Closing the Gap: Navigating the Tension Between Lifespan and Healthspan in Pursuit of a Healthier Future

Featured & Cover Closing the Gap Navigating the Tension Between Lifespan and Healthspan in Pursuit of a Healthier Future

In 2014, Dr. Ezekiel Emanuel, a bioethicist, gained notoriety for his essay titled “Why I Hope to Die at 75,” asserting that pursuing maximum human lifespan isn’t worthwhile if it results in additional decades marred by disease and poor health. Almost a decade later, Emanuel maintains his stance, expressing his intent to forego most life-extending medical care at the age of 75, emphasizing the quality of life over mere longevity. The disparity between the average life expectancy in the U.S. (77.5 years) and the years lived in full health (66.1 years) remains, highlighting the distinction between “lifespan” and “healthspan.”

Tim Peterson, CEO of Healthspan Technologies, underscores the importance of focusing on “healthspan,” stating that living to 100 is commendable but less so if the last decades are plagued by poor health. The COVID-19 pandemic and increased rates of suicide and drug overdoses led to a temporary decline in U.S. life expectancy, which rebounded in 2022. Despite this, the substantial increase in life expectancy over the past century, from 59.6 years in 1922 to 77.5 years in 2022, is not mirrored in healthspan improvements.

Persistent challenges in healthspan result from high rates of age-related chronic conditions such as cancer, dementia, and heart disease. Lifestyle factors, including insufficient sleep, exercise, and poor nutrition, contribute to diminished well-being. This issue isn’t exclusive to the U.S., as global life expectancy reaches 73.4 years, while healthy lifespan lags behind at 63.7 years, as per the World Health Organization’s 2019 estimates.

Dr. Andre Terzic, a regenerative medicine specialist at the Mayo Clinic, acknowledges the prolonged life but emphasizes the potential trade-off—extended life without necessarily enhanced health. Bridging the gap between lifespan and healthspan becomes a lofty goal for researchers, policymakers, and entrepreneurs. The United Nations designates 2021-2030 as “the decade of healthy aging,” with the American Heart Association striving to increase U.S. healthy life expectancy by at least two years during the same period.

Numerous startups offer consumer-focused solutions, including DNA tests providing personalized recommendations for nutrition and exercise. Some caution against these approaches, stating they might be ahead of the scientific understanding. Concurrently, companies are developing therapies to counter the effects of aging, aiming to extend healthspan.

In a 2021 paper, Dr. Terzic and colleagues propose strategies for closing the healthspan gap, from global tobacco cessation to drugs eliminating damaged cells accumulated during aging. Other avenues involve gene therapy and restoring protective caps on DNA strands. Encouraging developments, such as cancer immunotherapy and genetic testing, suggest progress in the medical field. New diabetes drugs like Ozempic and Mounjaro, along with potential longevity-enhancing effects of metformin and rapamycin, provide additional optimism, though some individuals adopt these drugs off-label ahead of conclusive scientific evidence.

The U.S. Food and Drug Administration (FDA) recently acknowledged a drug potentially extending canine lifespans, signaling a willingness to consider drugs targeting aging itself rather than accompanying diseases. This development holds significance for humans, indicating a shift in approach.

Emanuel aligns with the goal of expanding healthspan but proposes a different focus. Instead of prioritizing new aging-reversal drugs, he advocates addressing prevalent health issues like hypertension, diabetes, and maternal and infant mortality, particularly in underserved populations. The 2022 data reveals lower life expectancies for Black and American Indian/Alaska Native individuals, underscoring health disparities.

Emanuel emphasizes the role of behaviors in lifelong health, citing the importance of a nutritious diet, sufficient sleep, exercise, and social support. He contends that promoting these habits universally and maximizing existing medical treatments takes precedence over the “pipe dream” of a future where aging is optional.

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