How Long and Healthy Will We Live?
There is a limit to longevity. We also need to limit disease within our lifespan. Physical activity is perhaps the single most important factor to help us do that. Five new 2024 papers discussed.
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Bhavin Jankharia
The Detailed 15-Point Guide to Live Long, Healthy
Bhavin Jankharia
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In 2024, five major studies have brought clarity to a crucial question: what are the realistic limits of human longevity, and more importantly, how can we live healthy within those limits?
Many people confuse the concept of “living long, healthy” with longevity and life extension. In my post “Longevity is Inevitable: Extended Healthspan is Not and Requires Effort” in Apr 2024, I said
Whether you follow the Atmasvasth guide to living long healthy or not, you will pretty much live till 90. What would be your main concerns? That you live these long lives without physical and mental disability. That basically means not having heart attacks and strokes, not getting knocked out by infections, not getting dementia, not falling and fracturing and being able to carry out your daily activities on your own without being dependent on family and the system, with enough money to be able to live well till you die. What this guide and others like these do, is not necessarily to help you live longer, but to help you live these longer years better, with as little disease and suffering as possible, with as long a healthspan as possible.
Bhavin Jankharia
These days, there’s much hype in the lay press about extending life, especially due to individuals like Bryan Johnson and ageing experts who believe replicating cellular processes in long-lived animals and eliminating ageing at a cellular level could allow us to live for hundreds of years.
Currently, there’s no evidence this is possible, even in mice. 2024 research suggests fundamental limits to human longevity that make such extreme life extension unlikely.
The world has gone from a life expectancy at birth of around 40 years in the early to mid 1800s, to 72 years worldwide and 67.7 years in India (2022). Life expectancy is higher in higher income countries (84 years in Japan) and in mid and high income groups within India (65.1 years for low income and 72.7 years for high income groups) [1].
Bhavin Jankharia
All this has happened in the last 100-150 years due to improved socio-economic factors, clean water, better food, vaccines, antibiotics, laws like smoking bans and seatbelt laws, disease screening for high blood pressure and diabetes, and better healthcare.
Bhavin Jankharia
This brings us to the central question: will life expectancy continue its onward march with the same trajectory, or is there a natural limit?
The most definitive of these new studies, published in Nature Aging by Olshansky and colleagues in October 2024, examined data from high-income countries (Japan, US, Hong Kong, etc). They say,
“The life expectancy at birth associated with these composite mortality schedules as of 2019 is 88.68 years for females and 83.17 years for males…reducing death rates to zero for the first 50 years of life adds 1.0 years to the composite most favorable life expectancy of females and 1.5 years to the composite most favorable life expectancy of males.”
They say that in high-income countries, increase in life expectancy has slowed or stalled, while low and middle-income countries are still catching up. In the best-case scenario, 1.8% of men and 5.1% of women currently alive in high-income countries will live till 100.
They say,
“It is suggested here that humanity’s battle for a long life has largely been accomplished. This is not a pessimistic view of a longevity game over or that further mortality improvements at all ages (especially at older ages) are no longer possible or that healthspan can no longer be improved through risk factor modification or reductions in survival inequalities. Rather, it is a celebration of more than a century of public health and medicine successfully allowing humanity to gain the upper hand on the causes of death that have, thus far, limited human lifespan.”
India is still catching up and most of us will live longer. In 2019, the probability of premature death (PPD) in India (before age 70) was 37% [3]. This doesn’t consider income and healthcare access disparities, so it is likely that middle to high income populations in India will have a much lower PPD, but not as low as middle to high income countries, mainly because of increasing air pollution, our largest killer.
This brings us to the crucial question explored by the other 2024 studies: what’s the point of living long, unless you’re also healthy for most of that lifespan?
A concerning study from the Journal of Gerontology [4] addresses this question, revealing an expansion of limiting and self-limiting pain with increasing longevity. Instead of compressing illness into 5-6 years before death, we're seeing longer periods of pain and disability paralleling our extended lives (10-15 years of suffering). An Indian modeling study showed about 8.8 years of diseased life before death [5] assuming a lifespan of 70.8 years.
We need to compress morbidity and increase our healthspan within a long lifespan.
Two 2024 studies offer practical guidance. A JAMA Network Open study [6] examined what it takes to reach 100, finding that just three parameters in octogenarians predicted centenarian status: not smoking, physical activity, and food diversity. Another recent paper looked at the NHANES cohort in the US [7] and found the only parameter that predicted mortality was physical activity (PA)...just the presence or absence of PA determined using wrist accelerometers was the best predictor of mortality, compared to any other clinical or disease parameter (blood pressure, diabetes, etc). The authors make an interesting statement,
“Movement and health are intrinsically linked. Mobility loss with aging occurs across species and is linked to deterioration of the central and peripheral nervous systems, musculoskeletal systems, and sensory systems. To this end, health and functional status are often better assessed with physical and cognitive assessment than clinical disease measures.”
So what does this mean for you and I?
Take everything you read, especially in the lay press and on WhatsApp about extending longevity beyond age 90 or 100, with a huge pinch of salt. Most middle to high-income people in India will live till 80-90. The goal is to compress pain, disease and suffering to as few years as possible, which the 15-point atmasvasth guide is about. Among these points, the most important is physical activity, followed by not smoking and food and alcohol moderation. Add to this, not falling and not getting into road accidents, and diagnosing and controlling high blood pressure and high blood sugar…and we’ve done almost everything we can, to ensure a long healthspan within that long lifespan.
Bhavin Jankharia
Footnotes:
- Asaria M et al. Socioeconomic inequality in life expectancy in India. BMJ Glob Health. 2019 May 9;4(3):e001445. doi: 10.1136/bmjgh-2019-001445.
- Olshansky SJ . Implausibility of radical life extension in humans in the twenty-first century. Nat Aging. 2024 Nov;4(11):1635-1642. doi: 10.1038/s43587-024-00702-3.
- Norheim OF et al. Halving premature death and improving quality of life at all ages: cross-country analyses of past trends and future directions. Lancet. 2024 Dec 14;404(10470):2437-2446. doi: 10.1016/S0140-6736(24)02417-6.
- Zimmer Z et al. Are We Adding Pain-Free Years to Life? A Test of Compression Versus Expansion of Morbidity. J Gerontol A Biol Sci Med Sci. 2024 Aug 1;79(8):glae157. doi: 10.1093/gerona/glae157.
- Jena D et al. Statistical modeling and estimating number of healthy life years lost and healthy life expectancy in India, 2000-2019. Aging Med (Milton). 2023 Sep 27;6(4):435-445. doi: 10.1002/agm2.12269.
- Li Y et al. Healthy Lifestyle and the Likelihood of Becoming a Centenarian. JAMA Netw Open. 2024 Jun 3;7(6):e2417931. doi: 10.1001/jamanetworkopen.2024.17931.
- Leroux A et al. NHANES 2011-2014: Objective Physical Activity Is the Strongest Predictor of All-Cause Mortality. Med Sci Sports Exerc. 2024 Oct 1;56(10):1926-1934. doi: 10.1249/MSS.0000000000003497.
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