8.2. Self-reported health and disability at age 65
Most OECD countries conduct regular
health surveys which allow respondents to report on different aspects of their health. A
question that is often found among such surveys relates to self-perceived health status,
and is usually similar to: "How is your health in general?" .
Although these questions are subjective, indicators of perceived general health have been
found to be a good predictor of people's future health care use and mortality (see
Miilunpalo et al., 1997). However, cross-country
differences in perceived health status may be difficult to interpret. This is because
survey questions may differ slightly, and cultural factors can affect responses.
Keeping these limitations in mind,
more than half of the population aged 65 years and over rate their health to be good or
better in 12 of the 31 OECD countries for which data are available (Figure 8.2.1). New Zealand, the United States, Canada have the highest
percentage of older people assessing their health to be good or better, with at
least three out of four 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
most other OECD countries, introducing an upward bias in the results (see box on
"Definition and comparability" ).
In Israel and Spain, around 40% of
persons aged 65 years and over rate their health as good. In Poland, Portugal and Estonia,
the figure was less than 15%. In almost all countries, men over 65 were more likely than
women to rate their health as good or better, the exceptions being Australia and Chile. On
average across OECD countries, 49% of men aged over 65 rate their health to be good or
better, while 42% of women do so.
The percentage of the population
aged 65 years and over who rate their health as being good or better has remained fairly
stable over the past 30 years in most countries where long time series are available. Some
improvement is evident in the United States, where the share has increased from 70%
in 1980 to 76% in 2009.
Measures of disability are not yet
standardised across countries. In Europe, based on the EU Survey of Income and Living
Conditions, 43% of people aged between 65 and 74 years reported that they were limited in
their usual daily activities because of a health problem in 2009, this being one common
definition of disability. The proportion rises to 60% for people aged 75 and over (Figure 8.2.2). While a large proportion of the population reported only
moderate activity limitation, over 14% aged 65-74 years, and 25% aged 75 years and over
reported being severely limited, on average among a group of 24 European OECD countries.
Severe activity limitations are more likely to create needs for long-term care, whether
formal or informal.
People in Nordic countries reported
the lowest level of moderate or severe disability, with the exception of Finland, where
self-reported disability rates are higher and close to the European average. The highest
rate of self-reported disability rates are in the Slovak Republic, followed by Portugal
Definition and comparability
Self-reported health reflects
people's overall perception of their own health, including both 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 cultural
factors. 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 Australia, Canada, New Zealand and the United States 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
difference in response categories biases upward the results from those countries that
are using an asymmetric scale.
Perceived general disability is
measured in the EU-SILC survey through the question: "For at least the
past six months, have you been hampered because of a health problem in activities
people usually do? Yes, strongly limited/Yes, limited/No, not
limited" . Persons in institutions are not surveyed, resulting in an
under-estimation of disability prevalence. Again, the measure is subjective, and
cultural factors may affect survey responses.