The World is Living Longer Than Ever – But With Increased Illness and Disability

The good news is that global life expectancy has risen more than six years since 1990.

The bad is that people will spend more years living with illness and disability.


According to a new analysis of all major diseases and injuries in 188 countries, the main causes of health loss around the world are ischemic heart disease, lower respiratory infections, and stroke.

Published in The Lancet on August 27, the study was conducted by an international consortium of researchers working on the Global Burden of Disease study and led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Global life expectancy at birth for both sexes rose from 65.3 years in 1990 to 71.5 years in 2013, while healthy life expectancy, or HALE, at birth rose from 56.9 years in 1990 to 62.3 years in 2013. The improvement in health across the globe is attributed to declines in death and illness caused by HIV/AIDS and malaria, as well as advances made in addressing communicable, maternal, neonatal, and nutritional disorders.

The increase in healthy life expectancy, however, has not been as dramatic as the growth of life expectancy. As a result, people are living more years with illness and disability. So, even though we’re living longer – even in some of the poorest countries – we’re not necessarily living better.

“The world has made great progress in health, but now the challenge is to invest in finding more effective ways of preventing or treating the major causes of illness and disability,” said Professor Theo Vos of IHME, the study’s lead author.

Although the changes in life expectancy between 1990 and 2013 were predominantly positive for most countries, for others, the difference was minimal. In countries like Botswana, Belize, and Syria, healthy life expectancy in 2013 was not significantly higher than in 1990. In some – like South Africa, Paraguay, and Belarus – healthy life expectancy has actually dropped since 1990.

The difference between countries with the highest and lowest healthy life expectancies is glaring. For example, in 2013, Lesotho had the lowest, at 42 years, and Japan had the highest globally, at 73.4 years.

As both life expectancy and healthy life expectancy increase, changes in rates of health loss become increasingly crucial. The study’s researchers use disability-adjusted life years (DALYs) to compare the health of different populations and health conditions across time. One DALY equals one lost year of healthy life and is measured by the sum of years of life lost to early death and years lived with disability.

As measured by DALYs, the leading global causes of health loss in 2013 were ischemic heart disease, lower respiratory infections, stroke, low back and neck pain, and road injuries. These causes differed by gender. Males experienced more road injuries, while females were susceptible to depressive disorders.

The fastest-growing global cause of health loss between 1990 and 2013 was HIV/AIDS, which increased by 341.5 per cent. On a positive note, we’ve seen progress on this front in recent years; since 2005, health loss due to HIV/AIDS has diminished by 23.9 per cent.

Not surprisingly, the countries with the highest rates of DALYs are among the poorest in the world, and include several in sub-Saharan Africa: Lesotho, Swaziland, Central African Republic, Guinea-Bissau, and Zimbabwe. On the other hand, countries with the lowest rates of health loss include Italy, Spain, Norway, Switzerland, and Israel.

When it comes to life expectancy, Canada comes tenth on the list, with a life expectancy of 70.1 years.

Countries with highest healthy life expectancy, both sexes, 2013

1. Japan
2. Singapore
3. Andorra
4. Iceland
5. Cyprus
6. Israel
7. France
8. Italy
9. South Korea
10. Canada

Countries with lowest healthy life expectancy, both sexes, 2013

1. Lesotho
2. Swaziland
3. Central African Republic
4. Guinea-Bissau
5. Zimbabwe
6. Mozambique
7. Afghanistan
8. Chad
9. South Sudan
10. Zambia

Leading causes of DALYs or health loss globally for both sexes, 2013

1. Ischemic heart disease
2. Lower respiratory infection
3. Stroke
4. Low back and neck pain
5. Road injuries
6. Diarrheal diseases
7. Chronic obstructive pulmonary disease
8. Neonatal preterm birth complications
10. Malaria