The idea of measuring how healthy a population (or individual) is while alive was controversial when first proposed, and difficult to do because the data requirements were onerous. The problems with developing this metric were first outlined by the statistician Daniel Sullivan in an article in 1966 — Sullivan worked for the National Center for Health Statistics.
Five years later, Sullivan solved the problem of how to calculate healthy life expectancy (also called disability-free life expectancy but hereinafter referred to as “healthspan”) in a now famous paper outlining how a single statistical index can be used to reliably gauge health status while people are alive. The “Sullivan Method” is well known among population scientists like those of us at Lapetus; the methodology has advanced since 1971; and a concerted effort has been put forth by scientists across the globe (including myself) to harmonize the healthspan metric so it can be measured and compared among populations living in different countries and time periods. The first published measure of healthspan appears in Table 1 originally published by Sullivan in 1971.
Lapetus scientists have devised a proprietary method of assessing healthspan at the level of the individual rather than at the population level originally devised by Sullivan.
Sullivan did not know at the time his index was developed how useful this and related health indices would become to multiple industries — Lapetus scientists have deployed our proprietary methodology into a broad range of industries.
At Lapetus, we use the healthspan metric to:
- Help guide our assessments of survival for individuals in our life settlement business using the core elements of the healthspan metric — activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The loss of ADLs and IADLs statically and across time have been shown in the scientific literature to be highly predictive of survival — independent of the presence or absence of impairments. Lapetus physicians are acutely aware of this and carefully scour the medical records for valuable information that can help us generate science-based estimates of survival that utilize measures of health beyond those traditionally used in the industry.
- At Lapetus we’ve created an assessment tool that interacts with clients to help them understand not only what their current healthspan is based on their personal attributes, but also what behavioral risk factors they can change to improve and extend their healthspan and lifespan. This tool is called “Healthy Advice”.
- For examples of how lifespan and healthspan can be useful metrics, the Biodemography team at Lapetus published an assessment of these projected metrics for all of the presidential candidates running in September of 2019; and then we published them again for the final two candidates.
- Lapetus will be deploying a “frailty index” in our lifespan and healthspan assessment toolbox in the coming months that will enhance even further our ability to gauge both health and survival in individuals. I’ll describe this new index and how it will be used in a future newsletter.
- The Chronos platform that drives our Summary Adjust Life Expectancy (SALE) in our life settlement business, has been modified, enhanced and deployed for use in wealth management to measure both lifespan and healthspan for individuals and couples.
- Chronos makes it easy for advisors to assist their clients in retirement planning; manage health care costs; decide whether long-term care insurance is needed and when; and establish an estate plan that is matched to the unique needs of the client. The consequences of getting retirement and estate planning wrong can be catastrophic, so providing science-based justification for retirement planning decisions that is straightforward and easy for clients to understand, makes it easy for advisors to justify their recommendations. You can learn more about the use of this technology for wealth management/estate planning here.
- The federal government has proposed a Federal Long-Term Care Insurance Program for the U.S. population; Lapetus technology is ideally suited for a program like this as we generate hyper-personalized assessments of both healthspan and lifespan that can be used for assessing the need for and cost of such a program.
Daniel Sullivan could not have known at the time he developed the metric named after him just how useful his health metric would become, nor could he have anticipated the variations on his methodology that have been developed or their subsequent uses in a broad range of industries.
