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with the onset of risk factors, progresses to diseases and impairments, and then to functioning loss and to the inability to perform expected tasks or disability, frailty, and death (Crimmins, Kim, and Vasunilashorn, 2010). This can be termed the “morbidity process.” No one individual needs to experience problems reflecting all of these dimensions, as some people die very suddenly with no warning that their health has begun to deteriorate. In addition, for individuals the process is not always unidirectional, but back and forth movement is possible (Crimmins, Hayward, and Saito, 1994). These dimensions of population health relate to mortality differently. For instance, many important causes of disability are not highly related to mortality, for instance, arthritis. In contrast, cancer is highly related to mortality but not disability. Heart disease tends to be a major cause of both mortality and disability. In this analysis, we examine self-reported indicators of functioning, disability, and disease presence and cancer incidence from registries. We also examine both self-reports and measured prevalence of high cholesterol and high blood pressure, along with body mass index based primarily on self-reports.


Where possible, our analysis uses information on health for the population ages 50 and older, or 65 and older, in the 10 countries. However, in some cases, we expand or limit the age range because of data unavailability. Most of the countries have conducted national surveys of their older populations, which provide individual-level data on a number of health indicators, risk factors, and drug usage. Many of the self-reported indicators of health status come from a family of surveys designed to be comparable: (1) the Health and Retirement Study (HRS) for 2004 for the United States (Health and Retirement Study, 2006); (2) the Surveys of Health, Ageing and Retirement in Europe (SHARE) for 2004 for Denmark, France, Italy, the Netherlands, and Spain (Börsh-Supan and Jurges, 2005; Börsch-Supan et al., 2005); and (3) the English Longitudinal Study of Ageing (ELSA) for England collected in 2002 (Marmot et al., 2007). Sometimes we employ information for England and Wales or the United Kingdom when we use other sources. All of these surveys use similar formats for their questionnaires and survey national samples of people ages 50+. The Nihon University Japanese Longitudinal Study on Aging (Nihon University Japanese Longitudinal Study on Aging, 2009) provides a representative sample of those ages 65+ for Japan, with most of the data used in this analysis from the 2003 wave. For Canada, much of the self-reported information comes from the 2003 Canadian Community Health Survey (CCHS), and for Australia, the source is often the National Health Survey 2004-2005.

Our comparison of national cancer rates is not based on self-reports from surveys but is taken from the GLOBOCAN 2002 database from the

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