The 12-year gap we should be paying attention to when it comes to ageing

When we consider how we want to age, we often think about it in numerical terms, saying we want to live until 100 or for as long as possible. But a new study, published in JAMA last month, suggests we should be looking at more than the number of birthdays we’d like to be around to celebrate.

Taking data from 183 World Health Organisation Member States, including Australia, researchers looked at the healthspan-lifespan gap, which is the divide between years lived in good health and years lived.

Australia was among the countries with the greatest healthspan-lifespan gap, sitting at 12.1 years, second only to the United States with a gap of 12.4 years. Globally, it found the mean gap had risen to 9.6 years in the past two decades.

Credit: Marija Ercegovac

Why is the gap widening?

While life expectancy has risen dramatically around the world in the past few decades, health-adjusted life expectancy (years lived without disease) has remained relatively stagnant. This means that while we are living longer, we are living a greater proportion of our lives burdened with disease.

According to researchers, musculoskeletal diseases, mental and substance use disorders, and neurological disorders contributed most to disease burden.

Professor Luigi Fontana, scientific director of the University of Sydney’s Charles Perkins Centre, says major advancements in the medical field mean we have become far better at treating acute morbidity, allowing us to live longer.

But he says things like high rates of obesity and a rise in lifestyle diseases – including among younger people – mean we are not necessarily living better.

“There is no doubt that the major advancements in treatments has been spectacular ... but the epidemic of unhealthy ageing and unhealthy lifestyle is causing problems,” he says.

Jaya Dantas, a professor of international health at Curtin University, points out that some countries, including Rwanda and Ethiopia, saw the greatest increases in both healthspan and lifespan, in part due to reduced conflict across the region and advances in healthcare.

As far as the growing gap in western and developed countries goes, Dantas explains we are getting better at managing communicable and non-communicable diseases and are monitoring them more widely.

The data also showed women to have a mean healthspan-lifespan gap 2½ years higher than men.

Dantas says this is partly because women are living longer than men, but also because women are generally more resilient and better at managing diseases, particularly musculoskeletal diseases for which they bear a greater burden.

“They might have non-communicable diseases, but they are proactive in looking after their health.”

And, Dantas adds, “there are some things you can’t prevent – you can’t prevent ageing. You can’t prevent the effects that come from menopause, or osteoarthritis or the autoimmune conditions that some people get. But people can still manage these conditions and lead healthy, productive lives.”

Prevention, not intervention

In light of this growing gap, many researchers like Fontana are advocating for a focus on prevention, rather than medical intervention.

“The goal of medicine should be to minimise the unhealthy window,” he says.

In 2020, The United Nations launched its Decade of Healthy Ageing resolution, which sought to shift societal focus from longevity to healthy longevity.

And Fontana says this gap does not need to be growing, as many of the diseases which contribute to poor ageing and burden the healthcare system are preventable.

According to the WHO, over 75 per cent of cardiovascular diseases and 40 per cent of cancers are preventable.

Fontana says the medical field is still focused on diagnosis and intervention, rather than prevention, and we should be looking at alternate models of care.

A novel Australian trial, conducted by Fontana and Kevin Chang in Sydney over three years, used a value-based preventative primary care model to propose an alternative to our current system. Strikingly, it found a 51 per cent reduction in hospital admissions and significant improvements across various markers of health. Scaled across Australia, its researchers estimate it could save $30 billion annually.

Fontana also believes prevention needs to start from a young age in homes and schools.

“We are not teaching our kids how nutrition, exercise and emotional health can be changed in a mechanistic way,” he says.

Healthy ageing

If we want to live healthier – not just longer – lives, our lifestyle is important. On an individual level, most of the advice for healthy ageing is simple and sensible: stay active, prioritise a whole food diet, don’t smoke, reduce alcohol consumption and maintain meaningful connections with friends and family.

But Dantas says this also needs to come with structural changes invested by governments that allow people to make these healthier choices. This includes things like building liveable cities that encourage walking and cycling, supporting the elderly in maintaining active and independent lives and improving access to healthcare and food security.

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