Recently, I’ve been seeing the term healthspan pop up here and there and I really like the concept. Some of these ideas are already very much out there it’s just that we now have a name for it. While your lifespan is the time you’re alive your healthspan is the time that you are healthy.
The idea of a healthspan is a pretty new one and it still needs some flushing out. It takes the focus from how many years we are here to how many we spend here in good health. Specifically, being in good health means being free from serious disease, disabilities that impact our daily lives and basically being able to live our lives to the fullest. We will dig deeper into what that means though.
Living well vs just living well at the end
I’ve often made the joke that I hope to die in a sky diving accident at age 75. It’s a bit tacky but it gets the point across. In all seriousness in researching this I found out that 75 is the most common age that people choose to decline further medical intervention if they make that choice. Lots of us feel that if we can’t be healthy at the end of our lives we don’t necessarily want to be here.
I never thought about this sort of thing in my 20’s but as l get older I’ve started thinking about it more. I think we all do. It’s a pretty universal feeling but it’s one we don’t talk about. I think that having a term and a concept like healthspan in our tool box can be the best way to start to talk about it.
As nice as it would be to be struck down by magical lightning the day before a terminal cancer diagnosis it’s just not realistic. More than likely we will all and up with a period of life at the end that isn’t perfect. The idea of healthspan gets us to acknowledge it in a realistic way.
Working definitions of healthspan
Looking into this there are a few detailed definitions floating around out there. One thing that everyone agrees on is that your healthspan is over once you are suffering from chronic disease. We will get into the minutia but I think that to some degree we can have a sort of personal definition of healthspan too.
One popular definition is that once you are diagnosed with one of the chronic health issues that is also a top 10 leading cause of death your healthspan is over. For me this has two issues. It doesn’t allow you to resolve that issue and it leaves out people with debilitating health issues that dramatically effect your quality of life that aren’t a leading cause of death. Those top 10 conditions are:
- Heart Disease
- Lung cancer
- Lower respiratory infections
- Alzheimer’s disease
- Type 2 diabetes
- Colorectal cancers
- Breast cancer
- Prostate cancer
For me this has two issues, one is people who are diagnosed with one of these issues and resolve them. For example, my own mother was diagnosed with breast cancer 22 years ago. She did have a couple of years of treatment where she didn’t have a great quality of life but that was over 2 decades ago now. Another was my uncle who had type 2 diabetes but lost the weight through a daily walking program and lived into his 80’s with a full quality of life up until the last 5 years. For these two this definition means their health spans were over in their 40’s.
The other is our neighbor who was diagnosed with Multiple Sclerosis apparently very early in life (30’s or 40’s). I’ve known him for 20 years this year and he was in a wheelchair since before then. For the last 15 years he really can’t leave the house without a medical team to help. Since MS isn’t a top 10 condition, even though he is now in his 70’s he is still ‘healthy’ by this definition.
I think the idea that your healthspan is like a light switch at diagnosis of certain conditions is too simple. I would argue my uncle’s diagnosis didn’t effect him at all and my mom’s did end a healthy period for her but she quickly got back there. The lady travels the world and runs half marathons after all!
I would argue that people like my neighbor or who have declined into ill health can look back to a specific time period (say the summer of 2004) as the last time they had a real quality of life. Of course we might only be able to acknowledge that moment looking back and not in that exact moment. Then to me my healthspan is over.
My definition would be that when I can no longer do all of the things that I would like to do or used to be able to do in some reasonable, way then my helathspan is over. So if I can no longer, drive, get my own groceries, do my own gardening or get a workout in, then healthy part of my life is over. Perhaps there will be a period of time where I can’t do all that but if I get back to those things I will consider it a blip rather than an end of my healthspan. If I have to switch to walks instead of runs, take smaller wheelbarrows of soil or let someone else re-shingle my roof for me this time I’ll just consider those things a normal part of aging and not a sign my healthy years are totally behind me just yet.
The ‘big 10’ definition is helpful for policy makers and public health though. Using this definition I think we can get a lot of information about the healthspan of the population as a whole. Using this definition the age the average American’s healthspan ends is about 64. I might argue though that this is later than reality as it leaves out people with other diagnoses or who have a low quality of life without a formal diagnosis or medical intervention.
That means the average person lives for 20 years after they are done ‘being healthy.’ To me that sounds like a problem that needs addressing. First and foremost people shouldn’t be living a quarter of their life in ill health. That’s just incredibly unfair and I feel like as a whole we can do so much better than that.
All but one of the things on that list (respiratory infections) is in large part a lifestyle related health issue on some level. Five of the top 10 are almost entirely lifestyle driven. While that might seem depressing I think it’s a great thing. That means we can do something about almost every single thing on that list and people can live better lives for longer!
The second problem that is clear here is that this is incredibly expensive for our governments. People who are sick cost a lot for the healthcare system and aren’t able to work and pay taxes. Since the age of 64 reflects current conditions it’s no surprise our medical systems are struggling and sometimes failing to keep up. Imagine the healthcare we would have if we could get this period down from 20 years to 5!
We live in an obesogenic environment that leads to poor health outcomes, but if we made some changes we don’t have to! It’s better for individuals, governments and companies to give people the money, time, skills and resources to raise the top number on all of our healthspans.
The reality is though that we all have to work too much to take good care of ourselves. Healthy food and the time to workout are luxuries very few can afford for most of their lives. We also can’t expect people to live one way for the first three decades of their life and change it overnight after that.
We know that being poor is already associated with poor health, poor diets and poor health outcomes. Should it lead to decades of suffering too?
You can do something about your healthspan
On average a person can do a lot to control the ratio of healthspan to lifespan. You can choose not to smoke, to drink very little alcohol, keep your weight within a healthy range and get 150 minutes of activity per week. There is no reason to become vegan, run marathons or only drink imported spring water in order to maintain your health for as long as possible.
Mostly for compassionate reasons but also financial ones I think that we as a society should do all that we can to set children up to have the longest healthspans possible. We can do this by prioritizing healthy food and movement both at home and in our school systems. Personally I would support universal free, actually healthy breakfast and lunch programs in all of our schools. I would also love to see the school day extended by an hour for activities like walking, run club, intramural sports or hiking for school credit. I would love to see students spend time moving in ways that are easy, cheap and realistic to keep up for a lifetime.
Any money that we spend setting people up for staying healthier longer is likely to pay for itself in lower healthcare costs and higher tax bases. It’s probably not realistic to think that the majority of families have the time or resources to provide these things alone. Whether you are healthy and fit or have children or not I think it is in everyone’s best interests to support the longterm health of the population as a whole. I love that the concept of healthspan gives us the tools to talk about it.
Is the idea of a healthspan something you have heard about? Is it something you’ve thought about in your own life? What are you doing to live as well as you can as long as possible? Leave it in the comments below!
I haven’t heard of that term, but for years people have been talking about quality of life and extending that as far into old age as possible.
While it would be great to live to 100, who wants to live with heart disease or being on dialysis for decades?
Running and staying active will prevent many of those issues as you noted.
I think the younger generations will be better off.
My mother was in high school in the 1940’s and she said that girls didn’t sweat. And she was never active in an athletic sense at any time in her life. She did live to 92.
Social Determinants of Health (SDOH) have become a prime concern in healthcare. Just your zip code can tell a clinician a lot about how long you may live.
I think that poorer people have fewer resources to tend to their health and are too busy just trying to survive. It is unfortunate how many people live in food deserts and/or don’t think about the quality of the food they eat.
Someone once told me that most of the increase in average lifespan is the result of a significant decrease in childhood deaths. I’ve never verified this, but it does make sense.
Just immunizations and anti-biotics must save millions of children every year.
Totally agree 100%. I think that historically increasing lifespans have been as a result of reduced childhood mortality. Recently epidemiologists have started to raise concerns about the cumulative effects of later in life health trends like the rates of obesity, diabetes and how sedentary we are as a population. This could have an effect on lifespans and or health pans going forward. I love the idea of having a good word to start to talk about these things.
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interesting topic, an being almost 65 one I think about a lot. My maternal grandfather lived well to almost 100, my paternal, died in his 60s…he did smoke like a chimney, but, well my dad’s three brothers and one sister also passed away young…..and my dad, 90, right now in hospital with an infected heart and heart valves, and not doing all that well, and he’s had a pacemaker for over a decade, I wonder what my future is like…I smoked a bit in my teens, but never inhaled and didn’t last long, I do like my wine, but I bike run and swim do yoga and weights, and my diet is real food…but I keep looking at my dad, and think…if I ever need a pacemaker, I may say, maybe not?…..I know a lot of people don’t like Doc Fauci, but I admired hom when he said if COVID hit him where he’d need the help of a ventilator he’d say no, and give it to someone else who needs it….I feel the same way….I’m a do not resuscitate, and if the heart gives up, that’d be fine….
I think you bring up a good point that individually there are no guarantees. You could be a life-long, vegan yoga teacher and have a poor health outcome early in life. Things like your genetics aren’t in your control but that doesn’t mean your hands are tied. It also doesn’t mean your choices won’t have consequences. My dad was one of 5 brothers with arguably faulty genetics. All of them had lifestyles we wouldn’t consider healthy these days as well. Four of them died in their early 60’s if not before. One however started walking and lost weight when he was diagnosed with diabetes in his 50’s. He lived into his 80’s with a high quality of life and continued to drive until the year before he died. Thank you for your comment and I hope your dad is doing better!
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