Italian women live on average four years longer than men, but they spend three fewer years in good health. Where does the longevity paradox arise and what can be done?
In 2024 the average lifespan in Italy reached a record of 83.4 years. The years lived in good health, however, are 58.1: one less than 2023 and also less than 2019, the last year before the pandemic.
The data on women weighs more. They live on average 85.5 years, four more than men (81.4), but they spend 56.6 of them in good health compared to 59.8 for men, more than three less. Those who live longer, in other words, spend more years without being able to say they are in good health.
It is not an Italian oddity: in the world the gap between years of life and healthy years has widened since 1990, almost everywhere. Understanding why says a lot about what aging well means today.
How to count healthy years
Healthy years are counted in two ways. Istat relies on the answers of those interviewed: the years lived by those who say they are “well” or “very well” are healthy. It is a subjective measure, which records how you feel rather than what diseases you have.
The Institute for Health Metrics and Evaluation (IHME), which leads the Global Burden of Disease project, starts from diseases: it estimates how much health is lost due to 375 diseases and injuries in 204 countries and territories. The difference between average life and healthy years is the morbidity gap.
According to the latest analysis, published in July on The Lancet Public Healthbetween 1990 and 2023 the global average lifespan went from 64.6 to 73.8 years, and healthy life from 55.9 to 63.1. The gap grew from 8.8 to 10.7 years, 21.9% more: it widened in 203 out of 204 countries and territories, and is wider in more developed countries.
The greatest burden is not from the big killers, but from chronic and mostly non-lethal causes, such as musculoskeletal and mental disorders. Among the main risk factors the authors indicate high fasting blood sugar and excess weight.
For now the data goes in the opposite direction to that hoped for in 1980 by the American doctor James Fries, who envisaged a “compression of morbidity”: by postponing chronic diseases, the years of illness would be concentrated at the end of life.
For Italy the IHME estimates a gap that has gone from 10.0 to 11.8 years. It should not be compared with that of Istat, which has 25.3 between 83.4 years of average life and 58.1 in good health: the methods are different.
The paradox of women
The paradox repeats itself at every age.
According to Istat, after the age of 65, women have an average of 22.6 years of life ahead of them compared to 19.8, but they spend 10.3 of them without limitations in daily activities, compared to 10.6 for men.
This is also true worldwide: in the IHME study the gap in 2023 is 12.1 years for women and 9.3 for men, as reported by the National University of Singapore. There are two proposed explanations.
The first concerns the type of diseases. In 2005, economists Anne Case and Christina Paxson analyzed 14 years of data from the American national health survey: the difference in perceived health between women and men can be explained entirely by the chronic diseases they suffer from. But for the same disease, men die more, for example with cardiovascular or pulmonary problems.
The second looks at lifespan. Marc Luy and Yuka Minagawa compared 45 developed countries: women spent 14.3% of their lives in poor health, men 13.3%, and the female disadvantage was greater where their advantage in longevity was greater. For the two scholars, women are worse off “not despite living longer, but because they live longer”.
Neither of them closes the question: they are observational studies, which identify associations without being able to demonstrate causes.
What can be done
The picture is not only downhill. Compared to 2014, life expectancy without limitations at 65 has increased in Italy by ten months, and among those over 75 the share of those living with three or more chronic diseases has fallen from 51.9% to 48.9%.
The most consolidated indications concern movement. The WHO recommends that adults do at least 150-300 minutes a week of moderate intensity aerobic activity, or 75-150 minutes of intense activity, and after the age of 65 a “multi-component” activity that trains balance and strength for at least three days a week.
And when has fragility already begun? This was verified by SPRINTT, a randomized study on 1,519 people aged 70 and over, with physical frailty and sarcopenia, i.e. loss of muscle mass and strength. Half followed a program of moderate physical activity and nutritional counseling, the others received training on healthy aging. In the most impaired group, with an SPPB score between 3 and 7 out of 12 (see box), the inability to walk 400 meters in less than 15 minutes appeared in 46.8% of those following the program and in 52.7% of the others.
It is a concrete but limited benefit: it concerns the ability to walk, not the length of life, and it applies to already fragile people, not to those who want to prevent.
Thinking today about tomorrow’s age
Some of the work is done before the age of 65. Among the risk factors that weigh most heavily on the gap, the IHME indicates blood sugar and weight, which can be acted upon at any age. And the WHO, with the ICOPE approach, proposes that primary care services look soon for the first declines in “intrinsic capacity”, the set of physical and mental abilities available, from mobility to vision, from memory to mood.
It is also the thread of «Wellbeing has a long pace», the booklet with which Nestlé, through its «Age without Age» Observatory, collected four interviews with experts. It starts from the idea that longevity does not only concern old age, and approaches it from four perspectives: nutritional, clinical, psychological and social. Among those interviewed there is also the scientific director of the Observatory, the clinical nutritionist Giuseppe Fatati. The text can be downloaded for free; the theses are those of the interviewees and the Observatory, not of the editorial team.
On a global scale, “morbidity compression” has not yet been seen. But studies on movement and prevention suggest that a stretch of the road can be done.
