When Lifespan Outruns Health Span

We have become remarkably good at helping people live longer. We have been far less successful at helping them live those additional years healthily ageing.

A new analysis in The Lancet Public Health estimates the gap between life expectancy and healthy life expectancy was 10.7 years in 2023, up from 8.8 years in 1990.

I found that difficult to absorb.

For more than forty years, the compression of morbidity hypothesis has held the possibility, that effective prevention and care would delay disability more than death, compressing poor health into a shorter period near the end of life.

Longer life would also become healthier life.

The results published in the Lancet suggests otherwise.

We have spent decades celebrating longer life, and rightly so. Heart attacks and strokes that once killed can now be survived. Many cancers now become known as chronic conditions and treated for years. Infections that once ended lives are now prevented or controlled.

We have made more progress in preventing death than in reducing the years people live with declining function.

Saving a life is an achievement, but that is not the whole story.

It would be easy to read 10.7 years and imagine a decade of decline at the end of life. The study found something more complicated.

Although disability is concentrated at older ages, the morbidity gap has widened across the adult life course. Poor health is accumulating over many years, not simply arriving at the end.

This is not about how we care for older people. It is about whether we protect health across the whole of life.

What struck me was what sits behind the number. Nearly 58 per cent of the years people live in poor health come from just five broad groups starting with musculoskeletal disorders, especially low back pain being the largest contributor. The others are mental disorders such as depression and anxiety, sense organ diseases such as age-related sight and hearing loss, unintentional injuries, particularly falls, and other non-communicable diseases.

Future gains in healthy ageing will depend less on further reductions in mortality and more on preventing disease, reducing the severity of disability and shortening the time people live with non-fatal conditions.

That raises a difficult question.

Are we investing enough in prevention and risk reduction across the life course, or are we waiting until risk has become disease and disease has become disability?

The answer is no, not nearly enough.

Prevention does matters but it will not close the gap on its own.

Illness and disability will still occur. The task is reduce the severity and shorten the time people live with their consequences.

A person who survives a stroke should not wait months for rehabilitation. Cancer treatment should not end while pain, fatigue and cognitive changes remain unaddressed. Rehabilitation, assistive technologies, mental health services and chronic care are not optional additions.

They are part of reducing the years people live in poor health.

This is not a choice between prevention and support. We need systems that prevent where possible, intervene early and remain present when health changes.

Increased life expectancy is treated as evidence that countries are becoming healthier. And while it remains important, it can no longer be our principal measure of progress.

A health system can perform complex surgery and still fail to provide rehabilitation.

It can prescribe medication while leaving pain, hearing loss or depression untreated.

It can speak of prevention while excluding older people from screening, vaccination and risk-reduction programs because they crossed an age threshold.

Prevention should not stop at a birthday. This is called ageism.
Eligibility should be based on evidence, health status, individual preference and likely benefit, not age alone.

A life that includes disability is not a failed life, and a person who needs support has not become less worthy.

The failure lies in preventable suffering, missed opportunities for earlier intervention, delayed care and systems that count survival as success without asking whether people are being supported to remain healthy and connected.

The great achievement of the last century was extending life.

The unfinished work of this century is ensuring that prevention, treatment and support extend across the whole of life.