Lifespan minus Healthspan

Years lived in poor health. Australia at the top of the list.

I came across this paper, titled:

Global Healthspan-Lifespan Gaps Among 183 World Health Organization Member States

in a daily email list of papers I get from the Journal of the American Medical Society (JAMA), from December 2024. Healthspan minus Lifespan is a measure of how many years people live in poor health before they pass away.

Life Expectancy

Australia has one of the highest life expectancies in the world. From AIHW report April 2025 life expectancy in Australia has turned down by a small amount since Covid. It is now 81.1 years for males and 85.1 years for females.

For persons (ie male and female) we now rank 7^th in the world. I recall before Covid we used to be 3^rd in the world. An annoying thing about the Australian Institute for Health and Welfare (AIHW) is that they don’t provide access to archived versions of their reports, which is a bit useless. I found a news reference here from 2022 before the Covid numbers affected us boasting our high life expectancy.

Everyone looking happy.

From the JAMA paper Figure 2:

In the boxplots above the outliers are marked. The vertical axis is the measure of Healthspan minus Lifespan in years. Each dot is a country. Globally the countries with largest number of years lived in poor health are the USA, Australia, New Zealand and the United Kingdom. There’s our AUKUS Alliance, although not for a good thing. AUKUS is the defence alliance between Australia UK and US for construction of new nuclear submarines.

What it means for Australia is that, although we have a high life expectancy compared to other countries, this comes at a cost of longer time in poor health for many people. It’s actually a bit of a complicated relationship. The countries that have lower time in poor health tend to be countries with lower life expectancy.

The following plot shows the relationship between Healthspan minus Lifespan on the vertical axis and the average of Healthspan and Lifespan on the horizontal x axis. Figure 2A from the paper:

Looking closely at the graph, I was confused because there were countries at zero on the x axis. I was about to send an email to the authors but I think what has happened is that the zero should be 50 years. Lesotho at the bottom end (less than 50 years lifespan/healthspan average), is a small Southern African country. HIV AIDS has a severe impact on their health. The life expectancy number is the expected length of life at birth and therefore infant mortality has an impact on that number From this site:

Infant, Child and Mother Mortality Rates: An important cause of the reduced life expectancy in Lesotho is an infant mortality rate of 44.6 deaths per 1,000 births and a maternal mortality rate of 487 deaths per 100,000 births. This is largely due to preterm birth complications that come from the frequently poor living conditions of mothers.

We have to be grateful for what we have in Western countries.

At the other end of the life expectancy scale, with higher life expectancy, the AUKUS Alliance are all above the 95% confidence interval for the number of years in poor health. The US, with the largest health expenditure per capita, has a lower life expectancy than many modern countries and has the highest length of time in poor health. And there is criticism of RFK Jr for wanting to improve this. Go figure.

The article caught my attention because Australia appeared in the rankings. But also I imagine this property of time in poor health will influence the effects of Covid in Australia. People in poor health are going to be more adversely affected by Covid. People who died from Covid had on average 3 comorbidities, and possibly inappropriate health interventions will affect those in poor health greater.

Other Articles of Interest

Other recent important substack articles. Julian Gillespie on the Slovakian response here. Reading the translation of the Slovakian Prime Minister’s speech he seems to speak very concisely and clearly. Hopefully he won’t be shot at again. And Professor Ian Brighthope today on myocarditis.