How Long Can You Expect to Work in Good Health? A 28-Country Study Offers New Answers

As governments around the world push retirement ages ever higher in response to aging populations, a fundamental question has taken on new urgency: how many years can the average person actually expect to work in good health? A sweeping new study published in PLOS Medicine offers the most comprehensive answer yet, drawing on data from more than 175,000 adults across 28 countries to calculate what researchers call healthy working life expectancy, or HWLE, the average number of years a person can expect to remain both healthy and employed after age 50. The findings reveal a striking gap between how long people are being asked to work and how long they can realistically expect to stay healthy on the job, while pointing to a set of individual behaviors and national policies that could help close that gap.

The research team, led by Jingjie Zhu, Bo Ye, and colleagues at Fudan University, combined data from six large health and retirement cohort studies, including 79,833 men and 95,485 women aged 50 and older. Rather than relying on a single national dataset, the investigators pooled longitudinal information across 28 countries, allowing them to compare how personal circumstances and national conditions jointly shape working lives. To estimate healthy working life expectancy, they used discrete-time Markov multi-state models, a statistical framework that tracks how individuals move between three states over time: healthy and working, unhealthy or not working, and death. This approach captures not just whether people are employed, but whether that employment is sustained by good health, making it a far more meaningful metric for retirement policy than simple life expectancy.

The headline numbers are sobering. At age 50, participants could expect to live a total of 33.59 years on average, but only 10.98 of those years were expected to be spent in good health while working. In other words, fewer than one in three of the years remaining to a typical 50-year-old are likely to be healthy working years. The gender gap was pronounced: men could expect 12.36 healthy working years, while women could expect just 9.82, a difference of more than two and a half years. That disparity reflects a tangle of factors, including differences in employment patterns, caregiving burdens, chronic disease profiles, and the types of jobs women disproportionately hold, all of which compound over the second half of life.

At the individual level, the study identified a familiar but powerful set of predictors. Marriage, higher educational attainment, and healthy lifestyle behaviors were all associated with longer healthy working life expectancy, while chronic diseases consistently shortened it. The magnitude of some of these effects is remarkable. Stroke emerged as the single most damaging condition, cutting healthy working life expectancy by 5.49 years on average, nearly half of the total healthy working years a typical 50-year-old can expect. The findings underscore that the diseases and behaviors tracked by public health agencies for decades are not merely matters of personal wellbeing; they directly determine how long people can remain economically active, with consequences for household income, pension systems, and national labor supply.

What sets this study apart, however, is its systematic examination of country-level factors. The researchers assembled a battery of national indicators from the World Bank spanning three domains: economic conditions, employment conditions, and governance quality. The economic measures included gross domestic product per capita, health expenditure, tax revenue, and the Gini index of income inequality. Employment measures captured flexible working arrangements, labor force participation, equal workforce opportunities, and hiring and firing practices. Governance measures assessed government effectiveness, control of corruption, and political stability. By linking these national metrics to individual-level cohort data, the team could ask whether the societies people live in shape their healthy working years independently of their personal characteristics.

The answer, in short, is yes. Higher health expenditure, greater GDP per capita, and higher tax revenue were all associated with longer healthy working life expectancy, consistent with the idea that better-funded health systems and stronger social safety nets keep older workers healthy and attached to the labor force. Governance mattered as well: countries with more effective governments, better control of corruption, and greater ease of doing business showed longer healthy working lives, while higher income inequality, as measured by the Gini index, and political instability were associated with shorter ones. These associations suggest that the institutional environment, not just individual fortune, plays a substantial role in determining who gets to age productively and who is forced out of work by illness or circumstance.

The employment-related findings carry particularly direct policy implications. Higher levels of flexible working arrangements, greater labor force participation, stronger equal workforce opportunities, and more favorable hiring and firing practices were consistently associated with longer healthy working life expectancy and longer healthy non-working life expectancy, alongside shorter unhealthy non-working life expectancy. In practical terms, this means that in countries where older workers can negotiate flexible schedules, where age discrimination is limited, and where labor markets are neither so rigid that older workers cannot be hired nor so precarious that illness leads to immediate exclusion, people spend more of their later years in a healthy state, whether working or not. The pattern suggests that labor market design is not merely an economic lever but a public health one.

The study’s authors are careful to note its limitations. Follow-up periods differed across the six cohorts, some countries contributed relatively small samples, and the 28 countries included do not cover the entire globe, particularly underrepresenting low-income regions. These constraints may limit cross-country comparability and the generalizability of the estimates. Multi-state models also depend on the accuracy of self-reported health and employment data, which may be measured differently across cultures. Even so, the consistency of the associations across such a large and diverse sample lends considerable weight to the central conclusion: extending healthy working lives requires action at both levels, the individual and the national, and neither alone will suffice.

The timing of these findings could hardly be more consequential. Across Europe, East Asia, and North America, policymakers are legislating later retirement ages to shore up pension systems strained by rising longevity and shrinking workforces. France’s contested pension reforms, China’s gradual retirement age increases, and similar debates elsewhere all rest on an implicit assumption that people can work longer. This study quantifies how much healthy working capacity actually exists, and the answer, roughly 11 years after age 50 in the pooled sample, suggests that simply raising the retirement age without improving health and working conditions risks pushing many older adults into years of unhealthy employment or involuntary exclusion from the labor force.

The authors argue that interventions targeting modifiable individual risk factors should be pursued across the life course, from preventing stroke and other chronic diseases to promoting education and healthy lifestyles, while national measures should be tailored to each country’s social, economic, and employment context. There is no single prescription: a country with high income inequality may need different policies than one with weak labor protections or underfunded health care. But the study’s central message is clear and, in an era of demographic anxiety, quietly optimistic. Healthy working life expectancy is not a fixed biological destiny. It responds to the choices individuals make about their health and the choices societies make about how they organize work, distribute resources, and govern themselves. As the world ages, those choices will increasingly determine not just how long people live, but how long they live well and productively.

Subject of Research: Country- and individual-level determinants of healthy working life expectancy among adults aged 50 and older across 28 countries

Article Title: Country- and individual-level factors associated with healthy working life expectancy: A multinational longitudinal study

Article References: Zhu, J., Ye, B., Huang, Z., You, H., Jiang, J., Yang, S., & Gao, J. (2026). Country- and individual-level factors associated with healthy working life expectancy: A multinational longitudinal study. PLOS Medicine, 23(9), e1004676. https://doi.org/10.1371/journal.pmed.1004676

Image Credits: AI Generated

DOI: 10.1371/journal.pmed.1004676

Keywords: healthy working life expectancy, population aging, retirement age, PLOS Medicine, longitudinal cohort study, chronic disease, stroke, labor force participation, income inequality, governance, flexible working arrangements, multi-state models