Study links Singapore’s widened “morbidity gap” to poor diets and metabolic disease

Research links dietary risk factors, diabetes, and metabolic disease to the growing number of years Singaporeans spend in poor health, despite the “garden city” nation having one of the world’s highest life and healthy life expectancies. 

The new global study funded by the Gates Foundation was led by the US Institute for Health Metrics and Evaluation (IHME), in collaboration with the Yong Loo Lin School of Medicine at the National University of Singapore (NUS Medicine).

Spanning data from 204 countries and territories between 1990 and 2023, the study focuses on the morbidity gap — comparing how long people live and how long they live in good health.

According to the report, this gap has widened in almost all countries, including Singapore. It represents an increase in the morbidity gap of approximately 2.35 years, or 26.6% growth, based on the study’s unrounded estimates, compared with a global increase of 21.9%. Globally, the gap expanded from nearly nine years in 1990 to almost 11 years in 2023.

“Singapore’s position as a global leader in life expectancy and healthy life expectancy is a major public health achievement. However, the widening morbidity gap shows that living longer does not automatically mean that every additional year is lived in good health,” says study co-author and associate professor Marie Ng, director of the NUS-IHME Global Burden of Disease Research Centre, NUS Medicine.

“The next frontier for Singapore is, therefore, not simply to add more years to life, but to reduce the burden of chronic illness, disability, and functional decline across the life course. This will require stronger prevention, earlier intervention, rehabilitation, and sustained support to help people remain healthy and independent as they age.”

Disproportionate health years

Published in The Lancet Public Health, the findings suggest that despite Singapore’s substantial progress in preventing early deaths and extending lifespan, boosting citizens’ average years spent in good health has not kept up with the country’s longevity gains.

“Singapore has an opportunity to lead not only in how long people live, but in how long they live well,” comments Ng. “The conditions contributing most to the morbidity gap are often non-fatal, but they can have a profound effect on people’s independence, ability to work, and quality of life.”

“Tracking healthy life expectancy and the morbidity gap can help policymakers identify where additional attention and resources are needed, and whether programs are successfully turning added years of life into added years of good health.”

In Singapore, the leading risk factors for expanding the morbidity gap included high fasting plasma glucose, high body mass index (BMI), high systolic blood pressure, and dietary risks.

In Singapore, the factors contributing most to its morbidity gap were musculoskeletal disorders, mental disorders, unintentional injuries, sensory organ diseases, and cardiovascular diseases.

Meanwhile, five leading risk factors for expanding the morbidity gap were high fasting plasma glucose, high body mass index (BMI), occupational risks, high systolic blood pressure, and dietary risks.

“These findings highlight the importance of preventing and managing diabetes and metabolic disease, obesity, hypertension, unhealthy diets, workplace-related health risks, mental health conditions, falls, hearing loss, and musculoskeletal problems,” notes the study team.

As top global risk factors, the authors identified high fasting plasma glucose, high BMI, child and maternal malnutrition, tobacco use, and air pollution. The relative significance of these risks varied based on countries’ income and socio-demographic development.

Compression of morbidity

The authors believe their results challenge the “compression of morbidity” hypothesis, which suggests that advances in prevention and health care would delay illness and disability, concentrating them into a shorter period near the end of life.

Instead, the study found that non-fatal health loss has generally accumulated across adulthood, rather than being confined to the final years of life. Estimates in the paper indicate that the morbidity gap has widened in 203 of the 204 countries and territories included in the research.

Globally, the authors note that life expectancy increased from 64.6 years in 1990 to 73.8 years in 2023. They add that healthy life expectancy also improved, rising from 55.9 to 63.1 years.

However, as total life expectancy increased more quickly, they report that the global morbidity gap widened from 8.8 to 10.7 years, which is an increase of 1.9 years, or 21.9%. Global statistics in the paper reveal that people spent an average of 14.5% of their lives in poor health in 2023, compared with 13.6% in 1990.

Women spend more years in poor health

The study also highlighted a persistent difference between women and men. In Singapore, women had an estimated life expectancy of 87.5 years in 2023, compared with 83.1 years for men.

However, women spent an estimated 12.1 years in poor health, compared with 10.4 years among men. They explain that this reflects the global “gender health paradox,” in which women generally live longer than men but experience more years with illness and disability — largely because of conditions disproportionately affecting females in later life, such as musculoskeletal and mental health disorders.

Globally, the morbidity gap reached 12.1 years for women and 9.3 years for men in 2023.

“Over the past three decades, the world has achieved remarkable gains in survival, but gains in health span have not kept pace. For most populations, the additional years of life gained are accompanied by more years lived with illness or disability,” says study first author professor Simon Hay, director of Research Strategy at IHME.

“This does not diminish the importance of preventing deaths, but highlights that the definition of public health progress must broaden. Health systems should be assessed not only by how many deaths they prevent, but also by whether people are able to live longer with good health, mobility, and independence.”

Food-first approaches

The paper authors emphasize that these findings have critical implications for monitoring the UN Sustainable Development Goal target 3.4 on non-communicable diseases and target 3.8 on Universal Health Coverage, which they argue currently overemphasize mortality and survival rather than long-term care, rehabilitation, and disability reduction.

In the US, previous research projected health care spending to hit US$8.6 trillion by 2033 — an estimated 20.3% of the country’s GDP that year. S2G Investments previously told us that converging food and health care systems could enable entrepreneurs to build investable businesses that leverage nutrition to drive measurable health outcomes.

Aligning with this approach, the Food Is Medicine Coalition and Harvard Law School have released a “first-of-its-kind” national framework designed to inform hospital professionals how to introduce medically tailored meals into the US health care system.

Last March, the Rockefeller Foundation predicted that Food Is Medicine programs could boost the economy, creating over US$45 billion in economic activity and generating jobs.