Life Expectancy Is Slowing or Falling: Why Is This Happening?
For decades, living longer seemed almost inevitable. Advances in medicine, vaccination, sanitation, childhood survival and the treatment of chronic diseases gradually pushed the average age of death higher.
But that progress is no longer as steady as it once was.
The COVID-19 pandemic produced a historic shock. Between 2019 and 2021, global life expectancy fell by 1.8 years, wiping out almost a decade of progress in just two years. Since then, the situation has improved considerably. According to the latest World Health Organization estimates, global life expectancy reached 73.3 years in 2023, almost back to the 73.4 years recorded in 2019.
So why are experts still talking about falling or slowing life expectancy?
Because the global average hides a much more complicated reality.
The pandemic is not the whole story
COVID-19 clearly played a major role. Millions of direct and indirect deaths disrupted mortality trends around the world. The WHO estimates that the pandemic was associated with around 22.1 million excess deaths between 2020 and 2023, including indirect effects.
But the problem started before COVID-19.
In several countries, life expectancy gains had already begun to slow. The pandemic did not create every underlying problem; in many cases, it exposed or intensified trends that were already developing.
In several high-income countries, the progress made against heart disease and stroke has become slower. This matters because cardiovascular diseases remain among the leading causes of death worldwide.
Heart disease remains a major part of the story
For many years, falling death rates from heart attacks and strokes were among the biggest drivers of increasing life expectancy.
Those improvements are now slowing in several populations.
Part of the explanation lies in risk factors that remain widespread: high blood pressure, diabetes, obesity, smoking, unhealthy diets, physical inactivity and high cholesterol.
The OECD has specifically highlighted rising obesity and diabetes, together with population ageing, as factors making further reductions in cardiovascular mortality more difficult.
This points to something that is easy to forget: living longer does not depend only on doctors’ ability to treat disease. Much of the battle takes place long before someone reaches a hospital.
An ageing population also changes the numbers
An ageing population is, in a sense, a consequence of medical and social success.
When more people reach their seventies, eighties and nineties, diseases associated with ageing naturally become more common. Dementia, cardiovascular disease, cancer, respiratory conditions and frailty all become increasingly important.
That does not mean population ageing is a problem in itself. It means that healthcare systems have to adapt to a population living longer and requiring different types of care.
The WHO reports that eight of the ten leading causes of death worldwide in 2023 were noncommunicable diseases, including cardiovascular and respiratory diseases.
Living longer does not necessarily mean living longer in good health
This may be one of the most important distinctions.
Life expectancy measures how long people are expected to live on average. Healthy life expectancy focuses more specifically on how many of those years are expected to be lived without significant disability or illness.
The two measures do not necessarily move together.
In 2023, global life expectancy had almost returned to its 2019 level. But healthy life expectancy was 62.8 years, still 0.4 years below its pre-pandemic level.
In other words, much of the lost life expectancy has been recovered, but some of the progress in healthy years has not.
The question for the future is therefore not simply, “How long will we live?”
It is also, “How healthy will those extra years be?”
Obesity and diabetes are becoming major challenges
The rise in obesity and diabetes is particularly concerning for public health.
These conditions do not necessarily lead to immediate death. Instead, they can gradually increase the risk of cardiovascular disease, kidney disease, certain cancers and other complications over many years.
Their effect on life expectancy can therefore remain invisible for a long time.
A person may feel healthy for years while gradually accumulating several risk factors. This is why prevention remains so important.
Reducing obesity, controlling blood pressure, quitting smoking, eating a balanced diet and staying physically active are not simply lifestyle recommendations. At a population level, they can help reduce premature mortality.
Pollution, climate and new threats matter too
The causes of death are not limited to traditional diseases.
Air pollution, extreme heat, infectious diseases and the health consequences of climate change can also affect population health.
Older adults and people living with chronic diseases are particularly vulnerable during heat waves and periods of severe air pollution.
An ageing population can make these events even more significant: the larger the number of vulnerable people in a society, the greater the potential health impact of extreme events.
Inequality remains a major factor
It is also impossible to discuss life expectancy without talking about the conditions in which people live.
The WHO emphasizes that housing, education, income, working conditions, the environment and access to healthcare can have a profound influence on health. According to the organization, the gap in life expectancy between populations in countries with the highest and lowest levels can reach several decades.
There is therefore no single story when it comes to life expectancy.
Someone growing up in a healthy environment does not face the same risks as someone exposed from childhood to poverty, poor housing, pollution, unhealthy food or limited access to medical care.
Some countries are recovering while others are still behind
Global averages can therefore be misleading.
Across OECD countries, life expectancy in 2023 was still below its pre-pandemic level in 13 countries. In Europe, 18 EU countries had exceeded their 2019 level by 2023, while six remained below it.
The speed of recovery depends on the initial impact of the pandemic, population structure, healthcare systems and changes in other causes of death.
In some countries, other factors have also played a role. The OECD, for example, points to opioid-related deaths among working-age adults in the United States and Canada, while slower progress against cardiovascular disease is a broader concern.
Should we be worried about falling life expectancy?
Not in the sense that humanity has entered a period in which people will systematically live shorter lives.
The latest WHO data actually show that global life expectancy has recovered strongly from the pandemic shock. However, healthy life expectancy has recovered more slowly, and progress in several areas of public health has weakened.
The real warning sign is therefore not necessarily a permanent collapse in life expectancy. It is the growing difficulty of maintaining the improvements achieved during the previous century.
For decades, adding a few months or years to life seemed almost automatic. Today, maintaining those gains requires more effort.
The next stage may not depend on one spectacular medical breakthrough. It will also depend on much more ordinary things: preventing cardiovascular disease, controlling diabetes and hypertension, reducing smoking and obesity, improving air quality, strengthening healthcare systems and reducing health inequalities.
Ultimately, the question is no longer simply how to live longer.
It is how to make sure that the extra years we gain are also years lived in better health.
