This article originally appeared in The Atlantic.
In the mid-19th century, people in the developed world entered into a Faustian bargain with the aging process. In exchange for life expectancies gaining an additional 30 years in the space of only a few generations, billions of people had to find out what it was like to be elderly.
In 2019, more people than ever before get to see their grandkids grow up. They get to enjoy a lengthy retirement, if they have the resources. The price they have to pay, however, is “the rise of heart disease, cancer, stroke, Alzheimer’s, osteoporosis, osteoarthritis, and everything we associate with aging and growing old,” according to Jay Olshansky, an epidemiologist at the University of Illinois at Chicago School of Public Health. If the life in your years is supposed to matter more than the years in your life, it might feel like modern humanity has backed itself into a corner.
Olshansky, speaking on a panel at Aspen Ideas: Health, co-hosted by the Aspen Institute and The Atlantic, said it’s time to move away from the disease-specific model of modern medicine and toward an approach that addresses the process that’s at the base of it all: aging. “The time has arrived in our modern era to stop trying to make us live longer,” he argued. “Instead, we should just focus in on health extension rather than life extension.” In an era when billionaires like Peter Thiel are investing millions of dollars in quests for much longer—if not eternal—lives, the idea that people already live long enough might feel a little radical.
Health and longevity are frequently conflated. After all, aren’t people living longer precisely because they’re healthier? Instead, aging brings with it new health challenges that are all too familiar to anyone who has cared for an aging relative or is getting older themselves. In the current American health-care system, those maladies are treated individually, usually by specialists hired to deal with individual diseases or bodily systems. Often, older age becomes a series of health emergencies, growing more and more frequent as people get older.
“The problem is that physicians, in doing what they’re supposed to be doing, don’t look at the big picture,” Olshansky argued. “We’re supposed to look at the big picture.” But patients can’t become experts on everything, and as people age, it becomes harder for the very elderly to effectively advocate for themselves within the byzantine world of American medicine.
Susan Golden, another panelist and the director of the dciX innovation program at Stanford University, noted that shifting this system would require changing how the medical profession is structured. “It would be better if we had primary-care physicians as our navigators,” she said. “In England, primary-care providers are paid more than specialists, and that’s a good idea. It puts prevention up front and embeds it into the system.”
Golden said that if people are living longer lives, maintaining their health in the long term will require an emphasis on healthy habits starting in childhood. She also noted that it will require the political will to dismantle the structural disparities that impact the health of people of color and those living in poverty.
Olshansky expects to see major advances in increasing the American health span within his lifetime. “I’m extremely optimistic that the science has now caught up with the idea that we can modify our own biology and slow down the process of biological aging,” he said. “Not for the purpose of making us live longer, but for the purpose of extending the period of healthy life.”
In the meantime, Olshansky and Golden both emphasized that prevention is better than treatment, and that eating a healthy and diverse diet, getting plenty of sleep, and exercising regularly are reliable ways to make your life span, whatever it might be, more enjoyable.
For at least one other popular health tactic, they were less enthusiastic. “Everybody always asks about nutritional supplements as some sort of magical elixir,” Olshansky said. “I’m going to be frank: The vast majority of people who are taking nutritional supplements thinking it’s going to extend their life are really just producing expensive urine.”
