A cross-national comparison of health expectancy : Japan, the United States and Taiwan

Japan is the longest lived population in the world and has led the world in low mortality for over two decades. The United States, although its GDP exceeds all other countries, has a life expectancy that falls substantially below most other western countries. Taiwan, although it has an emerging economy with rapid aging population, has a life expectancy approaching that of the United States. Previous studies have investigated multiple domains of physical health for elderly Japanese, American, and Taiwanese, but very few studies have compared mortality across these countries and even fewer have examined how mortality and morbidity intersect differently across the countries to influence differences in healthy life expectancy. This dissertation is aimed at filling this gap. Based on studies in the United States and other Western countries, education is increasingly characterized as a "fundamental cause" of health -- with more years of educational attainment associated with better health. Although the association is robust for a variety of health measures and mortality in the United States and other Western countries, studies in East Asia report more modest associations or no associations. Thus, whether the association extends beyond the Western context is less clear. In my dissertation, I investigate these issues in detail. In the United States, the more-educated enjoy longer life expectancy and a compression of mortality comparing with their less-educated counterpart. Here, data from Taiwan and Japan are used to assess whether education has similar consequences in two important non-Western settings. In sum, the findings reveal that: (1) older Japanese people not only have the highest total life expectancy but also have the highest absolute healthy life expectancy in each gender group, (2) older American and Taiwanese people have similar total life expectancy in each gender group, but they have very different health profiles, (3) educational gradients on mortality/health differ across gender and country groups, and (4) within a population, having more education helps maximize lifespan, changes and delays the biological aging process in the different contexts. Overall, the results underscore the importance of international perspective in explicating health disparities, especially educational differentials in health.