People living longer but sicker — Lancet

FOR decades, longer life expectancy has been celebrated as one of humanity’s greatest achievements. But a new global study has found that millions of people are surviving longer only to spend more years living with chronic illness, pain and disability.

The study, published in The Lancet Public Health, found that although life expectancy has risen dramatically over the past three decades, healthy life expectancy has failed to keep pace, leaving people around the world spending an increasing share of their lives in poor health.

Based on data from 204 countries and territories, the study shows that the average morbidity gap—the number of years people live in poor health before they die—has widened from 8.8 years in 1990 to 10.7 years in 2023.

According to the findings, people today spend an average of 14.5% of their lives living with disease or disability, compared with 13.6% just over three decades ago. Researchers also found that this growing burden is no longer confined to old age but now stretches across much of adulthood.

“The challenge is no longer simply helping people live longer. It is helping them stay healthy for longer,” the study’s authors said.

The findings expose one of modern healthcare’s biggest contradictions. Between 1990 and 2023, global life expectancy increased from 64.6 years to 73.8 years, while healthy life expectancy rose from 55.9 years to 63.1 years.

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Although these gains are undeniable, they remain uneven. Medical advances have helped people survive heart disease, cancer and infectious diseases, but millions are now living for years with arthritis, depression, hearing loss, diabetes and other chronic conditions that rarely cause death but steadily erode quality of life.

Rather than compressing illness into the final months of life, healthcare systems are increasingly prolonging it. As a result, the countries with the longest life expectancy are also among those with the longest periods of ill health.

The United States recorded the world’s widest morbidity gap in 2023 at 14 years, narrowly ahead of Australia (13.9 years) and Canada (13.7 years).

Researchers said this reflects a paradox of development: wealthier countries have become exceptionally good at keeping people alive but far less successful at preventing or delaying chronic disease.

Across high-income regions, people are living longer than previous generations, yet many of those additional years are marked by disability, pain, or declining physical and mental health.

The study also highlights a persistent gender divide. Women continue to outlive men in almost every part of the world, but they spend significantly more of those extra years in poor health. Globally, women live an average of 12.1 years in poor health, compared with 9.3 years for men.

The findings suggest that longevity alone is an incomplete measure of progress, particularly if those added years are accompanied by increasing disability.

Lower back pain and other musculoskeletal disorders remain the leading contributors to years lived in poor health, followed by depression, anxiety, age-related hearing loss, falls and other non-communicable diseases.

Unlike infectious diseases, these conditions often persist for decades, requiring continuous care rather than one-time treatment.

The researchers said extending life expectancy can no longer be the sole benchmark of successful healthcare. Instead, governments should focus on reducing the number of years people spend living with illness by investing in prevention, rehabilitation and long-term management of chronic diseases.

High blood sugar, obesity, tobacco use and malnutrition remain among the leading preventable drivers of poor health worldwide, although their impact varies across regions.

The researchers warned that without stronger action, ageing populations could place unprecedented pressure on healthcare systems, while millions of people spend longer lives increasingly shaped by disability rather than wellbeing.