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Health at a Glance 2009: OECD Indicators
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branch 1. Health Status
  branch 1.11. Perceived health status

Most OECD countries conduct regular health surveys which allow respondents to report on different aspects of their health. A commonly-asked question relates to self-perceived health status, of the type: "How is your health in general?" . Despite the subjective nature of this question, indicators of perceived general health have been found to be a good predictor of people's future health care use and mortality (for instance, see Miilunpalo et al., 1997). For the purpose of international comparisons however, cross-country differences in perceived health status are difficult to interpret because responses may be affected by differences in the formulation of survey questions and responses, and by cultural factors.

Keeping these limitations in mind, in half of the 30 OECD countries, three-quarters or more of the adult population rate their health to be good or very good or excellent (Figure 1.11.1). New Zealand, Canada and the United States are the three countries that have the highest percentage of people assessing their health to be good or very good, with about nine out of ten people reporting to be in good health. But the response categories offered to survey respondents in these three countries are different from those used in European countries and in OECD Asian countries, which introduces an upward bias in the results (see box on "Definition and deviations" below).

In Spain and Finland, about two-thirds of the adult population rate their health to be good or very good. At the lower end of the scale, less than half of the adult population in Japan, the Slovak Republic, -Portugal, Hungary and Korea rate their health to be good or very good.

Focusing on within-country differences, in the majority of countries, men are more likely than women to rate their health as good or better, and especially so in -Hungary, Korea, Portugal, Spain and Turkey (Figure 1.11.2). Only in Australia, New Zealand and Finland do women rate their health as good or better more often. Unsurprisingly, people's rating of their own health tends to decline with age. In many countries, there is a parti-cularly marked decline in a -positive rating of one's own health after age 45 and a further decline after age 65. People with a lower level of education or income do not rate their health as -positively as people with higher -levels in all OECD countries (Mackenbach et al., 2008).

The percentage of the adult population rating their health as being good or very good has remained -reasonably stable over the past 25 years in most -countries where long time series are available, although some, such as Japan, have shown variation (Figure 1.11.3). The same is generally true for the population aged 65 and over. One possible interpretation of the relative stability of the indicator of perceived general health may be related to how it is measured - that is, based on a bounded variable (i.e. respondents are asked to rank their health on a five-point scale that is unchanged over time), whereas life expectancy is measured without any such limit. Another interpretation may be that people in these countries are living longer now, but possibly not healthier.

Definition and deviations

Perceived health status reflects people's overall perception of their health, and may reflect all physical and psychological dimensions. Typically, survey respondents are asked a question such as: "How is your health in general? Very good, good, fair, poor, very poor" . OECD Health Data provides figures related to the proportion of people rating their health to be "good/very good" combined.

Caution is required in making cross-country -comparisons of perceived health status, for at least two reasons. First, people's assessment of their health is subjective and can be affected by factors such as cultural background and national traits. Second, there are variations in the -question and answer categories used to measure perceived health across surveys/countries. In particular, the response scale used in the United States, Canada, New Zealand and Australia is asymmetric (skewed on the positive side), including the following response categories: "excellent, very good, good, fair, poor" . The data reported in OECD Health Data refer to respondents answering one of the three positive responses ( "excellent, very good or good" ). By contrast, in most other OECD countries, the response scale is symmetric, with response categories being: "very good, good, fair, poor, very poor" . The data reported from these countries refer only to the first two categories ( "very good, good" ). Such a difference in response categories biases upward the results from those countries that are using an asymmetric scale.

 
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Figures
1.11.1. Percentage of adults reporting to be in good health, females and males combined, 2007 (or latest year available) Figure in Excel
Percentage of adults reporting to be in good health, females and males combined, 2007 (or latest year available)
1.11.2. Gender differences in the percentage of adults reporting to be in good health, 2007 (or latest year available) Figure in Excel
Gender differences in the percentage of adults reporting to be in good health, 2007 (or latest year available)
1.11.3. Trends in the percentage of adults reporting to be in good health, selected OECD countries, 1980-2007 Figure in Excel
Trends in the percentage of adults reporting to be in good health, selected OECD countries, 1980-2007