Global morbidity gap widens across 203 countries as survival gains outpace healthy aging, Lancet study finds

Against a backdrop of rapid population aging, people across 203 of 204 countries analyzed are living longer but spending a rising share of those years coping with chronic illness, according to a study published in The Lancet Public Health. Researchers at the Institute for Health Metrics and Evaluation at the University of Washington found that the global share of life spent in poor health rose to 14.5% in 2023 from 13.6% in 1990. Over that period, life expectancy at birth climbed from 64.6 years to 73.8 years, while healthy life expectancy moved from 55.9 years to 63.1 years.

Lifespan and healthspan diverge sector-wide

Because survival gains consistently outpaced gains in healthy years, the "morbidity gap" (the span of life spent in poor health) widened in almost every country the researchers studied. The trend is most pronounced in wealthier nations, where life-extending medical resources are most concentrated. Among them, the United States stands apart: Americans face a morbidity gap of approximately 14 years, equivalent to 17.8% of expected lifespan. Women globally live longer than men but also accumulate more years in poor health.

Chronic conditions account for more than half the burden

A small number of largely non-fatal conditions drive most of the deterioration. Musculoskeletal disorders, especially low back pain, mental health conditions including depression and anxiety, hearing loss, and falls collectively account for about 57% of all years lived in poor health worldwide. High fasting plasma glucose and obesity were also identified as material contributors.

Dr. Christopher Murray, director of the IHME and senior author of the study, said progress in healthy aging should be measured by healthspan alongside lifespan, with greater investment in prevention, long-term disease management and chronic care. Dr. Antony Chu, a clinical assistant professor at Brown University's Warren Alpert School of Medicine, noted that modern medicine has achieved substantial results in reducing mortality from cardiovascular disease, cancer, trauma and infectious illness. Many of those additional years, he said, are now lived with chronic pain, disability, sensory loss, depression or reduced independence.

Preventive emphasis and the cross-border dimension

Both researchers converge on a shift in clinical priorities. Chu called for routine assessment of mobility, muscle strength, balance, hearing and cognition alongside standard markers such as blood pressure and cholesterol. Functional decline often begins years before disability becomes clinically obvious, he said, making early intervention the central opportunity. Progressive resistance training, fall prevention and early treatment of chronic back pain should be core components of preventive medicine.

Chu also raised a cross-border dimension relevant to the demand environment for chronic care. Older adults in many societies outside the United States continue to play active roles in multigenerational families, a pattern he described as offering meaningful protection against loneliness, depression and loss of identity. Many older Americans, he said, face increasing social isolation at precisely the stage of life when maintaining meaningful relationships matters most.

The IHME's analysis covered 204 countries and territories from 1990 through 2023. The researchers noted their findings map broad population health trends but do not establish the precise causes of rising years spent in poor health.