12.4 years: the number the longevity industry should be measured against

Two Mayo Clinic researchers, Armin Garmany and Andre Terzic, published today in JAMA Network Open an analysis of World Health Organization data for 183 countries from 2000 to 2019, measuring the distance between how long people live and how long they live in good health. Globally that gap grew from 8.5 years to 9.6. The United States has the widest gap of any country: 12.4 years, up from 10.9 in 2000 — 13.7 years for American women, 11.1 for men. If the goal of longevity is more life, this is the number that says what kind of life has been added.

What it shows. The study subtracts health-adjusted life expectancy — years weighted by time spent with disease or disability — from plain life expectancy, using WHO's modeled estimates. Those estimates carry assumptions, and comparisons across countries carry them too; the exact decimals deserve less confidence than the direction, which is consistent everywhere and worst in the United States. The conditions driving the American burden are mental and substance-use disorders and musculoskeletal disease; for women, musculoskeletal, genitourinary and neurological conditions. Women everywhere have a wider gap than men, by 2.4 years globally and 2.6 in the United States, because they live longer and carry more of those conditions.

Ben’s take

The longevity industry sells lifespan: biological age, decades added, the escape from decline. The customer's actual problem is these 12.4 years. A clinic that could show it shrinks that gap would have a product. None can, yet. Look at the conditions in the paper — musculoskeletal, mental health — and then look at the five fundamentals. Movement is the musculoskeletal intervention. Connection and purpose are the mental-health interventions. Nobody is selling them because nobody can.

Loree’s take

Twelve years is not an abstraction in my office. It is the woman who outlived her husband by a decade and spent eight of those years in pain she had filed under normal aging. The gap is where the fundamentals do their work — not by adding years, but by taking the sickness out of the years that are already coming.

Read it with last month's paper. Three weeks ago, "Ten Americas" in The Lancet reported a 20.4-year spread in life expectancy between the longest- and shortest-lived groups of Americans. Today's paper says the country as a whole spends more years sick than any other; the earlier one says who spends the most. Together they describe the actual target. Not more years — more well years, for more of the people who live here. Every product in the longevity aisle should be asked which of those two numbers it moves, and for whom.