A major study published in The Lancet Public Health suggests that although people are living longer than ever before, many of those additional years are increasingly being spent in poor health, reports Euronews.
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, according to the researchers. 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 nine 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 like 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, TB 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 10 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?
The authors said 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 well-being in older age, according to the World Health Organisation (WHO).
“Our research suggests 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, 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.”
Economic modelling indicates that improving health by targeting ageing could offer larger financial gains than increasing life expectancy by eliminating specific diseases, the authors suggested.
“Improving healthy ageing will require greater focus on the conditions and risk factors that drive years lived with disability,” said Catherine Bisignano, co-author. “Addressing these earlier through prevention and better long-term care could have meaningful social, health system, and economic impacts.”
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.
Study details
Global, regional, and national trends in the morbidity gap and contributing diseases, injuries, and risk factors, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023
Simon Hay, Paul Nam, Haaris Saqib et al.
Published in The Lancet Public Health in August 2026
Summary
Background
As survival improves globally, the central public health challenge increasingly shifts from extending life to extending healthy lifespan. The compression of morbidity hypothesis proposes that effective prevention and care will delay disability more than death, reducing the morbidity gap—ie, the duration or proportion of life spent in poor health. We aimed to comprehensively estimate changes in the morbidity gap globally, regionally, and nationally from 1990 to 2023, by socio-demographic development levels and sex, and analysed leading diseases and injuries and their underlying risk factors contributing to years lived in poor health.
Methods
Using Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 estimates of life expectancy and healthy life expectancy (HALE) at birth for 204 countries and territories from 1990 to 2023, we calculated the morbidity gap as life expectancy minus HALE, and the proportional morbidity gap as this difference divided by life expectancy. Results are presented globally, by GBD super-region and country, Socio-demographic Index (SDI) quintile, and sex. We decomposed the morbidity gap into cause-specific and risk-specific contributions, assigning to each cause group its proportional share of years lived with disability (YLD), adjusted for comorbidity to avoid double counting disability for co-occurring conditions. We report mean estimates and 95% uncertainty intervals (UIs) derived from 250 or more draws from posterior distributions.
Findings
From 1990 to 2023, the global morbidity gap increased from 8·8 years (95% UI 6·7–11·2) to 10·7 (8·2–13·7), an increase of 1·9 years (1·3–2·6), or 21·9% (16·0–27·9), with point estimates suggesting widening morbidity gaps in 203 of 204 countries and territories. Globally in 2023, an average of 14·5% of life was spent in poor health, compared to 13·6% in 1990. From 1990 to 2023, across locations, age-specific morbidity gaps widened across the adult life course, rather than concentrating in the final years of life. In 2023, morbidity gaps were largest in the high SDI quintile and smallest in the low SDI quintile. Countries with longer life expectancies had larger morbidity gaps and both had a positive relationship with SDI; however, the relationship between life expectancy and the proportional morbidity gap was less clear. A small number of chronic, largely non-fatal causes were the primary contributors to the morbidity gap, with musculoskeletal disorders (especially low back pain), mental disorders (depressive and anxiety disorders), sense organ diseases (age-related hearing loss), unintentional injuries (falls), and other non-communicable diseases together accounting for 57·4% of unhealthy years in 2023, globally. High fasting plasma glucose, high body-mass index, and child and maternal malnutrition were the leading risk factors contributing to the global morbidity gap.
Interpretation
The expansion of the morbidity gap across nearly all locations indicates that improvements in survival have consistently outpaced reductions in non-fatal health loss across geographies, SDI levels, and sexes, with most populations now spending a decade or more of life in poor health across the lifespan. Progress towards healthy ageing should therefore be assessed not only by reduced mortality, but also by declines in years lived in poor health, with emphasis placed on extending healthspan.
Euronews article – People are living longer, but not healthier, study finds (Open access)
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