Survival gains and healthy life expectancy across 185 countries: A global ageing surveillance study, 2000-2021

BACKGROUND: Longer life does not necessarily mean healthier ageing, and surveillance needs to distinguish survival gains from healthy-life gains. OBJECTIVE: We used a longitudinal conversion framework to examine whether national life expectancy (LE) gains were matched by healthy life expectancy (HALE) gains. METHODS: WHO LE and HALE series were linked with IHME burden and sociodemographic indicators, WHO expenditure data, and United Nations population data for 2000-2021. We decomposed survival gains into HALE gains and an unconverted remainder, reporting population-weighted trends, country-level conversion shares (ΔHALE/ΔLE), non-ratio checks, and a secondary age-60 module. WHO uncertainty bounds were propagated through 2000 Monte Carlo draws. RESULTS: Population-weighted global LE rose from 67.92 to 73.29 years in 2000-2019, while HALE rose from 59.17 to 63.69 years. The LE-HALE gap widened from 8.75 to 9.60 years, leaving 0.85 years of survival gain not matched by healthy-life gain (95% UI 0.50 to 1.21). HALE captured 84.2% of the LE gain (95% UI 77.9% to 90.5%). Among 185 countries, 181 (97.8%) had wider gaps; among 179 countries with positive LE gains, 177 (98.9%) had conversion shares below 1.0. In the age-60 module, LE60 rose by 1.92 years and HALE60 by 1.36 years. CONCLUSIONS: Added survival years were not fully converted into healthy years before 2020. Longer survival should not be treated as healthier survival unless HALE gains keep pace with LE gains.