Singapore now leads the world in both lifespan and healthy lifespan, but its remarkable longevity gains reveal a growing divide between years lived and years lived well.
Singaporeans live longer and remain healthy longer than people anywhere else, yet they are also spending an increasing number of years with illness or disability. A global analysis led by the Institute for Health Metrics and Evaluation (IHME), in collaboration with the Yong Loo Lin School of Medicine at the National University of Singapore (NUS Medicine), found that gains in lifespan are outpacing gains in healthy life expectancy.
The researchers examined 204 countries and territories from 1990 through 2023. They tracked the morbidity gap, the difference between total life expectancy and the number of years lived in good health. That gap widened in nearly every country, including Singapore, where it increased by approximately 2.35 years, or 26.6%, based on the study’s unrounded estimates. Globally, the increase was 21.9%.
Published in The Lancet Public Health, the findings show that Singapore has made major progress in preventing early deaths and extending life. However, the number of healthy years has not risen as quickly as overall 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.”
Longer lives bring more poor health
The morbidity gap expanded in 203 of the 204 countries and territories included in the analysis. Worldwide life expectancy rose from 64.6 years in 1990 to 73.8 years in 2023, while healthy life expectancy increased from 55.9 to 63.1 years.
Because total lifespan grew more rapidly, the average global morbidity gap climbed from 8.8 to 10.7 years. This represents an increase of 1.9 years, or 21.9%. In 2023, people spent an average of 14.5% of their lives in poor health, compared with 13.6% in 1990.
These results challenge the “compression of morbidity” hypothesis. That idea proposes that improvements in prevention and health care should postpone illness and disability, limiting them to a shorter period near the end of life. Instead, the findings indicate that nonfatal health loss has generally accumulated throughout adulthood rather than being compressed into a person’s final years.
Women live longer but suffer longer
A persistent divide also emerged 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. Yet women were expected to spend 12.1 years in poor health, while the estimate for men was 10.4 years.
The same pattern appears globally and is known as the “gender health paradox.” Women generally outlive men but experience more years with illness or disability. In 2023, the worldwide morbidity gap was 12.1 years for women and 9.3 years for men.
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.”
Five groups of conditions that are usually not fatal accounted for 57.4% of the global morbidity gap in 2023. They included musculoskeletal disorders, especially low back pain; mental disorders such as depression and anxiety; diseases affecting the senses, including hearing loss associated with aging; unintentional injuries, particularly falls; and other noncommunicable diseases.
The leading global risk factors were high fasting plasma glucose, high body mass index, child and maternal malnutrition, tobacco use, and air pollution. Their relative importance varied with national income and sociodemographic development.
Singapore’s challenge shifts to healthspan
In Singapore, the largest contributors to the 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.
The findings point to the importance of preventing and managing diabetes and metabolic disease, obesity, hypertension, unhealthy diets, workplace 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 programs are successfully turning added years of life into added years of good health.”
Reference: “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” by Simon I Hay, Paul Nam, Haaris Saqib, Susan A McLaughlin, Catherine Bisignano, Samuel M Ostroff, Marie Ng, Shuhei Nomura, Austin E Schumacher and Christopher J L Murray, August 2026, The Lancet Public Health.
DOI: 10.1016/S2468-2667(26)00098-8
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