North Americans are living longer, but spending less time in good health

According to an analysis of data from the Institute for Health Metrics and Evaluation’s Global Burden of Disease study, the estimated average proportion of life spent in good health in the United States declined from 85.8% in 1990 to 83.6% in 2021. This indicates that Americans are living longer but spending less time in good health.

The decrease in time spent in good health can be attributed to several factors. One reason is that medical advances have improved the ability to catch and treat diseases that previously would have been fatal. While this has extended life expectancy, it has also led to more years spent living with chronic illnesses.

Another contributing factor is the rising prevalence of conditions such as obesity, diabetes, and substance use disorders, particularly among younger people. These conditions can have a significant impact on overall health and well-being.

The implications of this trend are significant. Declining health not only affects individuals and their caregivers but also has broader societal ramifications. It leads to rising healthcare costs, which can strain household budgets, and can also result in a larger population of individuals who want to work but are unable to do so due to health issues.

Healthspan and the U.S. lifespan-healthspan gap

Healthspan refers to the number of years lived in good health, free from disability or disease. It is an important measure of overall well-being. In the United States, the gap between lifespan (how many years we live) and healthspan (how many years we are mostly healthy and feel good) is growing. While life expectancy from birth has increased from 75.6 years in 1990 to 77.1 years in 2021, healthy life expectancy, which measures the number of years we can expect to enjoy good health, fell from 64.8 to 64.4 in the same period.

The growing gap between overall years and good-health years is largely due to the fact that Americans are living longer. As we age, the likelihood of developing age-related conditions increases. This is a consequence of success in extending life rather than a failure. The more years of old age we have, the more opportunity there is for age-related conditions to develop.

Factors contributing to the U.S. lifespan-healthspan gap

Several factors contribute to the growing gap between lifespan and healthspan in the United States. One factor is the higher prevalence of certain conditions at earlier ages, such as substance use disorders, obesity, and diabetes. Mental health disorders, particularly among younger Americans, are also believed to be impacting healthspan.

Improved surveillance and diagnostic sensitivity may also be leading to the detection of more cases of diseases that were previously missed. Additionally, advances in treatment for many diseases have made it possible to live with chronic illnesses more effectively than in the past.

Comparison with other high-income countries

While the U.S. has experienced a decline in both lifespan and healthspan, other high-income countries have seen increases in both over the past three decades. The percentage of years spent in good health has shrunk slightly in these countries, but not to the same extent as in the U.S. This difference may be attributed to factors such as access to preventive healthcare and screenings, as well as a greater focus on disease prevention in other countries.


In summary, Americans are living longer but spending less time in good health. This trend can be attributed to a combination of factors, including medical advances that extend life but also lead to more years living with chronic illnesses, as well as the rising prevalence of conditions such as obesity, diabetes, and substance use disorders. The growing gap between lifespan and healthspan has significant implications for individuals, caregivers, and society as a whole.

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