Dr. Jesse Pines
People often talk about their desire to live longer, extending their lifespan. What they really mean is not just living longer but living better. Measuring lifespan is straightforward. It’s the time from birth to death. Yet a long lifespan can include decades of chronic illness, pain, and functional loss.
A better way of thinking about the real goal is captured by the term healthspan. Healthspan is about how long we live in good health before chronic disease or decline sets in. Healthspan is lifespan minus years lived in poor health. Optimizing healthspan is about adding years of health and function rather than years suffering from illness and frailty.
Why Healthspan Is the Real Goal
There are several reasons why people should focus more on healthspan than lifespan. First, quality of life is what matters. Extending life without preserving function can increase suffering and strain on families. Also, most people value more good years over simply more years.
Globally, people spend an average of about 9 to 10 years with significant disease or disability at the end of their lives. Chronic disease also dominates aging and is what Peter Attia calls the marginal decade in his book Outlive. Healthcare spending also skyrockets in the last years of life.
The healthspan-lifespan gap is the central issue that longevity science seeks to address. In high-income nations, gains in lifespan have outpaced improvements in healthy life expectancy. This means that more people are surviving diseases rather than avoiding them. Genetic studies show that long-lived families often have both extended lifespan and healthspan, suggesting resilience to age-related disease may be partly inherited.
Challenges In Reliably Defining Healthspan
Yet, a challenge in longevity science is that there’s no single definition of healthspan. A recent literature review found dozens of different ways scientists operationalize the term. Some define it as the time until onset of a major chronic disease such as heart disease, cancer, or diabetes. Others define it as disability-free survival, or the ability to live independently without assistance in basic daily activities.
More holistic definitions also exist, incorporating physical, cognitive, and emotional well-being, not just the absence of illness. Public-health researchers sometimes use health-adjusted life expectancy (HALE), which weights years of life by health status. HALE is essentially a population-level estimate of average healthspan.
How to Improve Your Healthspan
Understanding how healthspan is measured helps clarify what individuals can do to extend it. Unfortunately, no single “anti-aging pill” exists. Yet several strategies show promise in extending healthspan. This includes regular physical activity, a nutritious diet, quality sleep, and social engagement. Second, optimizing metabolic health by maintaining a healthy weight and keeping blood pressure and glucose levels under control reduces the risk of nearly every age-related disease. Third, addressing chronic stress is vital as it accelerates biological aging through inflammation and hormonal imbalance. Mindfulness, social support, and purpose buffer its effects. Finally, ensuring that you receive regular medical care, including preventive medicine, screenings, and working closely with physicians to manage and mitigate acute and chronic conditions.
Beyond traditional medicine, emerging drugs like metformin, rapamycin analogues, and senolytics target cellular aging mechanisms. While some early studies on these interventions are promising, long-term trials in humans are ongoing. Beyond individual habits, societal changes matter too. Public health approaches are also important, including pollution control, equitable access to preventive care, and community design that encourages movement can all expand population healthspan.
Importantly, the science of how to bring together all these approaches is still a work in progress. Because there is no universal definition, it is a challenge to compare interventions head-to-head. Additionally, many of the studies of healthspan are short in duration. Most clinical trials last months or years, while healthspan unfolds over decades. Finally, translating the known science to behavioral change can be a challenge for those aiming to implement lifestyle interventions.
Nevertheless, progress in this field is accelerating. New data-sharing collaborations, biobanks, and AI-driven analyses are beginning to unify definitions and identify biomarkers that truly predict healthy aging.
How the Science of Healthspan May Change in the Coming Years
In the decades ahead, healthspan and not lifespan will likely become the central measure of population health. The goal is not just to reach 100, but to reach it vibrant, mobile, and engaged.
To get there, we’ll need consensus on definitions, better integration of biology with clinical outcomes, and policies that prioritize prevention as much as cure. In that sense, the science of longevity is really the science of living well. Healthspan is both a metric and a moral compass. It reminds us that the measure of progress isn’t how long we live, but how fully.
Ultimately, perhaps the most important insight is that the earlier we start, the more impact we have. Habits formed in our 30s and 40s profoundly shape health in our 70s and beyond.