A Global Burden of Disease analysis of 204 countries finds that the gap between lifespan and healthspan widened almost everywhere between 1990 and 2023, challenging the hope that modern medicine would squeeze illness into life’s final years.
Featured image credit: Basile Morin
By two of the most closely watched measures in public health, Singapore is the best place on Earth to grow old. In 2023, the city-state ranked first in the world for both life expectancy, at 85.4 years, and healthy life expectancy, at 74.1 years. But a new global analysis finds a less flattering trend tucked beneath those headline figures: the number of years Singaporeans spend in poor health is growing faster than the global average.1,2
The study, led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in collaboration with the Yong Loo Lin School of Medicine at the National University of Singapore, examined 204 countries and territories from 1990 to 2023. It focused on what researchers call the morbidity gap — the difference between how long people live and how long they live in good health. Published in The Lancet Public Health, the analysis found that this gap widened in 203 of the 204 places studied.1
More years, not all of them good
In Singapore, the morbidity gap grew from 8.9 years in 1990 to 11.2 years in 2023. Based on the study’s unrounded estimates, that is an increase of about 2.35 years, or 26.6 percent — larger than the global increase of 21.9 percent.2 The country has done extraordinarily well at preventing early deaths. It has done less well at making sure the added years are lived free of chronic illness and disability.
“Singapore’s position as a global leader in life expectancy and healthy life expectancy is a major public health achievement,” said Associate Professor Marie Ng, director of the NUS-IHME Global Burden of Disease Research Centre at NUS Medicine and a co-author of the study. “However, the widening morbidity gap shows that living longer does not automatically mean that every additional year is lived in good health.”2
The task ahead, Ng argued, is a change of emphasis. “The next frontier for Singapore is therefore not simply to add more years to life, but to reduce the burden of chronic illness, disability, and functional decline across the life course,” she said.2
A global pattern
Singapore is an extreme case of a nearly universal trend. Worldwide, life expectancy rose from 64.6 years in 1990 to 73.8 years in 2023, while healthy life expectancy climbed from 55.9 to 63.1 years. Because total lifespan grew faster, the global morbidity gap widened from 8.8 to 10.7 years. In 2023, people around the world spent an average of 14.5 percent of their lives in poor health, up from 13.6 percent three decades earlier.2
The results cut against an influential idea in the study of aging known as the compression of morbidity. First proposed decades ago, it holds that better prevention and medical care would push illness and disability later and later, concentrating them into a short stretch at the very end of life. Instead, the new analysis finds that non-fatal health loss has generally accumulated across adulthood rather than being confined to life’s final years.2
Professor Simon Hay, the study’s first author and director of research strategy at IHME, said the findings should change how health systems define success. “Over the past three decades, the world has achieved remarkable gains in survival, but gains in healthspan have not kept pace,” he said. “Health systems should be assessed not only by how many deaths they prevent, but also by whether people are able to live longer with good health, mobility, and independence.”2
The gender health paradox
The study also documents a persistent difference between women and men. In Singapore, women had an estimated life expectancy of 87.5 years in 2023, compared with 83.1 years for men — but women also spent an estimated 12.1 years in poor health, versus 10.4 years for men. Globally, the morbidity gap reached 12.1 years for women and 9.3 years for men.2 Researchers call this the gender health paradox: women tend to outlive men, but they spend more of those years living with illness and disability.
What fills the gap
The conditions that drive the morbidity gap are mostly the ones that rarely appear on death certificates. Globally, five largely non-fatal groups accounted for 57.4 percent of the gap in 2023: musculoskeletal disorders, especially low back pain; mental disorders such as depression and anxiety; sense organ diseases including age-related hearing loss; unintentional injuries, particularly falls; and other non-communicable diseases. The leading global risk factors were high fasting plasma glucose, high body-mass index, child and maternal malnutrition, tobacco use, and air pollution, with their relative weight varying by a country’s income and level of development.2
In Singapore, the biggest contributors were musculoskeletal disorders, mental disorders, unintentional injuries, sense organ diseases, and cardiovascular disease. The top five risk factors were high fasting plasma glucose, high body-mass index, occupational risks, high systolic blood pressure, and dietary risks.2 That list points squarely at diabetes and metabolic disease, obesity, hypertension, diet, workplace hazards, mental health, falls, hearing loss, and joint and back problems.
Ng said tracking healthy life expectancy alongside lifespan gives policymakers a sharper tool. “Singapore has an opportunity to lead not only in how long people live, but in how long they live well,” she said. Monitoring the morbidity gap, she added, can show “whether programmes are successfully turning added years of life into added years of good health.”2
For the rest of the world, Singapore’s numbers offer both a benchmark and a warning. Even the country that has done the most to extend healthy life is watching its years of illness grow. Winning the fight against early death, it seems, is only half the job.
Notes
- Global, regional, and national trends in the morbidity gap and contributing diseases, injuries, and risk factors, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. (2026). The Lancet Public Health. https://doi.org/10.1016/S2468-2667(26)00098-8
- National University of Singapore, Yong Loo Lin School of Medicine. (2026, July 22). Singapore has the world’s longest, healthiest lives — but also more years in poor health [Press release]. EurekAlert! https://www.eurekalert.org/news-releases/1137059