The inhabitants of most countries around the world are reaching ages that seemed unattainable only a few decades ago. While it is true that the generalised mortality delay is an unprecedented collective success, it must be asked whether we are being equally successful in our efforts to postpone the onset of disease and disability (or, in other words, morbidity). If decreasing mortality rates are not matched by an equivalent decline in morbidity rates, individuals will tend to live for more years but in a worse state of health. This is a phenomenon with enormous consequences for the sustainability of health and pensions systems, as we know them.
In our recent work from the Center for Demographic Studies (Permanyer and Bramajo 2022), we explore the extent to which the increases in longevity recorded in Europe over the last 30 years have had parallel gains in years in good health (which is to say, ‘adding life to years’) or in bad health (‘adding years to life’). Focusing not only on quantity but also on the quality of the years gained, the study aims to shed new light on a pressing issue which should be taken into account in the design of a wide range of public policies that must go beyond the confines of what is strictly understood as the domain of health.
The findings of our study suggest that in the countries with lower longevity levels, any additional years added to one’s lifespan will be in ‘good’ rather than ‘less-than-good health’. This is because, in these countries, decreases in mortality tend to ‘save’ younger individuals’ lives, whose survival entails an increase in the number of years lived in good health. At the other extreme, increased longevity in countries with higher life expectancy levels can only be achieved by even further reducing mortality at advanced ages, since mortality levels at younger ages are already extremely low. Therefore, getting older tends to go hand in hand with more instances of disease and/or disability, where subsequent increases in life expectancy in longevous countries are more likely to be in ‘less-than-good health’.
Our findings suggest that the proportion of life expectancy lived in poor health tends to be higher among women – and increase over time. These results seem to support the ‘expansion of morbidity theory’ formulated by Gruenberg that suggests that reduced mortality simply entails a greater number of years lived in poor health – although such interpretations should be taken with extreme caution. First, the measurement of what ‘good’ or ‘poor’ health constitutes is still somewhat arbitrary, and the quality of data sources varies among countries. Second, what might nowadays be considered a severely limiting disease or disability might be treated very effectively in the near future due to the discovery of new drugs or treatments. Continual advances in technology and medicine can significantly improve the quality of life of people living in situations of morbidity.
Future increases in life expectancy could pose a major social challenge if, as our study suggests, they are accompanied not only by increased morbidity but also of co-morbidity. This suggests the need to devote more resources to reducing morbidity, either by means of preventive campaigns to delay the ages of onset of disease and disability (for example, by promoting healthy lifestyles and inclusive, sustainable socioeconomic environments) or with investment in treatments and technological innovations that would reduce the burden associated with individuals living in morbid states.