Is healthy life expectancy in Northern Ireland almost ten years lower than in Ireland?

• Healthy life expectancy (HLE) is the number of years a person can expect to live in good health: for NI, the current estimate for HLE is around 62 years while, for Ireland, it is 69.4 years

• However, Northern Ireland uses a different definition of good health, meaning direct comparisons between the two figures are ill-advised

• Analysis of other HLE estimates indicates the gap between NI and ROI is nowhere near ten years

On 4 March, Irish Times columnist David McWilliams claimed:

“The average person in the Republic can expect to live a healthy life for almost a full decade longer than people in the North. The figure for the North is 61 years and the corresponding one for the Republic is 69.4 years.”

Official figures for Northern Ireland indicate that healthy life expectancy is closer to 62 years, rather than 61, while in the Republic of Ireland healthy life expectancy is indeed around 69.4 years.

However, “healthy life expectancy” is defined in very different ways in the two jurisdictions and comparisons between the two figures are ill-advised.

When other estimates for healthy life expectancy are considered, it becomes clear that the gap between NI and RoI is nowhere near a decade.

Definitions

Life expectancy (LE) is the average number of years an individual born within a specific time period can expect to live. It is an estimate calculated using statistical analysis, based on official data.

Healthy life expectancy (HLE) is, broadly, the length of time a person can expect to live in good health. Its specific definition can change from jurisdiction to jurisdiction, making comparisons tricky, or even invalid.

Figures

The most recent figures on life expectancy and healthy life expectancy in Northern Ireland were published in January by the Department of Health, and cover the year 2019-21.

Those figures state that males born in NI during that period have a HLE of 60.6 years, while for females the figure is 62.7. This suggests that people in NI have an overall HLE closer to 62 years rather than 61 years, as claimed by Mr McWilliams (however, rounding errors are not the central problem with this claim).

Figures published by the Central Statistics Office (CSO) last year state that the HLE in Ireland is 69.4 years, as claimed in the Irish Times article. This relates to estimates for children born in 2018. The HLE for males was 68.4; for females, it was 70.4.

Differences

Unlike life expectancy, calculating healthy life expectancy relies on various survey data and individuals’ self-reporting of their own health.

In NI, the key survey question asks individuals to classify their own health on a five-point scale: very good; good; fair, bad; or very bad.

When calculating HLE in Northern Ireland, officials use analysis to estimate how long a person can expect to live in very good or good health.

In Ireland, the CSO relies on data provided by Eurostat and provides an estimate of “the number of years that a person at birth is expected to live without any severe or moderate health problems”. The key survey question is:

“For at least the past six months, to what extent have you been limited because of a health problem in activities people usually do? Would you say you have been:

• Severely limited?
• Limited but not severely?
• Not limited at all?”

Healthy in this case is defined as not living a “limited” life (either severely or not severely), based on any health problems. Answers to this question are then analyzed alongside mortality and other demographic data to arrive at an estimate of HLE.

Both of these approaches are valid. However, the different methodologies make direct comparisons between them difficult.

Self-reported questions are subjective, in any case, but it should also be noted that in RoI “healthy” broadly means not living a “limited” life – whereas in NI even describing your condition as “fair” is enough to not be considered healthy.

Other comparisons

Mr McWilliams’ article made other claims about HLE in Northern Ireland:

“Babies born in the most deprived areas of Northern Ireland will live considerably less healthy lives than children born in India. Poor people in the North have a “healthy” life expectancy on a par with those living in Sierra Leone.

“The most deprived 20 per cent of households in Northern Ireland are so deprived that their babies born today can expect a “healthy life” for only 53 years. The corresponding figure for Sierra Leona is 52.9. The average Indian can expect 60 years of a healthy life, more than someone born in a poor community in the northeastern part of this island.”

The tabular data published in January by NI’s Department of Health actually states that the HLE of people born in the most deprived parts of NI is 55.1 years for males and 52.3 for females, so the average HLE is closer to 54 years than 53 years.

The World Health Organization’s report World Health Statistics 2022 contains tables with LE and HLE figures for many countries around the world.

It states that the HLE for India is 60.3 and the HLE for Sierra Leone is 52.9, which matches the Irish Times article.

The obvious question is whether these figures are comparable to those from NI. Although the WHO doesn’t outline its methodology in great detail, there is a clear implication that the answer to this question is no.

Different questions lead to different answers

Northern Ireland’s healthy life expectancy is not recorded by the WHO, which only publishes figures for the UK as a whole. There is a huge difference between the WHO calculations for UK HLE and the UK’s own estimates.

According to WHO figures, HLE in the UK is 69.6 for males, 70.6 for females, and 70.1 overall.

In its most recent publication of HLE estimates the Office for National Statistics (ONS) states that the HLE for males in the UK (born in 2018-20) is 62.8 years, and for females the figure is 63.6 – lower on both counts by around seven years.

This indicates the ONS methodology for calculating healthy life expectancy is much stricter than the method used by the WHO. Note that the ONS uses the same definition for HLE as Northern Ireland.

Back to Ireland

The WHO may not publish HLE estimates for Northern Ireland – but it does for Ireland. For children born in 2019, those estimates are 70.7 years for males, 71.4 years for females, and 71.1 years overall.

These are, once more, higher than the official statistics of the country in question. However, the gap (2.3 years for males, and 1 year for females, when compared with figures published by the CSO) is nowhere near the same as with the UK data.

Purely considering WHO figures, Ireland has a higher HLE than the UK for both males, where it is 1.1 years more (70.7 years vs 69.6), and females, for whom it is 0.8 years more (71.4 years compared with 70.6).

This suggests a HLE gap between the UK and Ireland of around one year.

ONS figures estimate that NI’s healthy life expectancy is just over one year less than the figure for the UK as a whole (which is similar to other parts of the UK such as Wales and the West Midlands, and higher than some areas including Scotland and North East England).

Although this is still not comparing like with like, it does suggest that the gap in healthy life expectancy between Northern Ireland and the Republic of Ireland is (roughly) around two years in total.

These figures should not be taken as gospel – they rely on two separate comparisons made using different methods – but, taken altogether, the analysis of the wider evidence points to the difference in health life expectancy between NI and Ireland being nowhere near a decade.

Bearing all this in mind, the claim made by Mr McWilliams is inaccurate.