Why do people in Macao live longer than almost anywhere else on Earth?

Macao residents are among the longest-lived people on the planet. Government data shows average life expectancy in the SAR reached 83.5 years in 2025 – up from just 77.9 years before the 1999 handover – with women living to an average of 86.3 years and men to 80.6 years. The growth rate over the past two decades has outpaced many developed economies.

Authorities attribute the improvement largely to sustained public health investment after the establishment of the Macao SAR. Government healthcare spending as a share of GDP has nearly doubled, rising from 2.1 percent before the handover to 3.8 percent in 2023.

Today, Macao operates an integrated medical network of public hospitals, private hospitals and primary health centres, with 2.9 registered doctors, 4.4 nurses and approximately 2.5 hospital beds per 1,000 residents as of 2024.

Primary care coverage is comprehensive. Nine health centres across the territory provide vaccination, chronic disease management and other services, with vaccine coverage maintained above 98 percent for years. A Chronic Disease Shared Care Programme manages patients with conditions like hypertension and diabetes through a family doctor system.

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Macao is also among the world’s strictest on tobacco. Smoking rates fell from 16.9 percent before the Tobacco Control Law took effect in 2012 to 11.6 percent in 2023 — a 31.4 percent drop that put Macao ahead of the WHO’s target of cutting smoking by 30 percent by 2025. The SAR’s cardiovascular-disease mortality rate is also reported to be 17 percent lower than Hong Kong’s.

In July 2024, the government launched the Healthy Macao Blueprint, aligning with China’s Healthy China 2030 plan and integrating health considerations into all public policy.

For global context, Monaco tops the world ranking at around 86.5 years, followed by San Marino (around 86) and Hong Kong (around 85) – making the Greater Bay Area home to two of the world’s longest-lived populations. Japan and South Korea round out the top five, both in the 84 to 85-year range.

At 83.5 years, Macao sits just outside this group but comfortably ahead of the global average of 73.8 years, and ahead of virtually every large nation on Earth.