The case for prevention, part 1: improving lifespan and healthspan

Many of us probably already have a sense of why we should be healthy and encourage health among the population, though we so often lose sight of our motivations behind this. I am as guilty as anyone of occasionally slipping up on my habits, and I have found that the solution tends to trace back to reconnecting with my purpose for the behavior. In other words, I have to take a step back and remember what I am optimizing for by doing these things. This is the sort of conversation I have with patients and friends regularly when it comes to understanding their health motivations. If someone can’t connect with why they should be valuing their health, we can’t expect as providers that they will adhere to any behaviors geared towards it. With that said, I wanted to touch on a few factors both at the individual and population level that might incentivize one to value their health, and particularly getting out in front of disease with preventive strategies and healthy habits. Naturally given my life’s work, I feel like I have an almost never-ending list of reasons we should strive to optimize our health; these are just some of the most common ones I find myself coming back to (even so, this will require multiple posts). Of course, not all of these will resonate with you and what you are optimizing for in your life, but you might find one or two that do. At the end of the day, it is up to each person to discover what they value and want to get out of life. In my opinion, whatever that may be, you can just about always make a case for good health as a means to achieve it.

Lifespan

Perhaps the most straightforward benefit of preventive health: when done properly, on average, you will live longer when you take measures to look after your health with exercise, nutrition, sleep, stress management, etc. Studies particularly in centenarians and octogenarians (people living into their 80s) have consistently demonstrated that individuals who live longer do not live longer because they drag out their years after developing a disease. Rather, these people have longer lives because they spend more years free of disease. Compared to those who live shorter lives, they generally still have the same timeframe to demise once they develop a major chronic disease like heart disease, cancer, diabetes, dementia, etc. Therefore, the best way to prolong lifespan is to prevent the onset of disease in the first place.

Many of us can identify with wanting to live a longer life, such that we have the capacity to create more experiences, treasure relationships perhaps with our grandkids or great-grandkids, whatever it may look like for you. Populations worldwide that are prolonging their average lifespan have also been reaping several benefits such as intergenerational support, knowledge and mentorship, extended economic involvement and wealth distribution (see financial section to come in part 2).

Healthspan

As much as I value my lifespan, for me this may be the most important. Healthspan is broadly defined as how we are living, the condition in which we live. In medical contexts, it is technically the duration of time in which we live free of disability or disease. I think many people perhaps value this more than simply how long they live. After all, what’s the point in living forever if you feel miserable? Fortunately, the same efforts we employ preventively to prolong lifespan will also benefit our healthspan. Consistent exercise, a stable and balanced diet practicing moderation, a regular and sufficient sleep routine, a mindfulness practice - all of these things contribute towards helping one feel and function better on a daily basis. Countless studies can demonstrate this, but I’ll point out just one that I mentioned in our recent newsletter to highlight it. This study actually demonstrated that individuals who did bouts of exercise actually had decreased subsequent cortisol (“stress hormone”) spikes from psychosocial stressors. Essentially, exercise won’t just help you feel physically better, improve your functionality in tasks of daily living, reduce pain and debilitation, and so much more, but it will literally decrease the stress response you experience from a stressful situation.

Another point on healthspan is that not only does preservation of health help us feel better, but it dramatically reduces our net suffering. Any discomfort associated with healthy habits like regular exercise or watching what we eat pales in comparison to the suffering experienced with disease burden if we don’t take care of these things: frailty, chronic pain, mental health deterioration. Discomfort in life is inevitable, and generally even beneficial to make comfort and positive feelings all the more meaningful. One is far better off investing in something like the relatively mild discomfort of exercise or watching their diet on the front end, than suffering the protracted consequences of preventable disease. Because therein lies another concept, which is that most don’t understand the dying process. You may not value lifespan at all, and imagine that you’re fine experiencing a hasty demise earlier in life than you’d otherwise be capable of. The only problem is, in most cases, death is not so hasty and peaceful. Particularly from these preventable chronic diseases, rather, it is a drawn out process over years of relative suffering. While this isn’t meant to invoke end-of-life fear, it is simply the reality of what life and death often looks like, and yet another incentive to make our journey as smooth as possible through prevention.

At a population level, we certainly can benefit from improved healthspan as well, not only again from an economic standpoint, but also from things like removing caregiver burden late in life, and enhancing autonomy and independence across the board. With improved mental and physical condition of the population, we could see greater innovation and productivity, improvements in day-to-day interactions, and potentially even resolutions in our sociopolitical discourse. Imagine if our leadership all exercised sufficiently and decreased that cortisol response from their many stressors, and how better off we might be for the decisions they and all of us make. Imagine the things we’d all say or not say, how your social media feed might look different. As a society, we undoubtedly collectively do better when we all feel and function better.

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