When discussing longevity, it is easy to focus only on how many years people are expected to live. But medically, that tells only half the story. The equally important question is how many of those years will be lived in good health.
For the average Israeli, the gap between total life expectancy and healthy life expectancy now stands at 11.7 years, according to a new global study. That means more than a decade may be spent living with chronic illness, pain or disability.
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Life expectancy is rising, but healthy life expectancy is not increasing at the same pace
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The study, published in The Lancet Public Health as part of the Global Burden of Disease 2023 project, examined life expectancy and healthy life expectancy in 204 countries and territories between 1990 and 2023.
Its findings show that while medicine is succeeding in extending life, the number of years spent in good health is not increasing at the same pace. In 1990, global life expectancy stood at 64.6 years. By 2023, it had risen to 73.8 years, an increase of more than nine years.
Healthy life expectancy, meaning the number of years a person is expected to live in full health after taking disease and disability into account, also rose during that period, from 55.9 to 63.1 years. But it increased more slowly than overall life expectancy.
The difference between overall life expectancy and healthy life expectancy is known as the morbidity gap. Globally, that gap widened from 8.8 years in 1990 to 10.7 years in 2023, an increase of 1.9 years, or 21.9%. According to the study, about 14.5% of a person’s life is now spent in less than full health.
The estimates showed that the gap widened in 203 of the 204 countries and territories examined. The researchers noted, however, that the trend was not statistically significant in every individual country. Their conclusion was based on the fact that the gap moved in the same direction almost everywhere.
The figure does not mean that every person will be continuously ill for the final 10.7 years of life. It is a population-wide average that takes into account illnesses and disabilities of varying severity occurring at different stages of life.
The study also found that health loss does not accumulate only in the final years, but throughout adulthood.
“When we talk about longevity, it is easy to focus on how many years we will live, but medically, that is not the only question,” said Dr. Nitzan Anav, head of longevity at Maccabi Healthcare Services. “The real question is how we will live those years. It is not only about adding years to life, but about adding life to those years.”
Dr. Nitzan AnavPhoto: Maccabi Healthcare Services PRLiving longer, but not always better
In Israel, the morbidity gap widened from 9.8 years in 1990 to 11.7 years in 2023, an increase of nearly two years, or 20.2%. Israel’s gap is larger than the global average of 10.7 years, but smaller than the 12.7-year average in high-income countries.
A smaller morbidity gap does not necessarily indicate better health. In countries with shorter life expectancy, people may also live fewer years with chronic disease simply because they die younger.
The study found that the higher a country’s life expectancy, the greater the number of years people generally live in poor health. The relationship was less clear, however, when researchers examined the proportion of a person’s total life spent in poor health.
In Israel, the morbidity gap widened from 9.8 years in 1990 to 11.7 years in 2023
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“This is the paradox of modern medicine,” Dr. Anav said. “We are succeeding in saving people from conditions that once caused early death and turning fatal diseases into chronic illnesses that people can live with for years. That is a tremendous achievement, but survival is not necessarily health.”
Israel’s health system, he added, can take pride in the country’s high life expectancy. “Our next achievement should be reducing the number of years Israelis live with pain, limitations and loss of independence,” he said.
Not only cancer and heart attacks
When people think about diseases that shorten life, they usually think of cancer, heart attacks and strokes. But much of the time spent in poor health is caused by conditions that do not necessarily lead to death, yet can damage daily functioning and quality of life for years.
Five groups of diseases and injuries together accounted for 57.4% of the global morbidity gap in 2023. Musculoskeletal disorders, particularly lower back pain, ranked first and accounted for an average of 1.8 years.
They were followed by mental health disorders, especially depression and anxiety, which accounted for 1.6 years. Sensory disorders, particularly age-related hearing loss, contributed another 1.1 years. Unintentional injuries, mainly falls, accounted for 0.9 years, while other noncommunicable diseases accounted for 0.8 years.
“These are not always the diseases that receive the biggest headlines,” Dr. Anav said. “But they determine whether a person can leave the house, climb stairs, exercise, sleep well, hear their grandchildren and live independently.”
The leading risk factors are also familiar. The study found that high blood sugar, excess weight, obesity and smoking are among the main contributors to the morbidity gap. Globally, maternal and childhood malnutrition, particularly iron deficiency, also stood out. When researchers examined more specific risk factors, particulate air pollution ranked first.
Women live longer, but also spend more years ill
The study also identified a clear difference between women and men. Women live longer, but in every region examined, they also spend more years living with illness and disability. In 2023, the global morbidity gap for women stood at 12.1 years, or 15.9% of their life expectancy. For men, it stood at 9.3 years, or 13% of life expectancy.
Women live longer than men, but also spend more years living with illness and disability
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According to Dr. Anav, the findings show that prevention must focus not only on reducing deaths, but also on preserving people’s ability to function. “A health system that wants to address an aging population must measure not only whether a person is alive, but also how that person lives,” he said.
“It must address movement, muscle strength, balance, mental health, hearing, cognition and the ability to continue living independently.”
The goal: More healthy years
For years, the success of health systems was measured mainly through life expectancy, mortality rates, hospitalizations and survival from disease. Those remain important indicators, but they do not show how chronic illness, pain and disability affect daily functioning and quality of life.
The study suggests that while medicine has succeeded in extending life, it has not reduced the number of years spent in poor health to the same extent.
“The implication is that risks must be identified earlier, before a person becomes ill,” Dr. Anav said. That means addressing obesity, high blood sugar and smoking earlier, treating physical activity and the preservation of muscle mass as part of medical care, and offering physiotherapy, rehabilitation, pain treatment, mental health services and hearing tests at an earlier stage.
The goal, he stressed, is not to prevent every illness, but to delay the onset of disease and disability for as long as possible, reduce their severity and shorten the period in which they impair daily life.
In longevity medicine, this is known as the compression of morbidity: delaying illness until as late in life as possible and reducing the number of years spent living with it.
“The next revolution in medicine will not be measured only by the number of birthdays we celebrate,” Dr. Anav said. “It will be measured by the number of years in which we can continue to walk, think, create, work, hear and live independently. The goal is not only to add years to life but to add health, function and meaning to those years.”