Prevention Green Paper: how will we know if it’s working?

In 2018, the Government made a commitment to give people five additional years of healthy life by 2035, and reduce the gap between the richest and poorest.

This week’s publication of the Prevention Green Paper suggests that this will in part be measured by ‘disability-free life expectancy’.

While this might seem like a small, technical detail of little relevance, it isn’t! It is an important clarification that could have widespread implications across Government. Here’s why.

There are different ways to measure health. You can think about it from a national perspective: how much does the Government spend on health in comparison to other services or other countries?

You can also assess the quality of the services people receive: from prevention, to diagnosis and treatment, along with indicators like waiting times or disease-specific survival rates.

Or you can measure someone’s overall physical state – the impact of all these points above and the individual choices that people make, given the options available to them. Are people free from any sort of disease or disability that would prevent them from leading a fulfilling life? This what disability-free life expectancy captures.

When some people hear the word disability, they immediately picture wheelchairs and ramps. But this measure is different. It doesn’t ask what equipment you use or for a list of your medical conditions. Instead it asks whether you have a long-term condition that prevents you from doing everyday activities such as getting out of bed, dressing or eating.

Instead of categorising people by a diagnosis or their support aids, disability-free life expectancy seeks to understand people’s ability to perform essential, daily tasks.

The result? The government has committed to take action not just on the ‘big killers’, but also the ‘big disablers’.

Some of the leading and preventable conditions that cause disability are joint and muscle pain, respiratory diseases and sensory conditions (such as a loss of sight or hearing). And as reflected in the Green Paper, preventing these conditions means taking action to increase levels of exercise, improve diets and stop smoking (which are also the same preventative actions for the leading causes of death – cancer, heart disease and stroke).

Our strategy reflects the Government’s ambition here. We see health is an enabler, a foundation that supports people to socialise, to work and achieve their ambitions. And so, in addition to high-level trackers such as life expectancy and wider public health indicators (e.g. Public Health England’s Productive Ageing tool), we agree that disability-free life expectancy is an appropriate high-level measure to monitor the impact of the prevention policies set out in the green paper.

We also hope that the announcement contributes to a widespread reorientation of policy-making. The focus on (dis)ability should direct policy-makers towards initiatives that enable and empower people and prevent the onset or deterioration of ill-health.

By choosing disability-free life expectancy as a target, the Government has challenged itself, and all public services, to put people’s ability to live fulfilling lives at the forefront of decisions taken.

Disability-free life expectancy uses data from the Annual Population Survey and is calculated using the following questions:

1. Do you have any physical or mental health conditions or illnesses that have lasted or are expected to last 12 months or more?
   1. Yes
   2. No

If ‘Yes’ the respondent is then asked the following question:

2. Does your condition or illness/any of your conditions or illnesses reduce your ability to carry out normal day today activities?
   1. Yes, a lot
   2. Yes, a little
   3. Not at all

People are classified as having a disability if they answer yes to the first question and “Yes, a lot” or “Yes, a little” to the second question.  

The latest estimates for local authority and region can be accessed here.

The latest estimates by area deprivation can be accessed here:

England
Wales