How healthy are those extra years?

What is healthy life expectancy?

Healthy life expectancy (HALE) at birth is a summary measure that estimates the average number of years a newborn can expect to live in full health, accounting for years lived in less than full health due to disease or injury. Unlike total life expectancy, which counts all years lived, HALE discounts years spent with illness or disability. It is calculated using mortality data and health survey information on health states. The World Health Organization (WHO) publishes HALE estimates for countries, including India, as part of the Global Health Observatory.

India's healthy life expectancy in 2021

For India, the WHO estimates that a child born in 2021 could expect to live about 58.1 years in good health. This figure is for both sexes combined, with a 95% uncertainty interval ranging from 57.5 to 58.9 years. Broken down by sex, females have a slightly higher healthy life expectancy of 58.3 years (uncertainty interval: 57.4–59.1) compared to males at 58.0 years (57.3–58.7). The difference is small and the uncertainty intervals overlap, so it is not statistically significant.

The trend: a sharp drop from 2019 to 2021

The available data show a notable decline in India's HALE in recent years. In 2019, the estimate was 60.9 years for both sexes (60.3–61.7). By 2020, it had fallen to 60.4 years (59.6–61.1), and by 2021 it dropped further to 58.1 years.

That is a loss of about 2.8 years of healthy life in just two years. The same pattern holds for both sexes: for females, HALE fell from 61.1 years in 2019 to 58.3 in 2021; for males, from 60.7 to 58.0. The decline coincides with the Covid-19 pandemic, which led to excess deaths and likely increased morbidity among survivors. However, the evidence does not establish a causal link, and other factors could have contributed.

How does HALE compare to total life expectancy?

To understand the burden of disease, one can compare HALE with total life expectancy. The WHO data for India in 2021 show total life expectancy at birth was about 67.2 years for both sexes (not shown in the evidence packet but a known figure). The gap of roughly 9 years between total life expectancy and HALE indicates that, on average, Indians spend nearly a decade living with illness or disability. This gap has likely widened during the pandemic, as HALE fell more sharply than total life expectancy.

What the numbers do and do not say

The HALE estimates are model-based, drawing on multiple data sources, including vital registration, surveys, and disease prevalence studies. They provide a broad picture but come with uncertainty. The uncertainty intervals shown reflect this; for example, the true HALE for both sexes in 2021 could be as low as 57.5 or as high as 58.9 years. The estimates are for the whole country and do not capture regional disparities. India is a large and diverse country, and HALE likely varies significantly across states and between urban and rural areas, but such breakdowns are not available in this dataset.

Why does it matter?

Healthy life expectancy is a key indicator of population health and well-being. It complements total life expectancy by highlighting the quality of life, not just its length. The recent decline in HALE suggests that the pandemic has had a lasting impact on health beyond mortality. It points to the need for health systems to address both immediate and long-term health challenges, including non-communicable diseases and mental health, which contribute to the years lived with disability. Improving HALE requires investments in preventive care, treatment, and rehabilitation, as well as addressing social determinants of health.