About the index

ABOUT THE INDEX

The Healthy Ageing and Prevention Index offers a unique and holistic perspective to understanding population health, not just through health metrics but also through an economic and environmental lens.

We want the Index to sit at the heart of global policy and political engagement on prevention and healthy ageing, and to use it as a tool to:

Hold Governments to account by tracking progress on prevention and healthy ageing.
Engage leading global health leaders, including at the G7 and G20 level, to move from commitment to action on preventative health.
Support the Healthy Ageing and Prevention Coalition’s calls to action.

The Index ranks 153 countries against six metrics: life span, health span, work span, income, environmental performance, and happiness. This gives us a comprehensive picture of how well countries perform against key healthy ageing metrics and the extent to which different governments are investing in efforts to prevent ill health and support healthy ageing.

Healthy ageing isn’t just about the number of additional years people live, but: how many of those years are spent in good health; the opportunities for individuals to work and have an income that helps them meet their needs; the opportunity to live in an environment where they can live dignified and healthy lives; and the opportunity to do the things they value and to live fulfilled and enriched lives. This broad view of healthy ageing is based on evidence from wider literature and global policy developments that include the UN Decade of Healthy Ageing.

Now, with the publication of Wave 2: 2022, we can track global and country-by-country progress, see which nations are on a sustainable path and pinpoint best practice and key action areas. We also compare countries’ Index rankings to factors such as spend on prevention, availability of doctors and other policy interventions to identify what drives improvement on the Index.

WHY DEVELOP THIS INDEX?

This Index brings together health, wealth and societal metrics for the first time, to give us a comprehensive and easily accessible picture of sustainable longevity in different countries, and whether they’re investing in interventions that will help people live well for longer in the long term. The Index builds on existing indices, such as the Yale Environmental Performance Index (EPI) and the World Happiness Report).

Most importantly, in addition to ranking individual countries’ performance, the Index ranks 12 political and economic country blocs, such as the G20, EU and OECD. This information allows stakeholders another way to demand action on sustainable longevity from their governments. The Index can function as a roadmap for ministers to set their national priorities and measure their success.

THE INDEX METRICS

There are currently two waves of data published: Wave 1: 2019 and Wave 2: 2022 data.

The six metrics are:

LIFE SPAN

This is the number of years an individual can expect to live. This is measured at birth in years, using life expectancy measures obtained from the UN.

The top five countries in 2022 were Japan (84.8), Switzerland (84.3), Italy and Singapore (83.1), South Korea (84).

The top five countries in 2019 were Japan (84.4), Switzerland (83.8), Singapore (83.6), South Korea (83.7) and Italy (83.6).

Source: World Population Prospects – Population Division – United Nations

HEALTH SPAN

This is the number of years an individual can expect to spend in good health. This is measured at birth in years, using health expectancy measures obtained from WHO.

The top five countries in 2022 were Japan (74.4), Singapore (74.1), South Korea (73.3), Switzerland (72.9), Italy (72.6).

The top five countries in 2019 were Japan (74.1), Singapore (73.6), South Korea (73.1), Switzerland (72.5) and Israel (72.4).

Source: Life tables (who.int), ILC undertook its own projections for 2022. see section “how we developed the Index” for further details.

WORK SPAN

This is defined as the expected number of years spent being economically active. For this metric we use the labour force participation rate. We use 15 as our lower age limit and 65 as our upper age limit. The upper age limit is the average effective age of retirement in countries in the Index.

We translate this percentage figure into a number of years. For instance, if everyone in a given population were to be in work between the ages of 15 and 65, that country’s average work span would be 50 years across the life course. However, if only half of that population were to be in work (50%), the average work span would be only 25 years across the life course.

Data are obtained from the World Bank and the International Labour Organisation.

The top five countries in 2022 were Qatar (44.3), Madagascar (42.6), United Arab Emirites (41.2), Tanzania, (40.7) and Ethiopia (40.1).

The top five countries in 2019 were Qatar (43.7), Madagascar (42.8), United Arab Emirites (41.2), Tanzania, (40.8) and Ethiopia (40.2).

Source: ILOSTAT Data Explorer

INCOME

This is measured by GDP per capita, using purchasing power parity (ppp) in constant 2015 prices, with data obtained from the World Bank. Values are expressed in 000s.

We use GDP per capita as a measure of economic wellbeing and standard of living. GDP is a measure of the size and health of a country’s economy over a period of time (usually one year) and is based on the total value of all finished goods and services.

GDP is also used to compare the size of different economies at different points in time. We use ppp to ensure comparability between countries. This takes into account the relative cost of local goods, services and inflation rates of the country, rather than using international market exchange rates, which may distort the real differences in per capita income. We use constant 2015 prices to measure the true volume growth, by adjusting for the effects of price inflation.

The top five countries in 2022 were Luxembourg (109.7), Ireland (97.3) Switzerland (90.1), Norway (79.4), and Singapore (67.4).

The top five countries in 2019 were Luxembourg (107.4), Switzerland (87.1), Norway (76.7), Ireland (75.2), and Singapore (61.3).

Source: GDP per capita (constant 2015 US$) | Data (worldbank.org)

ENVIRONMENTAL PERFORMANCE

This is measured using the Yale Environmental Performance Index (EPI) which positions countries on a scale of 0 to 100 (100=best).

The EPI ranks countries against 40 performance indicators across 11 issue categories and three themes: climate change performance, environmental health and ecosystem vitality.

The global average EPI rating in 2020 was 45.8. In 2022 it was 41.1

The top five countries in 2022 were Denmark (82.5), Luxembourg (82.3), Switzerland (81.5), the UK (81.3), and France (80).

The top five countries in 2020 were Denmark (77.9), the UK (77.7), Finland (76.5), Malta (75.2), and Sweden (72.7).

We use 2020 data in Wave 1: 2019 Index, because the EPI is released only every two years, making 2019 data unavailable. Wave 2: 2022, uses data from their 2022 release.

Source: Downloads | Environmental Performance Index (yale.edu)

HAPPINESS

Happiness positions countries on a scale of 0-10. Scores of 0-4 are interpreted as “suffering”, 5-7 as “struggling”, and 8-10 as “thriving”.

Data are taken from the annual Gallup World Poll, which asks respondents to think of a ladder and rate their current lives on the 0-10 scale. Rankings are from nationally representative samples. The UN creates reports from these polls, from which we obtain the data.

The top five countries in 2022 were Finland (7.7), Iceland (7.6), Denmark (7.5), Costa Rice (7.4), and the Netherlands (7.3).

The top five countries in 2019 were Finland (7.8), followed by Switzerland (7.694), Denmark (7.693), Iceland (7.5), and Norway (7.4).

Source: Read the Reports | The World Happiness Report

HOW WE DEVELOPED
THE INDEX

We sought a simple way of combining information on living standards, health and life span, working lives, the quality of the environment, and life satisfaction. We found that simply ranking countries against the individual indicators from ‘best’ to ‘worst’ performing and then ranking their performance against all the indicators combined was the most straightforward and fair way to compare countries’ performance.

STEP 1

Countries are categorised from ‘best’ to ‘worst’ for each individual metric. We use the original values from the relevant data source for each metric except work span (for further details on this metric, see above section “work span”).

STEP 2

We assign each country a numerical rank for that metric.

Below is a visual representation of steps one and two, using the life span metric as an example. Country Y and country X are the two best-performing countries in the Index. In this example, we can see that despite being the best-performing countries across all metrics, they are ranked 13th and 2nd on life expectancy. This is because we are looking at one metric in isolation. When we take their performance across all six metrics, their average performance pushes them to the top of the Index.

Example: ranking the life span metric for the top two countries in the Index

Country	Step 1: categorising values from ‘best’ to ‘worst’	Step 2: numerical rank
Country Y	82.8	13
Country X	84.3	2

We repeat steps one and two for all six indicators for all 153 countries.

STEP 3

We then take the sum of these numerical ranks for each country to generate an overall score for each country.

Example: Generating a country score for the top two performing countries on the Index.

Country	Life span	Health span	Work span	Income	Environmental performance	Happiness	COUNTRY SCORE
Country Y	13	9	13	10	10	2	57
Country X	2	4	39	3	9	13	70

STEP 4

Aggregated country scores are then assigned a further and final numerical rank. The smaller the total score, the higher the rank.

Example: final ranking assigned from aggregated country scores for the top two countries in the Index

Country	Life span	Health span	Work span	Income	Environmental performance	Happiness	Country score	RANK
Country Y	13	9	13	10	10	2	57	1
Country X	2	4	39	3	9	13	70	2

For further information on the methods and developing the Index, you can read our publication: Introducing the Healthy Ageing and Prevention Index or view our: Additional methodology

The programme so far:
2019-2023

ILC has established itself at the forefront of the global prevention debate. We have engaged with political leaders, policymakers and experts from across the globe to understand not only “why” we ought to prioritise prevention across the life course but “how” we can deliver it. As a result:

We helped convince G20 Ministers in Japan to commit to a joint focus on the prevention of ill health across the life course in 2019.
We informed the WHO’s and UN’s joint Decade of Healthy Ageing (2020-2030), as well as the WHO Immunisation Agenda 2030, which led to a new chapter on life course and adult immunisation being added.
We fed into the Department of International Trade’s White Paper on Healthy Ageing.
We were selected to write a policy paper that informed the G20 in Italy on the role of prevention in global health and the management of the COVID-19 pandemic.
ILC’s policy recommendation was adopted in the 2022 changes to the NICE guidelines, recommending that an adult’s waist should be less than half their height to reduce health risks.

Explore our News and resources section to see all of our previous and upcoming publications and activities.

You can also view the first iteration of the Index with the original 121 countries here:

Original Map 2019

Our other programmes inspired by the Index

The Healthy Ageing and Prevention Index helps us drive the conversation on healthy ageing at the global, regional and national level. Since its initial publication in 2023, we have launched new projects, that take a deeper dive into some the biggest health issues society faces in an age of longevity. Using the Index, we are able to build our evidence base for why investing in healthy ageing has to be a priority for governments. Our current projects, inspired by the Index include:

Mental Health Matters: uses the findings from the Index to build a global policy agenda around mental ill health, highlighting the importance of tackling the substantial burden of acute mental health issues and giving countries tangible recommendations for doing so.

If you’d like the be involved or learn about the programme, you can do so here.

Boehringer Ingelheim (BI) has provided financial support to ILC to conduct this project. ILC has retained editorial control of all written outputs.

Going for Gold: examines how well countries compete with one another in terms of longer lives and the extent to which their governments are investing in efforts to prevent ill health and support healthy ageing. With Paris hosting the 2024 Olympics this summer, there is an opportunity to engage with policymakers and health stakeholders on prevention and to make the case for better investment in longer lives.