Living longer doesn't necessarily mean living healthier. Despite having the world's highest life expectancy, people in Singapore spend many of their later years in poor health, according to new research published in The Lancet Public Health.
The study used 2023 data to estimate lifespans in 204 countries and found that Singapore topped the leaderboard, with the average citizen expected to live beyond their 85th birthday.
“Singapore’s longevity reflects deliberate long-term policy rather than any single cause,” study author Dr Marie Ng – associate professor at Yong Loo Lin School of Medicine, National University of Singapore (NUS) – told BBC Science Focus.
“Its healthcare system, robust social protection and evidence-based governance all allow its citizens to thrive.”
The scientists also investigated healthspan: the number of years a person can expect to live in good health.
They found that Singaporeans may live well into their 80s, but the last 11.2 years of their lives are likely to be burdened by ill-health.
Researchers call this difference between life expectancy and healthy life expectancy the ‘morbidity gap’. In other words, people are spending more of their lives in poor health than they did in the 1990s.
Global life expectancy rose from 64.6 years in 1990 to 73.8 in 2023, the study found. But healthy life expectancy failed to keep pace, with adults now spending around one in seven years in poor health.
Women typically outlived men, but they also spent more of those extra years in poor health. Globally, the healthspan gap averaged 12.1 years for women, compared with 9.3 years for men.
In Singapore, the contrast was even sharper: although women lived just 4.4 years longer than men, they spent more than twice as many years in poor health – 21.1 years versus 10.4.
Dr Julian Mutz – research fellow at King’s College London, who was not involved with this study – told BBC Science Focus: “The gender health paradox, that women live longer but with more years in poor health, is long recognised but still poorly explained. This study is another reminder that this deserves much more attention.”
People in the US could expect to spend more years in poor health than those in any other country – 14 years on average – followed closely by Australia and Canada. These were the 10 countries with the highest average number of years spent in poor health:
- US (14 years)
- Australia (13.9 years)
- Canada (13.7 years)
- New Zealand (13.1 years)
- The Netherlands (12.9 years)
- San Marino (12.9 years)
- Switzerland (12.8 years)
- Lebanon (12.8 years)
- UK (12.7 years)
- Puerto Rico (12.7 years)
But the study’s findings were remarkably consistent; the gap between lifespan and healthspan seemed to be widening in 203 out of 204 countries, with the single exception of Palestine.
“Most populations now spend a decade or more living in poor health,” explained Ng. “For individuals and families, that means more years are spent managing chronic conditions like back pain, hearing loss, neurological disorders and diabetes.”
Indeed, five types of conditions accounted for 57.4 per cent of the global morbidity gap in 2023: musculoskeletal disorders, especially low-back pain; mental disorders including depression and anxiety; sense organ diseases such as hearing loss; injuries, especially falls; and non-communicable diseases like diabetes, high blood pressure and heart disease.
Prof Simon Jones – from the University of Birmingham’s Centre for Musculoskeletal Ageing, who was not involved in this study – told BBC Science Focus that this was the most notable finding.
“Musculoskeletal disorders were found to be the single biggest contributor to the healthspan gap,” he said. “This is a real demonstration of just how important muscles, bones and joints are to healthy ageing.”
Ng said that the study quantified something most of us had already noticed among our loved ones: “We have become remarkably good at adding years to life, but far less successful at adding life to those years.”
She said the study was a call to action. “The central message is that longevity alone is no longer the right measure of success. The urgent question is not simply how long we live, but how well we live in that final chapter – and whether those added years are ones of vitality or decline.”
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