We’re living longer with illness – and that changes everything

When I think about how healthcare has changed in my lifetime, one shift stands out above all others: People are living longer than ever before – but the quality of those extra years matters. Increasingly, we are living with chronic conditions, often for decades.

That we’re living longer is a remarkable achievement. It’s also a profound challenge. And it sits at the heart of our latest report, The Value of Chronic Care, which examines how all 38 OECD countries are coping with a chronic disease burden that has quietly reshaped what it means to be healthy, to work, and to plan for the future.

The findings are sobering, but they’re also hopeful. Because once you understand what’s driving the problem, you start to see where the answers lie.

The shift no one is quite prepared for

Across OECD countries, chronic conditions account for the majority of healthy life lost. The biggest threat to our wellbeing today isn’t a sudden, dramatic event – it’s the slow accumulation of years lived in poorer health. Diabetes managed across 30 years. Cardiovascular disease that quietly limits what someone can do at 55. Mental health conditions that ebb and flow across an entire life.

Our report covers more than 200 chronic conditions backed by over a decade of data. What emerges is a structural change, not a passing trend. Fewer people are experiencing premature mortality. That’s a great thing. But the burden has migrated from mortality to morbidity, from dealing with acute crises to dealing with lifelong management.

Here’s why that matters beyond the clinical picture: Chronic illness doesn’t just affect health. It affects income. It affects financial resilience. It affects whether someone can stay at work, support their family, or retire on their own terms. The boundary between a “health issue” and a “financial issue” has dissolved, and our systems haven’t quite caught up.

It’s not about spending more. It’s about designing better

One of the most striking findings – and one that surprised even me – is how little outcomes correlate with spending.

When we measured healthcare Capacity across countries, the spread was relatively narrow: about 22 points between the highest and lowest performers, suggesting that many systems operate within a similar range of resources. But Quality and Readiness show greater variation (41 and 67 points, respectively). So the largest differences between countries sit less in how much care systems can provide and more in how well that care is delivered – and whether it reaches people consistently over time.

Even well-funded systems can underperform if care is fragmented, hard to access, or designed around the wrong assumptions. The U.S., with some of the most brilliant doctors and greatest hospitals in the world, is an example of that.

And the wrong assumption, in most cases, is that healthcare is something you go to when something goes wrong. That model worked when the dominant threats were acute and episodic. It struggles when the threat is a 40-year journey with a condition that progresses slowly.

The top performers in our Chronic Care Index – Switzerland, the Netherlands, Luxembourg, Norway, and South Korea – aren’t necessarily the biggest spenders. They’re the ones who have invested in coordination, in continuity, and in treating chronic care as a system, not a series of appointments.

The lever we’re not pulling hard enough

This is where the importance of prevention comes in – and it’s the part of the report I feel most strongly about.

In the UK, for example, only 5.2 percent of healthcare spending goes toward prevention. So only a sliver goes to the things that prevent chronic conditions from developing in the first place – behavioral interventions, screening, early diagnosis, sustained lifestyle support.

This doesn’t reflect the science. It reflects a system designed for a different era.

In countries with higher disease burdens, many chronic conditions persist in ways that better-performing systems have learned to prevent or delay. The difference often isn’t access to better medication; it’s whether someone got support to address diet, physical activity, environmental exposures, and the broader social drivers of health before their condition became serious.

In lower-burden countries, the picture is different but no less urgent. People are living longer with overlapping conditions – multiple chronic diseases at once, layered on top of one another. That complexity demands sustained investment in long-term disease management, mental health support, and age-related care.

Across both contexts, prevention is what changes the trajectory. Without it, the cost of chronic disease and extended morbidity will keep rising, for households, for employers, for protection systems, and for societies as a whole.

A shared responsibility

This is where I think insurers, employers, and policymakers have to step forward together. Because no health system, however well-designed, can solve this alone.

Employers are well-positioned to make a difference: the workplace is where many people spend a large part of their adult lives, making it one of the most powerful settings to support wellbeing. At the same time, insurers have a role to play in expanding access to prevention, early detection, continuity of support, and ongoing condition management – working alongside, not replacing, public healthcare systems.

Increasingly, this means combining financial protection with services that help people navigate care, from virtual GPs and second medical opinions, to mental health support, specialist pathways, and tools for ongoing monitoring and self-management. In doing so, insurers and employers can help support more consistent, connected care over time – particularly for conditions that unfold over decades.

What’s needed is a mindset shift: from reacting to illness to actively sustaining health and financial resilience over decades.

The OECD’s chronic care challenge isn’t, fundamentally, a question of more spending or more services. It’s a question of better design – of systems, partnerships, and protections that work together across the long arc of a person’s life.