The Compression of Morbidity hypothesis—positing that the age of onset of chronic illness may be postponed more than the age at death and squeezing most of the morbidity in life into a shorter period with less lifetime disability—was introduced by our group in 1980. This paper is focused upon the evolution of the concept, the controversies and responses, the supportive multidisciplinary science, and the evolving lines of evidence that establish proof of concept. We summarize data from 20-year prospective longitudinal studies of lifestyle progression of disability, national population studies of trends in disability, and randomized controlled trials of risk factor reduction with life-style-based “healthy aging” interventions. From the perspective of this influential and broadly cited paradigm, we review its current history, the development of a theoretical structure for healthy aging, and the challenges to develop coherent health policies directed at reduction in morbidity. 1. Introduction The Compression of Morbidity paradigm was introduced as a hypothesis of healthy aging in 1980 [1]. It was a counterpoint to the then prevalent paradigm of the “Failures of Success” [2], which argued that increasing life expectancies would lead inevitably to additional years of chronic debilitating illness, economic collapse, and increasing misery for many seniors. In its simplest form, the new thesis was that “the age at first appearance of symptoms of aging and chronic disease can increase more rapidly than life expectancy.” Since most of the morbidity, disability, frailty, infirmity, decreased health-related quality-of-life, medical care costs and other descriptors of ill health (considered here as synonymous) occur later in life and are bounded at the lower end by their age at onset and at the upper end by the age at death; a more rapid rise in the age at first chronic infirmity than in the age at death would squeeze total lifetime morbidity into a shorter span, and thus reduce infirmity [3]. The health strategies necessary to attain morbidity compression, it was conjectured, would be based largely on postponement of ill-health by prevention of chronic disease [4–6]. Figure 1 extends a common representation of the compression of morbidity [4]. Present lifetime morbidity is contrasted with two of many alternate scenarios, one of life extension and one of morbidity compression. Disability/morbidity in the senior years is displayed as having an initial appearance in later middle age, and to increase linearly over time until death, with lifetime morbidity represented by
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