The average American now spends about 14 years of life in poor health, the largest such gap of any country on earth, according to a Global Burden of Disease analysis published July 21 in The Lancet Public Health. Worldwide, that gap between how long people live and how long they live in good health widened from 8.8 years in 1990 to 10.7 years in 2023, because gains in survival have outpaced gains in healthy years almost everywhere.
Key takeaways
- The global “morbidity gap,” meaning life expectancy minus healthy life expectancy, grew by 1.9 years since 1990 and widened in 203 of the 204 countries studied.
- The US ranks first at 14 years, then Australia at 13.9 and Canada at 13.7. The wealthiest countries have the widest gaps.
- Women averaged 12.1 years in poor health versus 9.3 years for men.
What the study found
Researchers at the Institute for Health Metrics and Evaluation at the University of Washington used GBD 2023 estimates for 204 countries, defining the morbidity gap as life expectancy at birth minus healthy life expectancy at birth.
Global life expectancy rose from 64.6 years in 1990 to 73.8 years in 2023, while healthy life expectancy rose from 55.9 to 63.1. That is 9.2 years of extra life against only 7.2 healthy ones. The share of life spent in poor health climbed from 13.6% to 14.5%. The 1.9-year widening is very likely somewhere between 1.3 and 2.6 years (95% uncertainty interval). COVID-19 disrupted both measures but did not reverse the trend.
Richer countries fared worst. The high-income super-region had the largest gap in 2023 at 12.7 years, while sub-Saharan Africa had the smallest at 9.0 years. The extra sick years were also not bunched at the end of life. The study found gaps widening “across the adult life course, rather than concentrating in the final years of life.”
Five groups of largely non-fatal conditions accounted for 57.4% of unhealthy years: musculoskeletal disorders (especially low back pain), depression and anxiety, sense organ disease including age-related hearing loss, falls and other unintentional injuries, and other non-communicable diseases. The leading risk factors were high fasting blood glucose, high body mass index, and child and maternal malnutrition.
Dr. Kumar’s take
Run the global arithmetic and the whole longevity conversation changes shape. Since 1990, humanity gained 9.2 extra years of life and only 7.2 of them were healthy. Every added year is buying less than a full year in the way that matters to the person living it.
That reframes the American number. The US is not failing to extend life. It is failing to compress disability. This country has the best rescue medicine in the world, and rescue medicine converts deaths into survivors with conditions. Sorting countries by this gap largely sorts them by how good they are at keeping sick people alive, which is why Australia and Canada sit right behind.
I would put a real caveat on the 14. A morbidity gap is built from years lived with disability, and disability has to be diagnosed and reported before it can be counted. Countries that screen aggressively and keep more people in contact with doctors will book more disability years. Some portion of America’s 14 is measurement, not suffering. That does not erase the finding, since the trend holds in 203 of 204 countries with very different health systems, but it should stop anyone from reading the rankings as a pure misery index.
The 2.8-year sex gap deserves the same care. Women live long enough to accumulate arthritis, back pain, and dementia, so part of it is the price of survival itself. Part of it is that musculoskeletal pain and depression are conditions medicine has been slow to take seriously in women.
The most useful detail got the least attention: the gap widened across adulthood, not just at the end. This is not a story about a longer dying process. It is about people in their forties and fifties carrying back pain, anxiety, and hearing loss for decades.
What it means for you
Low back pain, depression and anxiety, hearing loss, and falls are not the diseases that kill people, which is exactly why they go undertreated.
Strength training is the highest-yield response, because it works on back pain, bone density, and fall risk at once. Get your hearing tested rather than turning the volume up for another decade. Treat depression and anxiety as medical conditions with a long horizon, not as moods to wait out.
The two leading modifiable risk factors, high blood sugar and high body mass index, are the same ones on every cardiovascular list. Small changes in sleep, exercise, and diet are linked to about 9 extra years of life, and those same changes shrink the years spent in poor health.
If joint pain, back pain, or low mood has been treated as something to live with, that is precisely the territory this study says is costing years.