What’s Your Health Span?

To live without physical or mental discomfort is a fantastic goal. While this state may seem unattainable to some, others may experience the sort of calm equilibrium Leriche envisioned. We all want to live without pain, with healthy bodies that enable us to fully enjoy the gift of life for as long as possible.

Yet achieving this goal is challenged by numerous factors that degrade health and contribute to disease. Our environment—including where we live, what we do, what we eat and drink—can benefit or harm us. Living in a food desert, near a landfill or a plastics factory, alongside a busy highway, or in a community without green spaces is not conducive to good health.

Our well-being is influenced by choices we make, but also by factors beyond our control, such as our genome, family history and societal pressures. Many of these influences lead to less-than-ideal outcomes. Even when we strive to make the best choices, our efforts often fall short because the world most of us live in does not prioritize health or tranquility.

“If you can see things out of whack, then you can see how things can be in whack.”

Instead, much of what we encounter seems designed to stir up envy, want, discouragement and dissatisfaction. To choose to pursue good health, contentment and a quiet life rather than striving for more money, possessions and fleeting pleasures is, in a sense, to remove oneself from the consumer-driven marketplace. This is anathema to the go-go-go, get-get-get economy, the profit-driven world that treats people as cogs in someone else’s wheel. For those struggling to make ends meet, juggling multiple low-paying jobs and living paycheck to paycheck, the power to take control of their health is limited. When the rat race is all-consuming, poor health and disease can seem inevitable.

It’s a sobering reality that alongside such external impactors on our health, simply aging takes its toll. Physically we are a collection of biochemical processes subject to wear and tear. Our cells are not immortal, and the natural process of aging affects our wellness. So while it’s true that our physiochemical processes will deteriorate with time, there’s a growing understanding of the many choices and actions that can nevertheless contribute to healthy longevity.

The Health Trajectory

Although we may live under many constraints, most of us have some autonomy in how we decide to live, in the choices we make. As we consider making healthier choices, it’s important to understand that changing from unhealthy habits and practices can be difficult, especially in the face of pressures that push the opposite way. We might find solace in the promise of a future time when the sorrows of life we endure today will be healed. There is comfort in focusing on statements such as “He will wipe away every tear from their eyes, and death shall be no more, neither shall there be mourning, nor crying, nor pain anymore, for the former things have passed away” (Revelation 21:4). However, we should not use this assurance as an excuse to misuse or neglect the gift of life we have now.

Regardless of our beliefs about ultimate intervention, we are obligated to do what we can to improve our health—not only for our personal benefit, but because when we’re well and able, we’re in a better position to help others. Being productive, joyful and unhampered by illness allows us to be more fruitful in giving to our families, neighbors and community. While spiritual wellness and perspective are important, our physical lives are not simply to be ignored. It’s difficult to wipe away the tears of others when we’re drowning in our own.

“A long healthspan makes a vital, energetic life more possible, and that vitality can ripple outward, allowing us to spend some of our time creating conditions for better health and wellbeing in other people.”

In The Age of Scientific Wellness, Leroy Hood and Nathan Price suggest a simple way of picturing our health timeline, or direction. Just as a rocket has boost, cruise and descent phases, our lives also follow a three-part path. They describe it as a health trajectory consisting of “wellness, transition, and disease.” To put off the disease end point, and the physical and mental disability that ensues, they believe that the focus must be on the transition phase. Today, they argue, much health care is instead sick care, a focus on the disease after the fact. A better strategy is to understand the indicators that signal a transition out of wellness and then point the way back. They call this “P4 medicine”: preventing disease by predicting its pathways, both overall and on a personalized level, and ensuring that every individual has access to and can participate in this system.

This approach is a work in progress. Their starting place, called the Human Phenome Initiative, gathers and combines genetic, molecular and other physical data from a large population to create a predictive algorithm of wellness and these transition indicators. Such fine-grained detail will help individuals, and their physicians, see and manage the flight path of their own health. Hood and Price believe it will spark a new era in medicine, a systemic change in health care. Other genome-based studies, such as the All-of-Us Research Program, Geno4ME and BabySeq, will also contribute to deeper understanding.

“With this sort of lead time [gained from a more predictive knowledge of disease] and a positive focus on optimizing health and resilience,” they write, “we can use these same data to design and target personalized therapies that will end the transition long before disease materializes, when the pathological changes at hand are less complex and more reversible through interventions that are simpler, safer, and less intrusive.”

As it is now, health care often means doctors waiting for sick patients to arrive and then prescribing expensive medicines, surgeries, and a stay in an extremely expensive hospital ward (which itself carries certain risks). A new P4 health plan would be administered by a team that would help patients monitor their lifestyle, genome, health tendencies and history. “Within the next five years, the genome will become a basic tool in leading healthcare systems,” Hood and Price predict. “Within ten years, it will be an almost ubiquitous part of the healthcare environment.”

“For most people in the United States, United Kingdom, Western Europe, and many Asian countries, where sedentary habits, high stress, and poor diet are taking a particular toll, the transition to disease generally begins in one’s thirties or forties and accelerates in the fifties and sixties.”

As defined by the World Health Organization, “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Achieving this level of health requires sustained effort, ongoing feedback and support. Without these, we’re at risk of succumbing to the factors that can push us into a transition away from wellness.

While we wait for the system that Hood and Price envision, might we take more initiative to become our own health coaches?

Aiming for a Long Health Span

Clean water, antibiotics, vaccines and seatbelts have all contributed to our living longer today than ever before. Since 1950, global life expectancy has increased from 45 to 73-plus years. Someone born today is expected to easily reach the 22^nd century (2100). Many are now living decades longer than expected, and this population group is growing.

Today, according to UN statistics, there are approximately 720,000 centenarians (age 100 or older). By 2054—just 30 years from now—that number is projected to reach 4 million. Looking ahead to that time, none of us wants to imagine being bedridden, enfeebled and incoherent, a shell of ourselves, slowly sliding toward death. To avoid that dreadful fate as much as possible, our aim becomes not just to live longer but to live vibrantly for as long as possible. Simply existing for more years, lingering through increasing pain and bodily or mental dysfunction, is no one’s desire. A better plan is to aim for healthy aging.

In technical terms, when pressed to contemplate the end of our lives, most would admit that the objective is to compress morbidity. This concept, first developed by James Fries at Stanford University in 1980, suggests that by delaying the onset of chronic disease and disabilities (morbidity), we can have a longer healthy lifespan and a shorter (compressed) stage of end-of-life frailty. We now refer to this concept as health span—the hopefully longer period of life spent in good health, free from the chronic diseases and disabilities associated with aging.

“These considerations suggest a radically different view of the life span and of society,” Fries writes. This would be a life “physically, emotionally, and intellectually vigorous until shortly before its close, when, like the marvelous one-hoss-shay, everything comes apart at once and repair is impossible,” he suggests. “Such a life approaches the intuitive ideal of many and confounds the dread of others for the opposite model, that of an evermore lingering death.”

Despite much hype around the idea of extending human lifespan (reaching so-called longevity escape velocity, where each year of life lived adds another year of life expectancy, possibly allowing us to live up to 150 years), Fries does not argue for increasing longevity per se. Recognizing what he calls the “plasticity” of aging, he suggests that rather than focusing on pushing away the inevitability of mortality, we should embrace life habits that delay disease as long as possible. This is especially applicable to the leading noninfectious killers of humankind (cardiovascular disease and cancer) and to immiserating neurodegenerative conditions (Alzheimer’s and Parkinson’s).

Wellness: Do the Obvious

Fries offers a pathway that he believes is simpler yet equally predictive compared to scientific algorithms. When thinking about pushing back chronic disease and staying healthier over time, we should just do the obvious: avoid those things that stress the body in the first place. As he advised in a 2011 paper, our goal should be to not become trapped in destructive habits: smoking, being sedentary, or eating or drinking to excess. If these are indeed liabilities in your life, recognize the necessity to actively moderate them. He called this “Primary Prevention”; instead of wondering when to see a doctor, the better strategy is to explore how to stay healthy in the first place.

As Hood and Price note, preventing disease by predictive algorithms based on biomarkers is scientifically sound. But having a prevention mindset is an important fifth P embedded in the concept of health span. For instance, research shows that 40 to 50 percent of cancers can be attributed to lifestyle risk factors, just as Fries suggested. These include cigarette smoking (including secondhand smoke); carrying excess body weight; consuming processed meats; consuming too much alcohol or red meat; consuming too few fruits, vegetables, and other fiber- and nutrient-dense foods; physical inactivity; and exposing our skin to too much ultraviolet (UV) radiation. Various viral infections (such as Epstein-Barr, hepatitis B and C, HIV and HPV) are also cancer risk factors.

Diabetes, another slow killer, has clear links to obesity, and obesity has clear links to poor diet. Eating less animal protein and more high-quality plant protein has been found to be a good start in normalizing one’s metabolism.

Perhaps even more critical for better health is to avoid products that contain high doses of added sugar or that rely on “ultra-processing.” As defined in one 2021 study, an ultra-processed food is a product “with additives and industrially processed ingredients that have been technologically broken down and modified.” These include sugary beverages, candy and other sweets, heavily refined snacks and baked goods, sweetened yogurt, and most fast food. The corporations that produce, promote and distribute such products are a “vector of disease,” according to the report, which adds that “through the production, marketing, distribution and political activity of promoting these products on a global scale,” these corporations have created a “manufactured epidemic.”

“Ultra-processed foods offer convenient and often cheaper solutions to time- and income-poor families, but unfortunately many of these foods also offer poor nutritional value.”

A 2024 study added to these findings, stating, “Greater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes.”

The report concludes: “This umbrella review reports a higher risk of adverse health outcomes associated with ultra-processed food exposure. The strongest available evidence pertained to direct associations between greater exposure to ultra-processed foods and higher risks of all-cause mortality, cardiovascular disease related mortality, common mental disorder outcomes, overweight and obesity, and type 2 diabetes.”

This is a significant blow for those who depend on convenience foods, but it shouldn’t be surprising. Poor nutrition, especially eating foods that are far removed from their natural state (such as whole grains and complete fruits and vegetables) has long been known to undermine good health.

The Social Prescription for Wellness

There are many contributors to how healthy and long our lives will be. Some, such as genetics, parents and early life circumstances, are out of our individual control. But as we’ve seen, simple changes in our choices can also have a real impact on our well-being.

Journalist Julia Hotz adds one more aspect to consider when trying to get on a healthier track. She says we’ve been asking the wrong question. Rather than “What’s the matter with you?” the better question is “What matters to you?”

A response to the first question might suggest a symptom that is countered with a drug, but the second points to a social prescription. Hotz defines this as “a nonmedical resource or activity that aims to improve a person’s health and strengthen their community connections.”

In The Connection Cure: The Prescriptive Power of Movement, Nature, Art, Service, and Belonging, Hotz explores how creating better human connections is often the overlooked piece in the health puzzle. So rather than a chemical, what we may really need is a human interaction. “I hadn’t actively thought about health as something you feel,” Hotz writes. “Instead, I thought about the mechanics of health—pills and procedures and professionals using big words to describe our body’s chemicals, and the conventional stuff of looking healthy—skin care and slim bodies doing six-minute ab workouts.”

Being in the normal range of resilient, take-it-for-granted good health, Hotz says she didn’t think much about health at all. Health was just sort of there: “Kind of like fixing flat tires or putting out kitchen fires, it’s one of those things we don’t think about until something is threatening it. And then, usually, we’re too late.” What she discovered in her seven years of research travels, assimilation, synthesis and writing was surprising—surprisingly simple. The big question is “What makes you feel healthy?”

“The five core ingredients of feeling healthy [are] movement, nature, art, service, belonging. These [are] the gateway drugs for the truer medicines: joy, meaning, and relationships.”

“When we think like this,” Hotz concludes, “we’re forced to see what all those ancient thinkers and scientific theories make clear: how health isn’t just the end goal of diagnoses and treatments. It isn’t the hard-earned reward of fitness regimes and superfood diets and expensive supplements. Health is the product of our environment, and of what uniquely matters to us in those environments.”

Social prescribing is not a cure-all, of course. Sometimes the interventions of medical science—the drugs, surgeries and trauma care—are critically important and can even be life-saving. But preventive self-care is equally vital. In our health-care encounters we often overlook the importance of self-awareness in making better choices to improve our health span. Similarly the prescription for social connection is often left out of the conversation. “As we wait on health care to put social prescribing on its menu of options,” concludes Hotz, “each of us can work in our own lives to make its sneakier goal come true: creating our own health, in our own communities. Becoming our own health professionals—experts in and practitioners of the connections that uniquely bring us joy, meaning, and relationships.”

What to Do Now

According to the Global Wellness Institute, the consumer health and wellness industry had a market value of an amazing $5.6 trillion in 2022; they project that figure to grow to more than $8 trillion by 2028. Providing ways to be healthier is clearly lucrative, and one wonders what percentage of these funds are spent on dubious potions and fad practices. Chasing health can be costly. But seeking good health and Leriche’s “silent organs” need not be overly difficult or even expensive. It’s free to take a walk or to connect with others. A bag of apples costs no more than a box of donuts.

“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition,” notes the World Health Organization. To be in good health not only allows us to pursue personal goals but also gives us space to help others find their best path forward.

Hood and Price write of a data-driven future when we will all recognize that health span is pliable. “When people can see that the rate of aging is not immutable—when they can follow a number that can go up and down in response to what they eat, how much they exercise and their stress, toxins, and sleep—it will help promote healthy aging.” Even without more studies, we already recognize this is true, but will we take it to heart? “People are free agents, and not everyone will choose to act on this information. . . . But the choice, at least, will be in their hands.”