Rising Life Expectancy and the Longer Time Spent Living with Disease

A global study conducted by the Institute for Health Metrics and Evaluation of the University of Washington in collaboration with the National University of SingaporeYong Loo Lin School of Medicine shows that Singapore's life expectancy at birth reached 85.4 years in 2023, with a healthy life expectancy of 74.1 years—both ranking first in the world. The "disease burden gap" between the two has widened to 11.2 years, up from 8.9 years in 1990, an increase of 2.3 years, or 26.6%, above the global average increase of 21.9%.

These figures show that, as the economy develops and social welfare improves, average life expectancy can rise, but at the same time the number of years spent "living with disease" is also rising significantly. As humans enter old age, they must spend an increasingly long period coexisting with illness. Disability, dementia, cancer, and cardiovascular and cerebrovascular diseases—the most common chronic conditions of old age—will also become new problems facing many families. Medical needs related to chronic and geriatric diseases will grow further, and the economic burden families and society must bear for such diseases will grow as well.

I have recently been staying in the countryside with my elderly relatives, and I feel this keenly. In recent years, the pace of infrastructure development in China's rural areas has actually outstripped that in cities; our village changes in refreshing ways every year. The streetlights are designed more beautifully than those in Beijing, the landmark architecture at the village entrance has real artistic character, and the greening is well done.

Rural elderly today generally live longer than the elderly I saw and heard about in my childhood, but at the same time they suffer from more chronic and geriatric diseases than previous generations, with longer disease courses; the quality of life while living with disease is not high.

The care of these rural elderly is now a thorny problem; I myself now face the issue of caring for my father and my mother-in-law. My father is nearly 80, and my mother-in-law is over 70. Both have some geriatric conditions, and neither is used to leaving home to live with us elsewhere, which inevitably affects their quality of life.

My father now takes death very lightly. He does not pursue longevity—his age already exceeds China's average life expectancy—and he maintains a mindset of "striving to survive at every step, yet ready to die at any moment." He will live as long as he lives; he does not wish to linger on in a state of dementia or disability and become a burden to his children. At present he can still often ride his motorcycle around to places he likes nearby and can take care of himself, which is an immense blessing for my siblings and me.

My father is not without chronic diseases; he has simply adapted to coexisting with them. Apart from a few key monitoring issues that I handle, I now take a non-interventionist approach and let nature take its course. Just today, my father and I spoke about what will happen after his death. Both realistically and comfortingly, I told him that he need not worry about ending up disabled; most likely he will die of a myocardial infarction, a process that is essentially painless and quick. Everyone must die eventually, and there is a saying circulating in medical circles: "A fortune cannot buy death from a heart attack." Those who die of a heart attack are fortunate, because they do not have to go through a slow chronic dying process.

I made this judgment because I know my father's condition. Because he eats too vegetarian a diet, he has mild anemia, and his heart rate has long been rather slow. I cannot change his dietary habits, but he is already at an advanced age, so like him I do not deliberately pursue his lifespan; the priority is ensuring his quality of life. To prolong his life at the cost of prolonging his time living with disease would, in my view, be irrational.

My father is in good general condition now. Having been industrious all his life, he still grows some vegetables and fruit at home and does a little light labor every day. He does not strictly take the medicines I prescribe as directed; he only takes some from time to time when I remind him. I do not insist that he persist; I know there are some hidden risks in his body, but I do not take overly aggressive treatment measures.

His natural lifespan may extend beyond 85. The hidden health risks he carries are less like dangers and more like a bridge to the other world. We all need such a bridge to connect life and death; as a doctor, I prefer to choose the least painful bridge for myself and my family.