Healthy Life Expectancy within working age showed divergent trends by age group and health indicator, with deteriorating health in younger working-age groups and improving health in older working-age groups, suggesting the labour force may decline not only due to population ageing but also due to deteriorating health.
Key Findings
Results
For men, Healthy Life Expectancy between ages 18 and 64 increased in terms of Self-rated Health but remained largely unchanged in terms of mental and physical Health-related Quality of Life.
Study used the German Socioeconomic Panel (SOEP) with N = 232,393 observations
Three time periods were analyzed spanning 2002 to 2022
HLE was calculated between age 18 and 64 using three health indicators: Self-rated Health (SRH), mental HRQoL (mHRQoL), and physical HRQoL (pHRQoL)
Results differed by health indicator, underscoring that single-indicator analyses may be misleading
Results
For women, Healthy Life Expectancy decreased in terms of Self-rated Health and physical Health-related Quality of Life, while it remained stable for mental Health-related Quality of Life.
The decrease in HLE for women was observed across the working-age span of 18 to 64
Physical HRQoL and SRH showed declining trends for women while mHRQoL was stable
These findings indicate a sex-differentiated pattern in HLE trends over the study period
The divergence between indicators highlights the importance of analysing more than one indicator whenever possible
Results
Deteriorating health in younger working-age groups strongly contributed to decreases in Healthy Life Expectancy, while improving health at older working ages fostered increases in HLE.
Decomposition analysis separated changes in HLE into contributions by age group and distinguished between morbidity and mortality contributions
Younger working-age groups were identified as driving forces behind HLE declines
Older working-age groups showed health improvements that partially offset declines caused by younger groups
Mortality contributions to overall changes in HLE were minor compared to morbidity contributions
Results
Divergent contributions to HLE trends were found by age group, with the younger working-age population fostering decreases and older age groups fostering increases in HLE.
The decomposition method attributed specific proportions of HLE change to distinct age groups within the 18–64 range
The opposing directional contributions by younger versus older age groups were observed across multiple health indicators
These diverging within-working-age trends would be masked by analyses that do not decompose by age group
The finding applies to both sexes, though the net direction of overall HLE change differed between men and women
Results
Trends in Healthy Life Expectancy differed by health indicator, underscoring the importance of using multiple indicators in analyses.
SRH, mHRQoL, and pHRQoL did not always move in the same direction for the same sex and time period
For men, SRH showed increase while mHRQoL and pHRQoL remained unchanged
For women, SRH and pHRQoL decreased while mHRQoL remained stable
Authors conclude that 'trends differed by health indicator, which underlines the importance of analysing more than one indicator whenever possible'
Discussion
The findings suggest that the labour force may decline not only due to population ageing but also due to deteriorating health in younger workers, posing challenges for health and labour market policies.
The study was motivated by the backdrop of population ageing and growing labour shortage
HLE within working age is described as 'a key resource for individual wellbeing and economic growth'
Deteriorating health in younger working-age groups represents an additional, non-demographic pressure on labour supply
The authors characterize the findings as 'worrying' and note they pose 'growing challenges for both health and labour market policies'
What This Means
This research suggests that healthy life expectancy — the number of years people can expect to live in good health — during working age (18 to 64) in Germany has been moving in different directions depending on the age group and the way health is measured. Using data from over 230,000 observations collected across two decades (2002–2022), the researchers found that while older workers (closer to 64) have been getting healthier over time, younger workers (closer to 18) have been experiencing declining health. For men overall, healthy working years slightly increased when measured by self-rated health, but stayed flat when mental and physical quality of life were used. For women, the picture was worse: healthy working years declined by both self-rated health and physical quality of life measures.
A key methodological insight from the study is that these opposing age-group trends cancel each other out when looking at the overall picture, meaning analyses that don't break down results by age group can be misleading. Similarly, using only one measure of health — such as whether someone feels generally healthy — can give a different and potentially incomplete answer compared to also measuring mental and physical functioning. Deaths during working age played only a minor role in these trends; it was changes in illness and health status that mattered most.
This research suggests that shrinking workforce capacity in Germany and similar countries is not just a story about an ageing population — it may also be driven by worsening health among younger adults of working age. This has practical implications for both public health policy (which may need to focus more attention on the health of young and middle-aged adults) and labour market policy (which may need to account for health-driven reductions in workforce participation beyond what demographic projections alone would predict).
J. Tetzlaff, L. Mond, B. Safieddine, S. Sperlich, Susanne Steffens, F. Tetzlaff. (2026). Getting better or worse? How trends in healthy life expectancy within working age are shaped by diverging trends among age groups. European Journal of Public Health. https://doi.org/10.1093/eurpub/ckag059