ADDING LIFE TO YEARS, NOT JUST YEARS TO LIFE

Quality of life is slowly gaining global attention as a preferred target for healthcare systems. Once its metrics of measurement are widely accepted, resource allocation can be fairer

- K SRINATH REDDY

LIFE expectancy has been increasing globally over the last century due to a combination of improved social conditions and rapid scientific advances.

The former improved sanitation, nutrition, education, and economic security, while providing safer dwellings, transport and lowering crime. The latter provided a deeper understanding of the human body’s structure and functions, identified causal agents and mechanistic pathways of disease, and accelerated the development of medical technologies like vaccines, drugs, and devices. The spurt in knowledge creation and translation greatly amplified our ability to protect ourselves against a variety of disorders through prevention or cure.

While increased life expectancy (LE) has been a cause for celebration, preoccupation with lengthening human life has made us less attentive to the quality of life, functionality, and wellbeing across the life course. The gap between LE and healthy life expectancy (HLE) has been around 10 years in India over the past three decades. A similar pattern is seen in many other countries. Sadly, the gap between LE and HLE is wider among women than men. Women’s biological advantage of longer LE is dissipated by adverse social conditions and neglect by the health system.

Lack of attention to quality of life, encompassing functionality and wellbeing, has been due to difficulty in arriving at globally acceptable definitions and finding widely-accepted quantifiable measures. Economists and social scientists to public health researchers and policymakers have been challenged by disagreements in defining and measuring the ‘soft’ attributes of health. They are far more comfortable with measuring death as an easily identifiable end point and estimating the years of life saved by an intervention.