 15.7 84.2 72.0 12.2
North Hertfordshire E02004917 83.1 66.8 16.3 81.2 67.1 14.2
North Hertfordshire E02004918 83.6 68.3 15.2 81.2 67.8 13.4
North Hertfordshire E02004919 85.7 68.9 16.9 81.1 68.4 12.7
North Hertfordshire E02004920 84.1 69.6 14.5 81.0 69.2 11.8
North Hertfordshire E02004921 84.3 72.1 12.2 82.1 71.7 10.3
North Hertfordshire E02004922 85.3 71.3 14.1 80.0 68.5 11.4
North Hertfordshire E02004923 82.9 71.4 11.5 80.4 70.2 10.2
St Albans E02004924 88.2 75.0 13.2 83.2 73.8 9.4
St Albans E02004925 85.4 72.8 12.6 82.0 70.9 11.1
St Albans E02004926 87.1 76.5 10.6 84.2 76.1 8.1
St Albans E02004927 85.8 73.5 12.3 84.4 72.8 11.6
St Albans E02004928 88.5 78.1 10.4 83.2 74.9 8.2
St Albans E02004929 85.1 72.1 13.0 82.9 71.6 11.3
St Albans E02004930 83.8 70.9 12.9 81.6 71.1 10.5
St Albans E02004931 87.3 73.5 13.8 81.6 70.3 11.3
St Albans E02004932 81.8 66.9 14.8 79.7 67.0 12.7
St Albans E02004933 88.2 76.7 11.6 83.9 74.7 9.2
St Albans E02004934 83.3 71.5 11.8 80.5 70.1 10.4
St Albans E02004935 84.2 71.9 12.3 80.5 69.1 11.4
St Albans E02004936 86.1 72.8 13.3 83.3 71.8 11.5
St Albans E02004937 85.5 75.5 10.1 82.9 73.4 9.6
St Albans E02004938 84.7 70.4 14.3 80.1 67.2 13.0
St Albans E02004939 86.2 70.4 15.8 79.2 67.2 12.0
St Albans E02004940 83.7 68.1 15.7 77.9 65.8 12.1
St Albans E02004941 84.7 69.0 15.8 80.3 67.5 12.9
St Albans E02004942 85.8 72.4 13.4 81.1 69.4 11.7
St Albans E02004943 84.9 72.2 12.7 80.9 70.9 9.9
Stevenage E02004944 84.3 65.0 19.3 78.7 63.5 15.2
Stevenage E02004945 81.9 67.5 14.3 79.8 67.2 12.6
Stevenage E02004946 81.5 64.5 16.9 78.1 62.6 15.5
Stevenage E02004947 86.7 71.6 15.1 81.8 69.3 12.5
Stevenage E02004948 86.6 65.9 20.6 79.9 64.8 15.0
Stevenage E02004949 82.1 64.5 17.6 77.7 62.7 15.0
Stevenage E02004950 83.4 66.1 17.4 81.3 67.7 13.6
Stevenage E02004951 81.8 62.6 19.2 79.3 62.8 16.5
Stevenage E02004952 80.7 65.6 15.1 77.6 64.5 13.1
Stevenage E02004953 84.1 64.9 19.2 81.6 64.2 17.4
Stevenage E02004954 82.0 64.3 17.7 77.9 63.0 14.9
Stevenage E02004955 84.3 67.8 16.5 82.2 67.2 15.0
Three Rivers E02004956 85.2 71.1 14.1 82.5 70.3 12.2
Three Rivers E02004957 87.9 70.9 17.0 81.0 67.2 13.8
Three Rivers E02004958 87.5 74.5 13.1 82.9 72.0 10.9
Three Rivers E02004959 84.3 74.6 9.7 83.7 74.2 9.5
Three Rivers E02004960 87.8 76.9 10.9 83.4 73.0 10.4
Three Rivers E02004961 85.5 72.5 13.0 82.6 72.4 10.2
Three Rivers E02004962 84.1 71.6 12.5 80.7 69.8 10.9
Three Rivers E02004963 82.7 67.0 15.6 79.9 66.6 13.2
Three Rivers E02004964 83.5 68.1 15.4 79.1 65.3 13.8
Three Rivers E02004965 84.3 68.4 15.9 81.1 67.5 13.7
Three Rivers E02004966 86.7 75.5 11.2 82.6 72.9 9.7
Three Rivers E02004967 79.8 68.7 11.1 76.7 67.0 9.7
Watford E02004968 83.5 66.9 16.6 78.1 64.9 13.2
Watford E02004969 83.3 67.9 15.4 81.0 67.7 13.4
Watford E02004970 82.7 66.1 16.6 77.0 63.3 13.7
Watford E02004971 81.0 65.6 15.4 79.1 65.7 13.4
Watford E02004972 84.7 70.2 14.5 82.5 69.9 12.7
Watford E02004973 86.0 67.3 18.7 80.5 65.6 15.0
Watford E02004974 81.7 68.5 13.2 80.7 70.3 10.4
Watford E02004975 86.5 73.2 13.3 84.1 73.0 11.2
Watford E02004976 83.6 65.1 18.6 76.8 62.1 14.7
Watford E02004977 82.1 66.0 16.1 77.8 64.8 12.9
Watford E02004978 79.8 62.5 17.2 73.4 61.0 12.4
Watford E02004979 84.7 69.8 14.9 82.1 68.6 13.5
Welwyn Hatfield E02004980 91.9 75.9 16.0 85.0 73.8 11.2
Welwyn Hatfield E02004981 85.0 71.0 14.0 83.9 72.5 11.4
Welwyn Hatfield E02004982 87.6 71.5 16.0 84.2 71.5 12.7
Welwyn Hatfield E02004983 84.7 67.2 17.5 80.9 64.8 16.1
Welwyn Hatfield E02004984 81.6 66.6 15.0 78.6 65.6 12.9
Welwyn Hatfield E02004985 86.2 71.7 14.4 81.1 69.0 12.1
Welwyn Hatfield E02004986 80.4 62.1 18.3 78.0 62.2 15.9
Welwyn Hatfield E02004987 82.3 67.6 14.7 80.5 67.8 12.7
Welwyn Hatfield E02004988 83.3 66.7 16.6 78.6 64.1 14.5
Welwyn Hatfield E02004989 79.7 65.1 14.5 77.9 65.5 12.4
Welwyn Hatfield E02004990 83.6 68.2 15.4 79.2 67.0 12.2
Welwyn Hatfield E02004991 80.0 63.8 16.2 77.0 62.9 14.1
Welwyn Hatfield E02004992 79.6 64.8 14.8 77.5 63.2 14.3
Welwyn Hatfield E02004993 86.8 70.7 16.0 77.8 65.5 12.3
Welwyn Hatfield E02004994 88.8 75.8 13.0 84.6 74.6 9.9
Welwyn Hatfield E02004995 88.1 74.3 13.8 84.2 73.3 10.8
Epping Forest E02004527 84.6 71.4 13.1 81.3 69.7 11.6
Epping Forest E02004528 86.4 71.8 14.7 81.3 69.5 11.8
Epping Forest E02004529 86.0 72.0 14.1 81.8 69.7 12.1
Epping Forest E02004530 84.9 70.0 14.8 81.5 68.2 13.3
Epping Forest E02004531 84.3 70.9 13.4 79.5 68.0 11.5
Epping Forest E02004532 85.2 71.4 13.8 80.9 69.6 11.2
Epping Forest E02004533 80.5 64.1 16.4 74.5 62.0 12.5
Epping Forest E02004534 84.3 66.9 17.3 80.6 67.1 13.5
Epping Forest E02004535 81.6 66.0 15.6 78.2 63.6 14.6
Epping Forest E02004536 83.7 71.1 12.7 81.9 70.5 11.4
Epping Forest E02004537 83.8 65.2 18.5 77.6 63.3 14.3
Epping Forest E02004538 85.7 73.5 12.2 81.4 70.9 10.5
Epping Forest E02004539 84.4 69.3 15.2 79.7 66.7 13.0
Epping Forest E02004540 85.5 71.9 13.6 83.0 71.1 11.9
Epping Forest E02004541 84.2 71.9 12.2 80.9 70.2 10.7
Epping Forest E02004542 88.6 73.4 15.2 82.4 70.6 11.8
Epping Forest E02004543 81.7 67.8 13.9 79.8 68.6 11.2
Harlow E02004544 85.1 69.8 15.3 80.8 67.5 13.2
Harlow E02004545 81.6 62.3 19.3 78.8 62.0 16.8
Harlow E02004546 80.8 61.6 19.1 78.6 62.9 15.7
Harlow E02004547 80.5 62.8 17.7 77.1 62.9 14.1
Harlow E02004548 85.1 69.3 15.8 84.8 71.0 13.8
Harlow E02004549 81.4 62.3 19.1 79.3 63.9 15.5
Harlow E02004550 82.4 63.4 19.0 76.3 61.0 15.2
Harlow E02004551 81.6 62.0 19.6 76.8 60.9 15.9
Harlow E02004552 83.4 67.0 16.4 79.1 64.4 14.6
Harlow E02004553 82.6 63.5 19.0 77.8 62.0 15.8
Harlow E02004554 83.8 65.8 18.0 77.7 63.6 14.1
Uttlesford E02004591 87.0 74.6 12.3 85.6 75.1 10.5
Uttlesford E02004592 85.5 71.5 14.0 81.7 69.4 12.3
Uttlesford E02004593 90.1 76.1 14.0 83.4 73.4 10.0
Uttlesford E02004594 85.4 71.7 13.7 83.1 72.0 11.0
Uttlesford E02004595 85.3 72.2 13.1 82.3 71.8 10.5
Uttlesford E02004596 84.8 70.8 14.0 82.8 70.0 12.8
Uttlesford E02004597 87.6 74.3 13.3 81.2 70.4 10.7
Uttlesford E02004598 83.9 72.0 11.9 82.8 71.4 11.4
Uttlesford E02004599 84.9 72.6 12.2 83.8 71.8 12.0

Map of Healthy Life Expectancy

Note there is a small part of North Hertfordshire which is part of Cambridgeshire and Peterborough ICS.

Note there is a small part of North Hertfordshire which is part of Cambridgeshire and Peterborough ICS.

Using These Results

Services wanting a measure of strategic success may wish to use healthy life expectancy or other life expectancy breakdown measurements within their outcomes frameworks as a metric that may be more amenable than overall life expectancy. Services may additionally want to consider setting objectives around closing the gaps that exist between different demographic groups such as those living in deprived areas, those dying of specific conditions, or sex differences.

Further work is planned to drill down further in life expectancy to assist services potentially including work to identify different causes by which people move from good to poor health and ways to quantify wellbeing, another important part of helping residents live healthy and fulfilling lives.