Large-Scale Study: Where Do People Live Longest in Good Health?
We live longer, but not necessarily better: a study covering 204 countries found that people today spend a significant portion of their lives with illness and disability. This phenomenon is particularly noticeable in wealthy nations. Where does Israel rank in the global index? Welcome to our new column, "Longevity Science."
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A study recently published in the prestigious journal Lancet Public Health, led by renowned epidemiologist Prof. Simon Hay from the University of Washington, examined how many years adults in 204 countries are expected to spend in significant morbidity, which impairs quality of life. It found that increasing life expectancy does not necessarily extend healthy life expectancy as well.
The study, which examined the years 1990–2023, found the opposite: as life expectancy increases, we are expected to spend more years of life with significant impairments such as hearing loss, severe back pain, mental illness, and more.
The countries with the most years of unhealthy life are actually the wealthy countries with high life expectancy. The "leader" is the USA, with 14 years, followed by Australia (13.9), Canada (13.7), New Zealand (13.1), and the Netherlands (12.9). An exception at the top of the table is Lebanon, a non-wealthy country, where people live 76 years on average (compared to 85 for the longevity leader, Monaco), of which 12.8 years are spent in morbidity.
When examining the proportion of years that residents of countries spend in illness out of their total years of life, one gets a mix of wealthy and poor countries. The leader in this index is Afghanistan, where people live on average only 65 years, of which 12.2 are in poor health, almost 19% of life. Number 2 on the list is again the USA, with 18% of life in poor health.
At the end of the illness list are remote island nations, such as the Solomon Islands, the Marshall Islands, and Tuvalu, and not for good reasons — the relatively short life expectancy there does not leave residents much time to get sick. Exceptions are the Maldives, with a good life expectancy of 80 years, of which only 11% are in poor health.
Mainly back pain, depression, and anxiety
And what is the situation in Israel? We are in a respectable 110th place, with 14% unhealthy years, meaning 11.2 years out of an average life expectancy of 80 years.
The researchers did not intend to compare countries, but to understand whether, at a global level, an improvement in life expectancy leads simultaneously to more healthy life years or fewer. They found that on average, between 1990 and 2023, there was an increase in the number of unhealthy years, and as a result, 14.5% of life was spent by the population in poor health, compared to 13.6% in 1990. The deterioration was felt precisely in countries with high socio-economic status.
A small number of diseases and disabilities characterize most of the unhealthy years: musculoskeletal pain — mainly back pain, depression and anxiety, and sensory impairments, such as hearing loss. In sub-Saharan African countries, infectious diseases such as malaria or tuberculosis were also added to this.
The leading risk factors for long-term health impairment were falls and bone fractures, high blood sugar, high BMI, smoking, air pollution, and in poorer countries also maternal or child malnutrition and unprotected sex. It will be interesting to see how the obesity treatment drugs that came into widespread use in 2023 and are supposed to treat two significant risk factors — diabetes and obesity — will affect this.
The researchers further noted that significant improvements in the treatment of heart disease in the second half of the 20th century led in the Western world, at the first stage, to a shortening of years of morbidity along with an increase in life expectancy. Only later, after these achievements were recorded, did the period of life in morbidity increase again compared to the 1990s. That is, increasing life expectancy does not necessarily have to be associated with an increase in "bad" years.
