As global life expectancy rises, so too does the number of years people spend burdened by chronic disease. Modern medicine has turned death sentences into "manageable conditions," but manage is the key word here. The key question is whether we should measure population health solely on how long people live or how active and healthy they are. Around the world, while people live longer, they live a greater number of years burdened by disease.
Typically, gains in life expectancy “are recognized as a societal achievement.” But increasingly, some of those gains have come at the cost of chronicity. At the beginning of the 20th century, diabetes was essentially a death sentence. A child diagnosed with diabetes at age ten would die within a few weeks or months. Those deaths contributed to a lower life expectancy for the population. With the advent of an effective medical therapy, insulin, the life expectancy of a patient with diabetes was significantly extended to roughly 61 or better. That improvement raised our population's life expectancy. But insulin did not cure diabetes; it simply made it a manageable chronic illness.
The concept of so-called "healthspan" describes life without disability, years of good health. Healthspan can be estimated using a formula that subtracts, in a weighted manner, for disability. In the example of that patient with diabetes, their healthspan is far less than their lifespan. The number of years they spend disabled by their diabetes will be further influenced by how well they manage their diet as well as medical improvements like the introduction of continuous glucose monitoring and a range of synthetic insulins.
The increase in life expectancy indicates the positive effect of improvements in social conditions and health policies. However, the lack of substantial increase in healthy life expectancy suggests that, despite living longer, people spend a substantial amount of time in their old age with disability and illness. Preventable and controllable diseases account for most of the disease burden in older adults in the Americas. Society-wide and adequate health services are needed to respond to the health needs of older people world wide.
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