Health expectancy - From a population health indicator to a tool for policy making

This article presents a methodologic framework for a disability-adjusted life expectancy (DALE), an extended and enhanced variety of the common health expectancy indicator. The DALE is based on a causal link running from risk factors through diseases and disability to mortality. This causal link allows the DALE to be used for evaluation of potential interventions and analysis of observed trends. The DALE methodology consists of a combination multistate life table with explicitly modeled disease processes and disease-specific disability weights. In this article, two illustrations are presented: the impact on the DALE of trends in cardiovascular disease epidemiology and the benefits of nonsmoking. Two problems of the DALE are discussed: estimating "all other causes" disability and the presence of comorbidity.