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Life expectancy has risen dramatically over the past century — reaching 73.8 years — thanks to steep declines in infectious diseases, maternal and child mortality, and advances in the prevention and treatment of chronic conditions.
However, the years gained are not necessarily lived in good health, a new study, published in The Lancet Public Health, found. With gains in life expectancy outstripping improvements in healthy life expectancy across almost all 204 countries and territories analysed, the authors argue that health systems need to shift their focus from simply extending lives to improving the quality of those extra years.
Globally, people spent an average of 14.5% of their lives in poor health in 2023, with longer life expectancy increasingly accompanied by non-fatal illnesses and disabilities, researchers found.
Countries where people lived the longest also saw more years spent in poor health, suggesting that longer life expectancy is extending the period of illness and disability across adulthood rather than delaying it until the final years of life.
In 2023, people in the wealthiest countries spent 15.7% of their lives in poor health, while the sub-Saharan African super-region had the smallest morbidity gap, at 9 years.
The Netherlands saw the largest absolute increase, with the proportion of life spent in poor health rising from 13.2% in 1990 to 15.7% in 2023.
The greatest morbidity gaps — the duration or proportion of life spent in poor health — were in the United States, Australia and Canada.
By contrast, people in Nauru, the Solomon Islands and Laos experienced the smallest morbidity gaps, spending the fewest years of their lives in poor health.
What is driving this gap?
The authors found that non-fatal conditions accounted for 57.4% of the global morbidity gap, as they increase the time people spend living with disability or reduced health.
The main drivers among these conditions were musculoskeletal disorders such as low back pain, mental disorders, sense organ diseases such as age-related hearing loss and unintentional injuries.
In lower-income countries, nutritional deficiencies, respiratory infections, tuberculosis and neglected tropical diseases were also among the leading contributors.
The study also identified multiple risk factors, including high body mass index, child and maternal malnutrition, tobacco use, high fasting plasma glucose and air pollution.
Drug use and high alcohol use were among the ten leading risk factors contributing to the morbidity gap only in the high-income super-region, whereas unsafe sex emerged as a leading factor solely in sub-Saharan Africa.
What does a healthy future look like?
According to the authors, the findings raise questions about the sustainability of social care and the allocation of resources between prevention, treatment, and innovation. As the percentage of life spent in poor health has steadily increased since 1990, there is an urgency to focus on healthy ageing — the process of developing and maintaining the functional ability that enables wellbeing in older age, according to the World Health Organization (WHO).
“Our findings suggest that future gains in population health will come not only from helping people live longer, but from helping them live healthier,” said senior author of the study Christopher Murray, who is a director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine.
“Progress in healthy [ageing] should be measured not only by lifespan, but by healthspan, with greater investment in prevention, long-term disease management, and chronic care to reduce years lived in poor health,” Murray said.
Economic modelling indicates that improving health by targeting ageing could offer larger financial gains than increasing life expectancy by eliminating specific diseases, authors of the study argued.
“Improving healthy [ageing] will require greater focus on the conditions and risk factors that drive years lived with disability,” said Catherine Bisignano, co-author of the study. “Addressing these earlier through prevention and better long-term care could have meaningful social, health system, and economic impacts.”
To that end, the study calls for sustained investment in prevention, rehabilitation, mental health services, and chronic care, as well as improved access to assistive technologies and integrated long-term care models.
