Have You Heard of the Healthspan-Lifespan Gap?

When people express their desire to live to be at least 100 years old, they are assuming that their later years will be lived in good health.  But that is not the norm.  It does not take into account the healthspan-lifespan gap, the number of years near the end of a life that are spent enduring poor health, burdened by disease and powerless to enjoy the activities that they once loved.

A recent study, published in December 2024, defines the healthspan-lifespan gap as the difference between years lived in good health and total years lived (1).  This research analyzed the data of people from 183 World Health Organization member countries (almost all countries of the world including Canada) to determine their healthspan-lifespan gaps.   The answer is that the average person worldwide will spend 9.6 years dealing with illness in their elder years. In addition, the gap for women is 2.4 years longer because of their disproportionately larger burden of chronic diseases compared to men.

The healthspan-lifespan gap in the US is the highest in the world at an average of 12.4 years, 11.08 years for men and 13.73 years for women.

Canada’s healthspan-lifespan gap is an average of 10.94 years, 9.9 years for men and 12.05 years for women.

The lowest healthspan-lifespan gap was seen in the countries of Somalia, Lesotho and the Central African Republic whose gaps averaged 6.7 years.

It appears that most people won’t be enjoying the healthy life they are envisioning for their old age and those in more developed countries will be in the worst shape.

You may have heard that human lifespan has increased over the last two decades as worldwide global life expectancy increased by 6.5 years.  But the healthspan didn’t keep up, increasing by only 5.4 years worldwide, indicating that the global healthspan-lifespan gap has increased by 13% since the year 2000.   The result is that we are living an ever-lengthening proportion of our lives dealing with disease. (2)

The origins of the healthspan-lifespan gap are non-communicable chronic illnesses  – cardiometabolic diseases (diabetes and cardiovascular disease), musculoskeletel disorders (arthritis, osteoporosis, bone fractures, back and neck pain), degenerative neurological diseases (Alzheimer’s, Parkinson’s, ALS), mental disorders (depression and anxiety) and abuse of alcohol and drugs.  (1,2)

Currently about 65% of people over the age of 65 have two or more of these chronic diseases. Modern medicine cures very few of these but what it can do is prolong life and allow people to live with chronic illness for decades.   For instance, medication can be prescribed to keep a disorder under control at least temporarily, damaged organs can be removed to decrease risks, devices can be inserted to control a bodily function and infectious diseases can be treated with antibiotics.  We’re also getting better at palliative care which is focused on improving the quality of life for people with serious illnesses at the end of their lives.  But such treatments do not prevent the damage that impairs the lives of many aging seniors.  (3,4)

The present medical approach to chronic diseases in affluent countries is to react once disease is detected.  This “sickcare” system is not efficient.  Clinical trial data has revealed that many of our most common chronic diseases are preventable through nutritional and other lifestyle changes.  As much as 80% of cardiovascular disease, including heart disease and stroke, and 30 to 50% of all cancer cases are preventable (5,6).  A 2020 study of US men and women demonstrated that adherence to healthy lifestyle behaviours was associated with a longer life expectancy at age 50 with men living approximately 7.6 years longer and women 10 years longer free of major chronic diseases.  (7)

We need to acknowledge that the present process of waiting to care for people who are living poor lifestyles and eating unhealthy food until they develop a chronic disease is unethical. As lead author of the Healthspan-Lifespan study, Armin Garmany, points out, “If more people lived healthy lifestyles — eating a balanced, heart-healthy diet, exercising, maintaining a healthy weight and so on — that gap would likely narrow, but we can’t rely on individual “willpower” alone. …A lot of this relies on the structured environment. When everything relies on our [individual choices], everything works against us.”  (1)

Indeed, transitioning from disease-centered medical systems to preventative treatment systems is crucial. To accomplish this, both the healthcare itself and its infrastructures would have to be transformed into new operational components which would aim to prevent chronic diseases before they even start.  Beyond the medical goals are other practical governmental changes such as town/city planning that takes into account factors like opportunities for safe walking and cycling, planning for easily accessible grocery stores for everyone, making healthy foods more affordable relative to less healthy foods, and subsidies for farms which produce healthier foods.  All this would require considerable investment. (3)

But there is opportunity here to reduce healthcare costs and there has been quite a bit of thinking along these lines already.  One example is happening in Australia where a group has implemented a pilot program for a new model of primary healthcare called Osana (8).  Osana provides a range of health programs and services to patients and health care providers all aimed at creating pathways to better health.  The work of the General Practitioner physician shifts from a focus on caring for sick people to one about the prevention of illness. This system pays for good health outcomes not for sick care, resulting in both healthier people and greater efficiency.  Osana estimates that if this model was adopted across all of Australia, it could save 30 billion dollars on healthcare every year.

Additionally, over three years Osana has produced many positive outcomes (8);

• 51% fewer hospital visits
• 82% increase in satisfaction with health care
• 81% increase in diabetics meeting their HbA1c targets (industry average is 49%)
• 69% increase in meeting a healthy blood pressure target (industry average is 32%)
• 81% increase in meeting both blood pressure and cholesterol target levels (industry average is 42%)
• 21% increase in improvements in osteoarthritis function (industry average is 19% after surgery)
• 45% increase in patients meeting national exercise guidelines
• 21% reduction in psychological stress
• 11% reduction in obesity
• 21% reduction in smoking
• 21% reduction in moderate to heavy alcohol consumption

Major changes like these are not easily accomplished.  Nevertheless, focusing on prevention instead of intervention is a substantial step towards narrowing the healthspan-lifespan gap.  Many of the diseases at the root of the gap are preventable.  When it comes right down to it, our own goals for our futures are to live healthily into our old age, not just to live a longer life troubled by disease.

 

SOURCES:

1  Garmany, A., Terzic, A. Global Healthspan-Lifespan Gaps Among 183 World Health Organization Member States. JAMA Netw Open. 2024;7(12):e2450241. Doi:10.1001/jamanetworkopen.2024.50241

2  https://longevity.technology/news/widening-healthspan-lifespan-gap-highlights-global-challenges/

3  Fontana, L., Fasano, A., Chong, Y.S., Vineis, P., Willett, W.C. Transdisciplinary research and clinical priorities for better health. PLoS Med. 2021 Jul 27;18(7):e1003699. Doi: 10.1371/journal.pmed.1003699. PMID: 34314418; PMCID: PMC8315511.

4  Cheng, K., Fontana, L.  Investing in value-based primary care: a pathway to sustainable healthcare. European Heart Journal; 45(34): 7 September 2024: 3103–3105. https://doi.org/10.1093/eurheartj/ehae404

5  https://world-heart-federation.org/what-we-do/prevention/

6  https://www.who.int/activities/preventing-cancer

7  Li ,Y., Schoufour, J., Wang, D.D., Dhana, K., Pan, A., Liu, X., et al. Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study. BMJ. 2020;l6669:368.

8   https://osana.care/wp-content/uploads/2021/09/A-NEW-GP-MODEL-White-Paper-by-Osana.pdf