People are living longer but spending more years in poor health – Earth.com
07-29-2026
Healthspan, not lifespan, may be the next global health challenge
ByRaquel Brandao
Earth.com staff writer
A new global study has found that life expectancy grew faster than healthy life expectancy in 203 of 204 countries
People may be living for longer, but they now spend an average of 10.7 years in poor health. That is up from 8.8 years in 1990
Those extra years are increasingly years of illness and disability rather than good health. The widest gaps fall in the wealthiest countries, where people live longest. Furthermore, women lose more healthy years than men almost everywhere
The morbidity gap grows
In 1980, a physician named James Fries made a confident prediction about old age. As medicine improved, he argued, serious illness would be squeezed into a brief window just before death. His paper called this the compression of morbidity
Forty-six years later, the largest test of that idea has come back with the opposite answer. Researchers measured the difference between how long people live and how long they stay healthy in 204 countries and territories
They call that difference the morbidity gap. The study came from the Institute for Health Metrics and Evaluation (IHME) in Seattle. Its director, Dr. Christopher Murray, is the senior author on the research paper
The calculation is simple. Take life expectancy at birth and subtract healthy life expectancy. That second number counts only years lived without significant illness or disability
Healthy years fall behind
Between 1990 and 2023, global life expectancy at birth rose from 64.6 years to 73.8. Healthy life expectancy rose too, from 55.9 years to 63.1
So the world gained about nine years of life and roughly seven years of health. The leftover two years went into the gap
As a share, nearly 15 percent of an average life is now spent in poor health. In 1990 it was under 14 percent
More surprising is where in life those unhealthy years fall. The gap did not sit only at the very end. It widened across the whole of adult life
So this is not simply a longer stretch of frailty at the close of life. The pattern suggests people carry disease and disability through more of their working and family years
COVID-19 interrupted the trend but did not reverse it. Both measures dipped during the pandemic, then resumed their earlier paths
Rich countries have bigger gaps
The countries where people live longest are also the countries where people spend the most years unwell
In 2023, the United States had the largest national gap at 14 years. Australia followed at 13.9 years, then Canada at 13.7
The pattern holds regionally. Across the high-income countries as a group, the gap reached 12.7 years. In sub-Saharan Africa it was 9.0 years, the smallest of seven world regions
Wealth itself is probably not the cause. Strong health systems keep people alive through conditions that once killed them quickly. Surviving a stroke or a cancer diagnosis often means years of living with the damage
An earlier study of 183 countries that drew on different data reached the same conclusion. It put the global gap at 9.6 years and also placed the United States at the top
Women lose more healthy years
The sex difference is large and consistent. In 2023 women spent an average of 12.1 years in poor health, against 9.3 years for men
Women outlived men in every region examined. They also spent more years unwell in every one, at every level of national development
“Women are living longer than men almost everywhere in the world, but they are also spending more of those additional years in poor health,” said Catherine Bisignano, a senior scientific writer at IHME and a co-author of the study
Demographers have tracked this pattern for decades. A recent analysis of 24 countries warned that simple gender comparisons can obscure it. The headline gap blends women’s survival advantage with their higher burden of disability
Chronic conditions drive the gap
More than half of the world’s years in poor health come from a small group of conditions that rarely kill. Bone, joint and muscle disorders lead the list, and back pain is the single largest contributor
Mental health conditions come next, mainly depression and anxiety. After those come disorders of the senses, led by age-related hearing loss, and then falls and other unintentional injuries
These conditions rarely appear on death certificates. They subtract function rather than years
The risk factors behind them are mostly familiar. High blood sugar, excess body weight, tobacco use, and childhood malnutrition led the global list
The mix changes with income. In sub-Saharan Africa and other low-income settings, malnutrition in children and mothers ranked first. Air pollution also made the top five there
Healthspan becomes the priority
The field now has a clear answer to a question it has argued about for decades. Illness has not compressed into the final years of life. It has spread across more of adult life, in almost every country, for 33 years running
Researchers have a word for the years lived in good health. They call it healthspan, and the study argues it belongs beside life expectancy on national scorecards
“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 Murray
The practical consequence lands on health systems built to prevent death. Rehabilitation, mental health care, hearing services and long-term chronic care sit at the edges of most of them
Moving those services to the center would not add a single year to anyone’s life expectancy. However, it would change what those years feel like
The study is published in The Lancet Public Health
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