People are living longer but spending more of those years in poor health

Global gains in longevity have long been treated as an unambiguous success story, yet a large new analysis complicates that picture. People around the world are surviving to older ages than at any point in modern history, but a growing share of those extra years is being spent managing illness, pain and disability rather than in robust health. The finding reframes one of the central goals of public health, because adding years to life is turning out to be very different from adding healthy life to those years.

What the Global Burden of Disease study measured

The conclusion comes from the Global Burden of Disease (GBD) program, a sprawling international effort to quantify how much of humanity’s collective time is lost to sickness and premature death. The results were published in The Lancet Public Health and summarized by the effort’s coordinating institution, the Institute for Health Metrics and Evaluation, which framed the gap between living long and living well as an emerging challenge for health systems everywhere. Rather than tracking deaths alone, the analysis pairs total lifespan with “healthy” lifespan, the stretch of years a person can expect to live without significant disease or disability.

The two measures have moved in the same direction but at very different speeds. Between 1990 and 2023, global life expectancy at birth rose from 64.6 years to 73.8 years, while healthy life expectancy climbed more slowly, from 55.9 years to 63.1 years, according to the study’s summary. In other words, the world added roughly nine years of life over a single generation but only about seven years of health to go with them.

The widening morbidity gap

The difference between how long people live and how long they stay healthy is what researchers call the morbidity gap, and it is widening. Worldwide, that gap grew from 8.8 years in 1990 to 10.7 years in 2023, an increase of nearly two years within a generation. Measured as a share of the whole lifespan, people spent an average of 14.5 percent of their lives in poor health in 2023, up from 13.6 percent in 1990.

Perhaps the most striking detail is where those unhealthy years fall. The extra time lived with illness is not confined to the final months before death, as an optimistic reading of longevity might assume. Instead, the analysis found the widening gap spread across the adult lifespan, meaning working-age and midlife populations are increasingly living with chronic conditions rather than simply facing a compressed period of decline at the very end.

Why the United States has the largest gap

Wealthy nations, which have some of the longest lifespans, also post some of the widest health gaps. The United States recorded the largest national morbidity gap in the analysis, with an average of 14 years spent in poor health, followed closely by Australia at 13.9 years and Canada at 13.7 years. The pattern points to the toll of chronic, non-communicable conditions that rarely kill quickly but steadily erode day-to-day function over decades.

That mix typically includes cardiovascular and metabolic disease, musculoskeletal pain, and mental-health and neurological disorders, all of which tend to accumulate with age and with the diet, activity and environmental patterns common in high-income countries. Longer survival from conditions that were once rapidly fatal, such as certain cancers and heart disease, also converts what were previously deaths into extended periods of living with illness.

Why women carry a heavier burden

The analysis found a consistent divide between the sexes. Women across every region studied lived longer than men, a well-documented advantage, but they also spent more of their lives in poor health. Women had an average morbidity gap of 12.1 years in 2023, compared with 9.3 years for men, meaning the longevity edge women enjoy comes paired with additional years of managing disease and disability.

That combination has practical consequences for caregiving, long-term services and retirement planning, since the population living longest is also the population most likely to need sustained medical and social support in later life.

What a shift toward healthspan would change

The researchers argue the numbers should push health systems to treat “healthspan,” the length of healthy life, as a target in its own right, not merely a byproduct of falling death rates. Interventions that prevent or delay chronic disease, preserve mobility, and address mental health could narrow the gap in ways that simply extending survival does not. The data also suggest that the countries most successful at pushing life expectancy upward have not automatically been the best at keeping those added years healthy.

For policymakers, the message is that the historic victory over early death is incomplete. The next frontier is compressing the years of illness rather than merely postponing the end of life, a goal that runs through prevention, chronic-disease management and the everyday determinants of health long before old age arrives.

This article was researched and drafted with the assistance of AI and reviewed before publication.

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