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This document provides a comprehensive global anal This document provides a comprehensive global analysis of healthy lifespan inequality (HLI)—a groundbreaking indicator that measures how much variation exists in the age at which individuals first experience morbidity. Unlike traditional health metrics that capture only averages, such as life expectancy (LE) and health-adjusted life expectancy (HALE), HLI reveals the distribution and timing of health deterioration within populations.
Using data from the Global Burden of Disease Study 2019, the authors reconstruct mortality and morbidity curves to compare lifespan inequality (LI) with healthy lifespan inequality across 204 countries and territories from 1990 to 2019. This analysis uncovers significant global patterns in how early or late people begin to experience disease, disability, or less-than-good health.
The document presents several key findings:
1. Global Decline in Healthy Lifespan Inequality
Between 1990 and 2019, global HLI decreased for both sexes, indicating progress in narrowing the spread of ages at which morbidity begins. However, high-income countries experienced stagnation, showing no further improvement despite increases in longevity.
2. Significant Regional Differences
Lowest HLI is observed in high-income regions, East Asia, and Europe.
Highest HLI is concentrated in Sub-Saharan Africa and South Asia.
Countries such as Mali, Niger, Nigeria, Pakistan, and Haiti exhibit the widest variability in morbidity onset.
3. Healthy Lifespan Inequality Is Often Greater Than Lifespan Inequality
Across most regions, HLI exceeds LI—meaning variability in health loss is greater than variability in death. This indicates populations are becoming more equal in survival but more unequal in how and when they experience disease.
4. Gender Differences
Women tend to experience higher HLI than men, reinforcing the “health–survival paradox”:
Women live longer
But spend more years in poor health
And experience more uncertainty about when morbidity begins.
5. Rising Inequality After Age 65
For older adults, HLI65 has increased globally, signaling that while people live longer, the onset of morbidity is becoming more unpredictable in later life. Longevity improvements do not necessarily compress morbidity at older ages.
6. A Shift in Global Health Inequalities
The study reveals that as mortality declines worldwide, inequalities are shifting away from death and toward disease and disability. This transition marks an important transformation in modern population health and has major implications for:
healthcare systems
pension planning
resource allocation
long-term care
public health interventions
7. Policy Implications
The findings stress that improving average lifespan is not enough. Policymakers must also address when morbidity begins and how uneven that experience is across populations. Rising heterogeneity in morbidity onset, especially among older adults, requires:
stronger preventative health strategies
lifelong health monitoring
reduction of socioeconomic and regional disparities
integration of morbidity-related indicators into national health assessments
In Short
This study reveals a crucial and previously overlooked dimension of global health: even as people live longer, the timing of health deterioration is becoming more unequal, especially in high-income and aging societies. Healthy lifespan inequality is emerging as a vital metric for understanding the true dynamics of global aging and for designing health systems that prioritize not only longer life, but fairer and healthier life.
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