Self-rated health

How individuals assess their own health provides a holistic overview of both physical and mental health. Adding such a perspective on quality of life complements life expectancy and mortality indicators that only measure survival. Further, despite its subjective nature, self-rated health has proved to be a good predictor of future health care needs and mortality (Palladino et al., 2016[24]).

Most OECD countries conduct regular health surveys that include asking respondents how, in general, they would rate their health. For international comparisons, socio-cultural differences across countries may complicate cross-country comparisons of self-assessed health. Differences in the formulation of survey questions – notably in the survey scale – can also affect comparability of responses. Finally, since older people generally report poorer health and more chronic diseases than younger people do, countries with a larger proportion of older people are likely to have a lower proportion of people reporting that they are in good health.

With these limitations in mind, almost 9% of adults considered themselves to be in poor health, on average across OECD countries in 2019 (Figure 3.22). This ranged from over 15% in Korea, Lithuania, Portugal and Latvia to under 4% in Colombia, New Zealand, Canada, Ireland, the United States and Australia. However, the response categories used in OECD countries outside Europe and Asia are asymmetrical on the positive side, which introduces a comparative bias to a more positive self-assessment of health (see the “Definition and comparability” box). Korea, Japan and Portugal stand out as countries with high life expectancy but relatively poor self-rated health.

Among the few countries with data available for 2020, nearly all reported a reduction in the proportion of the population reporting themselves to be in bad or very bad health compared with 2019, with Finland reporting no change and no countries reporting an increase. While the data must be interpreted with caution – data are available for only seven countries and these include countries where the COVID-19 pandemic did not severely test health systems – it could be an indication of the influence of context on perceived health: health issues that may previously have been considered more serious may be downplayed in the context of the pandemic.

People on lower incomes are on average less positive about their health than those on higher incomes in all OECD countries (Figure 3.23). Almost 80% of adults in the highest income quintile rated their health as good or very good in 2019, compared with under 60% of adults in the lowest income quintile, on average across OECD countries. Socio-economic disparities are particularly marked in Latvia, Estonia, the Czech Republic and Lithuania, with a percentage point gap of 40 or more between adults on low and high incomes. Differences in smoking, harmful alcohol use and other risk factors are likely to explain much of this disparity. Socio-economic disparities are relatively low in Australia, Colombia, Greece, Israel and Italy, at less than 10 percentage points.

Self-rated health tends to decline with age. In many countries, there is a particularly marked decline in how people rate their health when they reach their mid-40s, with a further decline after reaching retirement age. Men are also more likely than women to rate their health as good.

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