OLD & BOLD

The healthspan paradox – and opportunity

How can you gain a bonus decade of active life, maybe two?

Old and Bold is passionate about promoting healthy ageing. Taking control of and managing your own ageing trajectory can give you those bonus healthy years.

Medicine and sociologists study population – you need to focus on yourself as an individual within that population, and boosting your healthspan, not just your lifespan. A healthy life in later years mean looking after the trilogy of physical health, mental health and brain function. And physical health is the foundation of all three.

Mind the gap!

Since the beginning of the 20th Century lifespan has increased around 30 years. Healthspan (years in good health) has also increased -but not as fast. So the healthspan-lifespan gap has actually increased, as a 2024 World Health Organisation study of 183 countries showed. Over the past 20 years the gap increased by 13%. In US the gap is now 12.4 years. In UK 11.3 years. This is because modern medicine is keeping us alive longer, and our resources and living conditions have improved. But this exposes us to long term non-communicable diseases associated with ageing, like musculoskeletal disease, heart disease, cancer, type 2 diabetes and neurological conditions such as dementia and Alzheimers.

But the healthspan-lifespan gap can be seen as an opportunity. Medical science and economic progress have allowed us to live longer; now we can seize the opportunity to live better.

Jargon buster!

Lifespan: maximum potential life for a species. For humans some consider this to be in around 120 years. Also used to describe an individual’s length of life, birth to death.

Life expectancy: an average of what the individual can expect to live given their individual circumstances (age, genes, health, habits, etc.)

Longevity is the length of an individual’s life. Often used in the context when that individual lives longer than the average or expected lifespan of the relevant population.

Morbidity: years spent with disease.

Healthspan: years lived in good health. Number of years lived without debilitating disease or disability. Put more positively, this means optimal physical and mental health, and cognitive function. Also called Health Adjusted Life Expectancy, which assesses the number of years people live free from disease. This is increasingly being adopted as a valuable metric for tracking global health.

We need to Focus on the Individual not the Population

A key thing to bear in mind is the difference between the population and an individual. Medical researchers and statisticians like to think in terms of population. To understand the difference, try looking at yourself through the lens of a life insurance or pensions provider – they see you as an individual who actions and lifestyle will have a very real impact on your health outcomes.

The lifespan and healthspan graphs show a solid line. In fact, at any point on the curve there is a distribution of likelihood of mortality. So, a series of probability bell curves. They should really be broad fuzzy lines.

At a societal level, it is a priority of many governments, as well as the WHO, UN, etc., to narrow the gap by improving healthspan – encouraging us to do more exercise is a key example. As the BMJ paper notes, the World Health Organization updated their physical activity guidelines in 2020 and now state that adults should undertake at least 150-300 minutes of moderate intensity physical activity, or 75-150 minutes of vigorous intensity physical activity, or an equivalent combination of aerobic based physical activity each week. The WHO points out to a ‘need for a pivot to proactive wellness-centric care systems’. Narrowing the healthspan-lifespan gap is also known as Compression of Morbidity’, i.e. reducing the number of years lived with disease.

As an individual you can be on the right hand side of those bell curves – someone has to be there in the long tail for the stats to make a bell curve! The great news is that you have agency. You can take action to increase your chances of narrowing your personal healthspan-lifespan gap. To live more years in later life being active and disease free, and later with managed pain or discomfort. Advances in medical science will also continue, but on their own are increasing rather than narrowing the gap.

‘At least 6 years of higher quality life for everyone is within reach’ McKinsey paper.

The paper, by the McKinsey Health Insititute, refers to the triple opportunity of enhancing average quality of life along the way, improving the portion of life spent in good health, and increasing global life expectancy.

A new paradigm of medical practice needs to emerge if the healthspan-lifespan gap is to be reduced at a societal level. This is clearly articulated by Dr Peter Attia, who advocates a holistic approach to medicine he advocates. He describes the current approach, where medical systems seek to identify disease then treat it, as Medicine 2.0. What is needed is systems which involve the individual, and encourage them to be part of the solution, by adopting habits and lifestyle which promotes good health, and prevents or reduces the risk of non-communicable diseases such as heart disease, cancer and cognitive decline. This he calls Medicine 3.0. His approach is compellingly advanced in his book Outlive3. We will cover that in more detail in a future blog.

The McKinsey Health Institute report notes: ‘Currently, health spending is heavily tilted toward curative care. OECD countries spend just 2.8 percent of their health budgets on organized prevention programs such as vaccinations, disease screenings, and health education.’

Focus on your Healthspan

Put in plain English, narrowing your personal healthspan-lifespan gap means living active, rewarding and empowered 70’s and 80’s and managing effectively your 90’s. It is vital (literally) that you think about your health goals for your later years, and articulate them. That allows you to develop plans for achieving them.

The quest for longevity is not just about living longer, but living better. In other words to focus on healthspan of the individual not just lifespan or the individual or the population of which they are part. Think preventive maintenance. Taking charge of your personal health-life journey will give many bonus years of active and fulfilled life.

The key is that we all need to look at how we can maintain and improve our physical health, mental health and cognitive functions. In subsequent blogs and interviews, O&B will dive deeper into each of these.

Lifestyle is key

Research shows that exercise is key to achieving improvements in all three areas. And we’re not talking about running marathons.... While the WHO’s vision of our ideal physical activity may seem ambitious, the BMJ notes that ‘an increase in Moderate to Vigorous Physical Activity (Yes, MVPA is a used acronym!) of 2 min/day (14 min/week) is associated with an 11% reduction in all cause mortality’. Now that’s a pretty good ‘return on investment’!

Diet and nutrition is a foundation of good health in later years. What constitutes a good diet and when it needs to be complemented by supplements will be covered in a future blog.

Quality sleep is the third pillar. The importance of sleep and how to encourage it through proper ‘sleep hygiene’ will also be address in detail in a future blog. In the meantime, if you haven’t read the life-changing ‘Why We Sleep’ by Professor Matthew Walker, then put it at the top of your reading list!

2 big takeaways:

• You can have an impact on your health outcomes in later life (while medical advances will continue to extend the ‘quantity’ of your life, the key is for you to take action to improve the quality of life – be at the right-hand side of that bell curve!)
• Exercise is key to improving all 3 pillars of healthy ageing (physical health, mental wellness and cognitive function). More on the importance of exercise to come…. Other aspects of lifestyle like diet, sleep routine and social interaction are also important, and work to support each other.

https://www.bmj.com/content/376/bmj-2021-068465

https://www.mckinsey.com/mhi/our-insights/adding-years-to-life-and-life-to-years

Outlive: The Science and Art of Longevity. https://peterattiamd.com/

Why We Sleep: Unlocking the Power of Sleep and Dreams, Dr Matthew Walker