For decades, medical advances have pushed life expectancy higher across the globe, but a major new study published in The Lancet Public Health reveals a troubling trend: those extra years are increasingly spent in poor health. The research, covering 204 countries and territories, finds that the gap between how long people live and how long they live healthily is widening almost everywhere.
In 2023, the average person spent 14.5 percent of their life in poor health, up from 13.2 percent in 1990. The study’s authors argue that health systems, particularly in Europe and other wealthy regions, must shift their focus from simply prolonging life to improving the quality of those additional years. “Progress in healthy ageing should be measured not only by lifespan, but by healthspan,” said Christopher Murray, director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine and senior author of the study.
Wealthier Nations See Widest Morbidity Gaps
The data show a stark paradox: countries where people live the longest also record the highest proportion of life spent in poor health. In the wealthiest nations, that figure reached 15.7 percent in 2023. The Netherlands experienced the largest absolute increase, rising from 13.2 percent in 1990 to 15.7 percent. The United States, Australia, and Canada posted the greatest morbidity gaps overall.
By contrast, the smallest gaps were observed in Nauru, the Solomon Islands, and Laos. Sub-Saharan Africa had the lowest morbidity gap at just nine years, though life expectancy there remains significantly lower. The findings challenge the assumption that longer life automatically means healthier ageing.
Non-Fatal Conditions Drive the Divide
The study identifies non-fatal conditions as the primary driver of the morbidity gap, accounting for 57.4 percent of the global disparity. Musculoskeletal disorders such as low back pain, mental health conditions, sense organ diseases like age-related hearing loss, and unintentional injuries top the list. In lower-income countries, nutritional deficiencies, respiratory infections, tuberculosis, and neglected tropical diseases also play a major role.
Risk factors vary by region. High body mass index, child and maternal malnutrition, tobacco use, high fasting plasma glucose, and air pollution are leading contributors worldwide. In high-income regions, drug use and high alcohol consumption are among the top ten risk factors, while unsafe sex is a leading factor only in sub-Saharan Africa. These patterns underscore the need for tailored public health strategies across Europe and beyond.
Implications for European Health Systems
The findings raise urgent questions about the sustainability of social care systems across the continent. As the percentage of life spent in poor health has steadily increased since 1990, the World Health Organization (WHO) emphasises the importance of healthy ageing—maintaining functional ability that enables wellbeing in older age. For European countries, where ageing populations already strain healthcare budgets, the study’s conclusions are particularly relevant.
“Addressing these earlier through prevention and better long-term care could have meaningful social, health system, and economic impacts,” said Catherine Bisignano, a co-author of the study. Economic modelling suggests that targeting the ageing process itself could yield larger financial gains than eliminating specific diseases. This aligns with ongoing policy debates, such as Spain’s proposed ban on smoking at terraces and beaches, which aims to reduce tobacco-related morbidity.
The study also highlights the role of environmental factors. Air pollution, a key risk factor, is linked to chronic conditions that erode healthspan. Meanwhile, traffic noise has been associated with higher Parkinson’s risk, according to a Danish study, further illustrating the complex web of influences on healthy ageing.
As Europe grapples with these challenges, the research calls for a fundamental reorientation of health policy. “Our findings suggest that future gains in population health will come not only from helping people live longer, but from helping them live healthier,” Murray said. For policymakers in Brussels, Berlin, and beyond, the message is clear: investing in prevention and chronic care is no longer optional—it is essential for the continent’s future wellbeing.
