Longer lives, poorer health

Longer lives increasingly mean more years in poor health

People are living longer across the world, but improvements in healthy life expectancy are failing to keep pace. Surprisingly, it is generally the wealthiest countries – where overall life expectancy is highest – that have developed the widest gap between lifespan and healthspan.

A major new study published in The Lancet Public Health examined trends in 204 countries and territories between 1990 and 2023. It found that the average “morbidity gap” – the difference between total life expectancy and the number of years lived in full health – had increased by almost 22%.

Globally, the gap grew from 8.8 years in 1990 to 10.7 years in 2023. This means that the average person now spends 14.5% of their life in poor health, compared with 13.6% a generation ago.

The researchers warn that increasing longevity has not been matched by equivalent progress in preventing and managing the conditions that cause disability, pain and loss of independence.
 

Wealthiest countries have the widest gap

The findings challenge the assumption that longer life expectancy necessarily means a longer healthy life.

People in the highest-income countries spent an average of 15.7% of their lives in poor health in 2023. The largest morbidity gaps were recorded in the United States, Australia and Canada, at 14 years, 13.9 years and 13.7 years respectively.

By contrast, the average gap in sub-Saharan Africa was around nine years.

This does not mean that people in poorer countries enjoy better health. Many still face much higher levels of premature death, infectious disease, malnutrition and inadequate access to healthcare. Rather, people in wealthier countries are more likely to survive conditions that would once have shortened their lives – but may then live for many years with chronic illness, disability or reduced functional ability.

Medical progress has been more successful at extending life than at ensuring that the additional years are lived in good health.

The Netherlands experienced the largest rise in the proportion of life spent in poor health, increasing from 13.2% in 1990 to 15.7% in 2023.
 

UK morbidity gap reaches 12.7 years

In the UK, the study estimates that the morbidity gap reached 12.7 years in 2023. This was wider than in France, Spain, Germany and Italy, although narrower than in the three countries with the largest gaps.

The finding comes amid growing concern about deteriorating health within the UK. Separate analysis by the Health Foundation, using Office for National Statistics data, recently found that healthy life expectancy has fallen by more than two years over the past decade.

Between 2012–14 and 2022–24, healthy life expectancy fell:

• from 62.9 to 60.7 years for men

• from 63.7 to 60.9 years for women.

The UK has fallen from 14th to 20th place for healthy life expectancy among 21 comparable high-income countries, with only the United States performing worse. It is one of just five countries in the group where healthy life expectancy has declined.

The two studies use somewhat different methods, so their figures cannot be compared directly. Nevertheless, they point towards the same fundamental problem: people may be surviving for longer, but too many of those years are being spent with illness or disability.
 

Large inequalities within the UK

The national averages also conceal profound inequalities.

According to the Health Foundation analysis, healthy life expectancy for men ranges from 69.3 years in Richmond upon Thames to just 50.9 years in Blackpool. For women, it ranges from 70.3 years in Richmond to 51.2 years in Hartlepool.

In more than 90% of UK local areas, people can now expect to develop poor health before reaching the State Pension age of 66.

This has important consequences not only for individuals and families, but also for employment, unpaid carers, the NHS, social care and the benefits system. A longer period of poor health can mean more years requiring treatment, rehabilitation, accessible housing, equipment, personal assistance and support with everyday activities.
 

What is driving the morbidity gap?

More than half – 57.4% – of the global morbidity gap was attributed to conditions that generally cause disability rather than early death.

The most significant contributors included:

• musculoskeletal conditions, particularly lower back pain

• mental health conditions, including depression and anxiety

• sensory impairments, such as age-related hearing loss

• injuries, including those caused by falls.

Important risk factors included high body mass index, smoking, high blood glucose and air pollution. Alcohol and drug use were among the ten leading contributors to the morbidity gap specifically in high-income countries.

Women continued to live longer than men but also spent considerably more time in poor health. In 2023, the global morbidity gap was 12.1 years for women, compared with 9.3 years for men.
 

More emphasis on healthspan

The researchers say that healthcare systems must move beyond measuring success primarily through longer life expectancy. Greater attention needs to be paid to “healthspan” – the period of life spent in good health and with the functional ability needed to maintain wellbeing and independence.

Professor Christopher Murray, senior author and director of the Institute for Health Metrics and Evaluation, said future improvements in population health would come not only from helping people to live longer, but from helping them to live more healthily.

The study calls for sustained investment in prevention, rehabilitation, mental health services and long-term management of chronic conditions. It also highlights the importance of assistive technology and better-integrated models of health and social care.

For wealthy countries such as the UK, the challenge is no longer simply to add years to life. It is to prevent those additional years becoming an ever-longer period of pain, ill health and avoidable loss of independence.
 

Read the Institute for Health Metrics and Evaluation summary

Read the study in The Lancet Public Health

Read the Health Foundation’s analysis of UK healthy life expectancy (external links will open in a new browser tab or window)

 

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