Singapore's Longevity Triumph, and Its Hidden Toll

A quiet paradox sits at the center of Singapore's public health success: people are living longer than anyone else on the planet, yet a growing share of those extra years are spent coping with illness or disability. The latest global analysis, led by the Institute for Health Metrics and Evaluation in partnership with NUS Medicine, pulls back the veneer on a victory that comes with new and stubborn challenges.

The study, published in The Lancet Public Health, examined 204 countries and territories from 1990 to 2023 and tracked what researchers call the morbidity gap — the difference between overall life expectancy and the years lived in good health. Worldwide, life expectancy climbed from 64.6 to 73.8 years over that period, while healthy life expectancy rose from 55.9 to 63.1 years. The result: more years of life, but proportionally more years spent in poor health.

Singapore stands at the top of both lists. Yet even here the morbidity gap widened by roughly 2.35 years, a jump of about 26.6 percent according to the study's unrounded figures. Across the globe the average gap grew by 1.9 years, or 21.9 percent, and people now spend about 14.5 percent of their lives in poor health compared with 13.6 percent in 1990. Small percentages. Big implications.

Why does this matter? Because it reframes what we mean by progress. Preventing early death remains essential, but surviving longer is not the same as thriving longer. As Associate Professor Marie Ng of the NUS-IHME Global Burden of Disease Research Centre explains, the next public health frontier is less about adding years and more about turning those years into healthy, independent life through prevention, early intervention, rehabilitation, and long-term support.

The data expose familiar culprits. Five groups of generally nonfatal conditions accounted for 57.4 percent of the global morbidity gap in 2023: musculoskeletal issues (low back pain chief among them), mental health disorders such as depression and anxiety, sensory diseases like age-related hearing loss, unintentional injuries (falls, notably), and other noncommunicable diseases. These are not always fatal, but they chip away at mobility, productivity, and quality of life.

Risk factors vary by country, but globally the leading drivers were high fasting plasma glucose, elevated body mass index, child and maternal undernutrition, tobacco use, and air pollution. In Singapore the picture leans toward metabolic and lifestyle risks: high fasting plasma glucose and BMI top the list, followed by occupational hazards, high systolic blood pressure, and dietary problems. In short: diabetes, obesity, hypertension, workplace risks, and unhealthy diets are central to the problem.

There is also a gendered element to the story. Women in Singapore were estimated to live to 87.5 years in 2023, compared with 83.1 for men. But women are likely to spend longer in poor health — about 12.1 years versus 10.4 for men locally — a pattern that mirrors global trends known as the gender health paradox. Women outlive men but often experience more years with disability or chronic conditions.

These findings challenge the long-held idea of compression of morbidity, the hope that illness and disability will be pushed into a brief period at the very end of life. Instead, nonfatal health loss appears to accumulate across adulthood, not just emerge at the finish line. That has consequences for how health systems are designed, how workplaces adapt, and how societies plan for ageing populations.

Practical solutions are already on the table. Strengthening prevention of metabolic disease, improving mental health services, reducing workplace injuries, investing in fall prevention and rehabilitation, and tackling hearing loss could all narrow the morbidity gap. Tracking healthy life expectancy alongside mortality gives policymakers a sharper lens for where to invest, and whether interventions are converting extra years of life into extra years of well-being.

Singapore's achievement in extending lifespan offers an invitation: lead the world not only in longevity, but in how to age well. The policy choices made now — from clinics to cafeterias to factory floors — will determine whether those added years are heavy or hopeful.