<p>The Healthy Life Expectancy programme is working, in an international community, to establish the changes in patterns of<p><p>health through the present demographic transition, and with their consequences for health policies. Many future estimates of the need for long term care tend to be pessimistic. They tend to assume that current age-specific rates of disability will continue. A more optimistic assumption is that the changes which are producing greater longevity will also improve health expectancy. Empirical evidence on trends in disability from the UK supports the view that health expectancy is indeed rising, at least at severe levels of disability. On this evidence, it is by no means impossible that the numbers of people needing intensive long-term care will stay the same as at present, even though the population ages. On the other hand, at milder levels of disability there appears to be no such improvement. The length of time in disability, and hence the demand for long-term care, is greater among women and those in lower social classes. There are considerable variations between areas of the UK. The empirical evidence from the UK remains slight, though it is supported by corresponding results in other developed countries. There is an urgent need for a national survey of health and disability particularly for elderly people, which will establish the incidence rates of ill-health and recovery, and allow us to project the future need for long-term care with much greater certainty
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