Data suggest Canadians can expect to spend about 17 per cent of their lives in poor health, writes André Picard.ipopba/iStockPhoto / Getty Images
People around the world are living longer. But they’re also living those additional years in poor health, a “morbidity gap” which is growing fastest in wealthy countries like Canada and the United States.
That is the paradoxical conclusion of new research published in the most recent edition of the journal Lancet Public Health.
“Progress in healthy aging should be measured not only in lifespan, but in healthspan,” said Christopher Murray, the lead researcher, and director of the Institute for Health Metrics and Education (IHME) at the University of Washington School of Public Health in Seattle.
IHME researchers analyzed data from the Global Burden of Disease Study from 1990 to 2003.
In that time period, essentially a generation, global life expectancy increased to 73.8 years from 64.6 years, a difference of 9.2 years.
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But, over that time, healthy life expectancy rose to 63.1 years from 55.9 years, an increase of only 7.2 years.
Stated another way, globally, the morbidity gap rose to 10.7 years in 2023 from 8.8 years in 1990.
In wealthy countries the morbidity gap is even more dramatic than the global average: 14 years in the U.S., 13.9 years in Australia, and 13.7 years in Canada.
Practically speaking, that means Canadians can expect to spend about 17 per cent of their lives in poor health. Women live longer than men, but also spend more years in poor health.
Driving the years of poor health are a handful of common conditions: Musculoskeletal disorders like lower back pain, mental health conditions like depression and anxiety, hearing loss, and injuries from falls.
It’s not just the big killers like cancer, cardiovascular disease, diabetes, and chronic obstructive pulmonary disease taking the pleasure out of life, but non-fatal chronic conditions and disabilities that leave people living in constant pain, and often in isolation.
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The data tell us that we have become exceptionally good at extending lifespan, but far less successful at extending healthspan.
A good deal of this can be explained by our approach to health care, where we spend profligately on medicine, and in a miserly fashion on prevention.
The greatest contributors to shortened lifespan and healthspan are lifestyle factors: Harmful behaviours like smoking and excess drug and alcohol consumption, inactivity, poor nutrition, and trauma (both mental and physical).
And, of course, we can’t neglect the role of socio-economic factors like income, housing, education, and physical environment, which often fuel poor lifestyle “choices.”
There are important lessons here for health systems, especially those largely funded publicly, as in Canada.
The main one is that we need to do a better job of prevention, and of long-term disease management.
We can’t fix everyone when they’re broken, or heal them when they’re sick, but we can do a lot more to prevent chronic illnesses and painful conditions.
A striking example of this is lower back pain, which researchers identified as the number one cause of life-altering poor health.
In our sickness care system, we provide a lot of disease-specific care that is medically and technologically superb. But we tend to neglect what really matters to people – to have the ability and capacity to participate in everyday life.
It’s great if your blood pressure, cholesterol and A1C levels are on target, but it’s more important if you can get yourself out of bed, go for a walk, pick up your grandchildren, and engage in conversation with your friends.
One of the main reasons people are turning to options like medical assistance in dying is that they are tired of living in pain, or joylessly.
They want more quality of life, not just quantity of life.
These days, there is a lot of focus on longevity. But that needs to be amended to healthy longevity.
As we age, a good question to ask ourselves is: What do we want the last 10 or 15 years of our lives to look like? Do we want to live them in pain, misery and isolation?
The way to avoid that is not expecting miracle cures, but to take preventive action earlier in life like remaining active (physically and mentally), eating well, avoiding harmful behaviours like smoking and drinking, and remaining connected to family and friends. And the health system has an important role to play.
As U.S. President John F. Kennedy famously said way back in 1963: “It is not enough for a great nation merely to have added new years to life. Our objective must also be to add new life to those years.”