What is the gap decade?
Modern medicine has been spectacular at extending lifespan. It has been far less successful at extending healthspan, the years lived in genuinely good health. Mayo Clinic researchers, surveying global data, put the gap at about nine years: nearly a decade, on average, lived at the end of life with disease or disability. The World Health Organization’s own ledger tells the same story, worldwide life expectancy sits in the seventies, while healthy life expectancy sits in the sixties. Australia enjoys one of the longest life expectancies on Earth, and the Australian Institute of Health and Welfare finds the same pattern here: we have been better at adding years than at filling them with health.
That reframes the whole longevity question. For most of us the meaningful goal is not a longer life in the abstract. It is fewer of those diminished years and more of the good ones. Not just years in your life: life in your years.
What is the compression of morbidity?
The concept has a distinguished birthplace. In 1980, Stanford physician James Fries published a landmark paper in the New England Journal of Medicine proposing what he called the compression of morbidity: since the human lifespan has natural limits, the real prize is to squeeze the period of illness and dependency into the smallest possible window at the very end, to stay vital deep into old age and make the decline short. Vital, vital, vital, brief. Four decades on, that is precisely what the healthspan movement, and, in our own way, what we at Diskin Life, are working toward.
Can the gap actually be closed?
Can the gap actually be closed? Harvard’s T.H. Chan School of Public Health followed more than one hundred thousand people for over three decades to find out. Writing in the BMJ, they reported that five ordinary habits, not smoking, a healthy weight, regular movement, sensible drinking and a quality diet, bought roughly ten extra years of life free of cancer, cardiovascular disease and diabetes for a fifty-year-old woman, and about eight for a man. An earlier Harvard analysis in Circulation found much the same for lifespan itself. Read that carefully: the extra years were healthy years. The levers that lengthen life and the levers that improve it are largely the same levers, and none of them is exotic, expensive, or beyond an ordinary person’s reach.
Why is healthspan decided daily?
Here is the shift in thinking that matters. Lifespan is decided once, at the end. Healthspan is decided continuously: in how well your body adapts, recovers and regulates, today and every day. It is felt as energy that outlasts the afternoon, sleep that actually restores, stress that visits rather than moves in, a body that says yes when you ask something of it. In our language: healthspan is life lived above the waterline. Our 4 Levels of Spiraling Health describe exactly this, the difference between merely not-being-sick and having capacity to spend, and the direction of the spiral, up or down, is being set now, years before it shows up in any diagnosis.
What actually ends a healthspan?
Not the same things that end a lifespan, and the difference is the whole point. The Australian Institute of Health and Welfare’s burden-of-disease work splits the national health burden into two ledgers: years of life lost to early death, and years lived in ill health. The conditions topping each list are strikingly different.
Deaths are dominated by cancer and cardiovascular disease. The years lived in poor health are dominated by something else entirely, musculoskeletal conditions, mental health conditions and neurological conditions. Back pain, arthritis, anxiety, depression, dementia. Complaints that rarely appear on a death certificate and routinely decide what a decade of someone’s life is actually like.
That is the healthspan gap described from the inside. The things that shorten your life and the things that shrink it are largely different lists, and almost all of our collective attention goes to the first one. If the aim is the years that count, the second list is where the work is.
Which markers predict the good years?
Encouragingly, the qualities that track a long healthspan turn out to be measurable, unglamorous and trainable. Four have accumulated particularly strong evidence.
- Grip strength. In the Lancet’s PURE study, across seventeen countries and nearly one hundred and forty thousand people, grip strength predicted mortality more strongly than systolic blood pressure. It is a proxy for whole-body strength, and it is measured with a device you squeeze.
- Walking speed. Pooled data on tens of thousands of older adults, published in JAMA, found gait speed predicted survival well enough to be clinically meaningful: a simple stopwatch over a few metres carrying information that expensive investigations often do not.
- Cardiorespiratory fitness. A Cleveland Clinic analysis of more than one hundred and twenty thousand people in JAMA Network Open found fitness associated with survival with no observed upper limit of benefit, and found poor fitness carrying risk comparable to major established conditions.
- Getting off the floor. Brazilian researchers scored how many supports people needed to sit down on the floor and stand back up, and found the score predicted all-cause mortality over the following six years. It is coordination, balance and strength in a single movement anyone can perform at home.
Note what is missing from that list: every one of them is a measure of function, not of disease. None of them requires a laboratory. And each is a capacity that responds to being asked for, which is what makes healthspan a variable rather than a verdict.
Is muscle the organ of the long game?
It has a fair claim. Muscle mass and strength decline from midlife at a rate that is partly inevitable and largely negotiable: a process formalised as sarcopenia, and given an agreed European definition in 2019 that put strength, rather than mass, at the centre of the diagnosis. Strength is what the body actually uses. Mass is merely where it is stored.
What makes this the most hopeful finding in the field is how late the door stays open. In a study that changed geriatric medicine, Maria Fiatarone and colleagues put frail nursing-home residents, average age around eighty-seven, many using walking frames, through a supervised, progressive strength programme. They got significantly stronger, walked faster and climbed stairs better, in ten weeks. Nutritional supplementation alone did nothing comparable. The exercise did the work.
Muscle also does far more than move you. It is the body’s largest site for disposing of blood glucose, a reservoir of protein for illness and recovery, and a source of signalling molecules that reach the brain. Strength in your sixties is not vanity; it is the physical account the last decades are drawn from, and, unlike most accounts, deposits are still accepted very late.
Why isn’t this the same as anti-ageing?
It is worth separating healthspan from the industry that has grown up beside it. Anti-ageing marketing sells more years, usually through a compound, a protocol or a subscription. Healthspan research is about the shape of the years you already have, and its interventions are almost embarrassingly ordinary: strength, fitness, sleep, food pattern, connection and purpose.
There is serious laboratory science on the biology of ageing, and it may in time deliver something remarkable. None of it has yet outperformed being strong, fit, well-slept and genuinely connected to other people. Those four are available this week, without a prescription, a waiting list or a credit card, and every one of them has decades of human evidence behind it rather than a promising mouse.
Where does our care fit?
The nervous system sits at the centre of that daily arithmetic, because it is your Master Regulator of the very functions the healthspan research keeps pointing to: recovery, sleep, stress response, movement quality. At Diskin Life, our gentle, Whole-Person care is directed at how well that regulation is working, and the Life Assessment measures it: a functional baseline you can actually track, rather than waiting for the end-of-life ledger to reveal how things went. The 13 Vitality By Design presentations then work the Harvard-style levers directly, through their four themes: Respond Better, Move Better, Eat Better and Think Better. We make no claim to extend anyone’s life, nobody honestly can. The aim of our work is the other number: the years that count. Premium Vitality, in the end, is healthspan by another name.
General information only, not a diagnosis or personal health advice. For questions about your health and longevity, please also speak with your GP.