Health-adjusted life expectancy (HALE) estimates the average time in years that a person (at a given age) could expect to live in good health (taking into account fatal health outcomes caused by premature mortality and non-fatal health outcomes caused by disability). It serves as a summary measure of population health. 

The regional trend shows a gradual long-term improvement, increasing from 63.05 years in 2000 to 64.49 years in 2023. This represents an overall gain of approximately 1.43 years (2.27%) between 2000 and 2023, consistent with a slow but sustained upward trajectory. Marked disruption was observed in 2020–2021, coinciding with the acute phase of the COVID-19 pandemic in the Americas. HALE declined from 65.18 years in 2019 to 62.38 years in 2021, corresponding to a cumulative reduction of approximately 2.80 years (4.30%) between 2019 and 2021 that effectively reversed nearly two decades of progress and returned the regional average to levels last observed in the early 2000s. The indicator partially rebounded in 2022 and 2023, as the immediate health effects of the pandemic began to subside. However, the 2023 level remained 0.69 years (1.06%) below the pre-pandemic peak recorded in 2019. 

The projection for 2025 is that the Region reached 64.61 years, which remains approximately 1.23 years (1.87%) below the 2025 target of 65.84 years. The available evidence indicates that, despite the post-pandemic recovery, the pace of improvement was insufficient to meet the target. As a result, this indicator is rated as stagnating. 

Subregional analysis reveals a clear and persistent HALE gradient across the Americas, with the pandemic affecting subregions to differing degrees. Prior to the pandemic, in 2019, the highest HALE values were observed in the Andean Area (66.48 years) and North America (65.76 years), while the lowest value was recorded in the Latin Caribbean (61.18 years), representing a gap of approximately 5.3 years between the highest- and lowest-performing subregions. 

The decline observed in 2020–2021 was universal, although uneven in magnitude. The Andean Area declined from 66.48 years in 2019 to 63.23 years in 2020 – a reduction of 3.25 years (4.9%) – with recovery to 65.34 years by 2023. North America declined from 65.76 to 64.28 years – a reduction of 1.48 years (2.3%) – with recovery to 64.91 years by 2023. The Southern Cone declined from 65.65 to 64.23 years – a reduction of 1.42 years (2.2%) – with recovery to 65.02 years by 2023. Central America declined from 64.00 to 60.87 years – a reduction of 3.13 years (4.9%) – with recovery to 63.71 years by 2023. The non-Latin Caribbean declined from 63.42 to 62.83 years – a reduction of 0.59 years (0.9%) – with recovery to 63.31 years by 2023. The Latin Caribbean declined from 61.18 to 60.44 years – a reduction of 0.74 years (1.2%) – with recovery to 62.50 years by 2023. 

These patterns suggest that some subregions with relatively high pre-pandemic HALE, such as the Andean Area, experienced the largest absolute declines, whereas lower-performing subregions such as the Latin Caribbean and the non-Latin Caribbean experienced smaller absolute losses but continue to face the compounded disadvantage of persistently lower baseline healthy life expectancy. The continued gap between subregions underscores longstanding disparities in the social determinants of health and differences in the capacity and resilience of health systems. 

Given that this indicator will continue to be monitored under the PAHO Strategic Plan 2026–2031, it remains important to understand the causes of underperformance beyond those specific to the pandemic. Tailored approaches adapted to specific epidemiological, social, and health system contexts are critical.