There are widespread political concerns about rising demographic dependency ratios, especially old-age dependency ratios following population aging globally. We discuss long-term trends in health-adjusted dependency ratios, accounting for both child and old-age dependency as well as variation in age-specific dependency across countries. We assess what effects changes in the health condition of populations worldwide have on demographic dependency ratios. We find that from a long-term perspective, total dependency ratios exhibit a return to historic levels, reversing the temporary effect of the trend that lasted from the latter part of the 20th century to the early parts of the 21st century, when lower dependency ratios were common. Until 2100, total dependency ratios will be lower than they were at their peak in the mid-20th century. In this period, the child dependency ratios are steadily falling while old-age dependency ratios steadily rise; however, the latter development will be much less pronounced among nations exhibiting better health at older ages. The real challenge will be for societies at mid and low SDI levels, which display much higher dependency ratios than high-SDI nations did at the same point in their economic development. We argue that higher dependency ratios associated with the demographic transition can be considered a manageable challenge for many.