Toggle Main Menu Toggle Search

Open Access padlockePrints

Assessing the validity of the Global Activity Limitation Indicator in fourteen European countries

Lookup NU author(s): Tony Fouweather, Emerita Professor Carol Jagger



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Background: The Global Activity Limitation Indicator (GALI), the measure underlying the European indicator Healthy Life Years (HLY), is widely used to compare population health across countries. However, the comparability of the item has been questioned. This study aims to further validate the GALI in the adult European population.Methods: Data from the European Health Interview Survey (EHIS), covering 14 European countries and 152,787 individuals, were used to explore how the GALI was associated with other measures of disability and whether the GALI was consistent or reflected different disability situations in different countries.Results: When considering each country separately or all combined, we found that the GALI was significantly associated with measures of activities of daily living, instrumental activity of daily living, and functional limitations (P < 0.001 in all cases). Associations were largest for activity of daily living and lowest though still high for functional limitations. For each measure, the magnitude of the association was similar across most countries. Overall, however, the GALI differed significantly between countries in terms of how it reflected each of the three disability measures (P < 0.001 in all cases). We suspect cross-country differences in the results may be due to variations in: the implementation of the EHIS, the perception of functioning and limitations, and the understanding of the GALI question.Conclusion: The study both confirms the relevance of this indicator to measure general activity limitations in the European population and the need for caution when comparing the level of the GALI from one country to another.

Publication metadata

Author(s): Berger N, Van Oyen H, Cambois E, Fouweather T, Jagger C, Nusselder W, Robine JM

Publication type: Article

Publication status: Published

Journal: BMC Medical Research Methodology

Year: 2015

Volume: 15

Online publication date: 02/01/2015

Acceptance date: 23/12/2014

Date deposited: 12/03/2015

ISSN (electronic): 1471-2288

Publisher: BioMed Central


DOI: 10.1186/1471-2288-15-1



Altmetrics provided by Altmetric


Funder referenceFunder name
EU Member State (Belgium)
EU Member State (Germany)
EU Member State (Greece)
EU Member State (Italy)
EU Member State (United Kingdom)
French National Solidarity Fund for Autonomy (CNSA)
EU Member State (Czech Republic)
EU Member State (Denmark)
EU Member State (France)
EU Member State (Sweden)
EU Member State (The Netherlands)
French Ministry of Health (DRESS)
DG SANCO 20102301European Commission