Singaporeans have the world’s highest life expectancy and healthy life expectancy, but a growing number of years are spent in poor health, according to a new global study led by the Institute for Health Metrics and Evaluation (IHME), in collaboration with the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine). Analysing 204 countries from 1990 to 2023, the study finds that the morbidity gap, which refers to the gap between how long people live and how long they live in good health, has widened in almost all countries, including Singapore, which has the world’s longest and healthiest lives. This represents an increase of approximately 2.35 years, or 26.6%, in the morbidity gap, based on the study’s unrounded estimates, compared with a global increase of 21.9%.
Published in The Lancet Public Health , the findings suggest that while Singapore has made substantial progress in preventing early deaths and extending life, improvements in the number of years spent in good health have not kept pace with its gains in longevity.
Associate Professor Marie Ng, Director, NUS-IHME Global Burden of Disease Research Centre, NUS Medicine, and a co-author of the study, said, “Singapore’s position as a global leader in life expectancy and healthy life expectancy is a major public health achievement. However, the widening morbidity gap shows that living longer does not automatically mean that every additional year is lived in good health. 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. This will require stronger prevention, earlier intervention, rehabilitation, and sustained support to help people remain healthy and independent as they age.”
A trend observed globally
Estimates indicated that the morbidity gap widened in 203 of the 204 countries and territories studied. Globally, life expectancy increased from 64.6 years in 1990 to 73.8 years in 2023. Healthy life expectancy also improved, rising from 55.9 to 63.1 years. However, as total life expectancy increased more quickly, the global morbidity gap widened from 8.8 to 10.7 years, which is an increase of 1.9 years, or 21.9%. In 2023, people worldwide spent an average of 14.5% of their lives in poor health, compared with 13.6% in 1990.
The results challenge the “compression of morbidity” hypothesis, which proposes that advances in prevention and healthcare would delay illness and disability, concentrating them into a shorter period near the end of life. Instead, the study found that non-fatal health loss has generally accumulated across adulthood, rather than being confined to the final years of life.
Women live longer but spend more years in poor health
The study also highlighted 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. However, women spent an estimated 12.1 years in poor health, compared with 10.4 years among men. This mirrors the global “gender health paradox”, in which women generally live longer than men but experience more years with illness and disability. Globally, the morbidity gap reached 12.1 years for women and 9.3 years for men in 2023.
Professor Simon Hay, first author of the study and Director of Research Strategy at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, said, “Over the past three decades, the world has achieved remarkable gains in survival, but gains in healthspan have not kept pace. For most populations, the additional years of life gained are accompanied by more years lived with illness or disability. This does not diminish the importance of preventing deaths, but highlights that the definition of public health progress must broaden. 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.”
Leading causes and risk factors
Globally, five predominantly non-fatal groups of conditions accounted for 57.4% of the morbidity gap in 2023: musculoskeletal disorders, particularly low back pain; mental disorders, including depression and anxiety; sense organ diseases such as age-related hearing loss; unintentional injuries, especially falls; and other non-communicable diseases. The leading global risk factors included high fasting plasma glucose, high body-mass index, child and maternal malnutrition, tobacco use, and air pollution. The relative importance of these risks differed according to countries’ income and socio-demographic development.
In Singapore, the causes contributing most to its morbidity gap were musculoskeletal disorders, mental disorders, unintentional injuries, sense organ diseases and cardiovascular diseases. The five leading risk factors were high fasting plasma glucose, high body-mass index, occupational risks, high systolic blood pressure and dietary risks. These findings highlight the importance of preventing and managing diabetes and metabolic disease, obesity, hypertension, unhealthy diets, workplace-related health risks, mental health conditions, falls, hearing loss, and musculoskeletal problems.
Assoc Prof Ng added, “Singapore has an opportunity to lead not only in how long people live, but in how long they live well. The conditions contributing most to the morbidity gap are often non-fatal, but they can have a profound effect on people’s independence, ability to work, and quality of life. Tracking healthy life expectancy and the morbidity gap can help policymakers identify where additional attention and resources are needed, and whether programmes are successfully turning added years of life into added years of good health.”
The Lancet Public Health
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
22-Jul-2026