What if we redefined aging as longevity?

LF40 | Shifting from 'end of life' aging to 'whole of life' longevity might make it easier to put the issue on everyone's agenda

Source: MidJourney. Prompt: a fantastical picture of dorian gray

We’re terrified of aging

Let’s face it, aging has an image problem. It’s something that happens to us all (if we’re lucky), yet people don’t like to be reminded of the fact. The anti-aging industry is on track to be a $120 billion money spinner, a complicated legacy of savvy Madison Avenue marketers and a commercial model elevating the new over the old.

I’ve been in the aging space for over a decade, and one of the first things I joked about with Aging2.0 was that ‘we wanted to make aging sexy’. In some sense we (and the market) succeeded, and startups in agetech are having a moment. However, it’s still a really hard slog and well-meaning entrepreneurs are spending their lives and 401ks trying to change the system, and it’s not turning fast enough. AARP and Joe Coughlin others have done a sterling job framing “it” as the longevity economy, mind-bogglingly worth tens of trillions of dollars.

Aging doesn’t resonate

The trouble is this the concept is still meaningless to most young people, and a good number of older people too.

Aging - and even the longevity economy as defined by everybody over 50 producing or consuming - still seen as ‘other’ by everyone under 50. A far -off thing, not to be thought of until it’s unavoidable, and mostly about decline and loss.

What we need is a fundamental reframing of aging away from ‘end-of-life’ and towards ‘whole-of-life’. To many people aging and longevity sound synonymous, but while longevity relates to who long something is alive, aging, according to the NIH, is the rather painful sounding: “the time-related deterioration of the physiological functions necessary for survival and fertility”.

A political opportunity?

If you were the governor of a State looking to get re-elected - let’s say California in the US or South Australia in Oz - what one policy could you pick that would satisfy everyone?

Despite California’s left-leaning credentials it wouldn’t be banning guns, cars or Big Macs. Nor would the generally conservative -leaning South Australians please everyone with compulsory church-going.

In fact pretty much the only thing we can agree on in this polarised world is that (almost) none of us want to die. Or worse still die after a prolonged bout of sickness and disease. It’s not a matter of choice, it’s instinctual. Our bodies are obeying the orders of our DNA, handed down over millennia.

How odd therefore, that our political system fails to reflect this one shared goal? Debates about health are particularly loud in the US, but it’s generally about how to pay for the sick, not prevent people getting sick.

A declining healthspan means we’re failing

Most people, after a moment’s thought, would agree that healthspan - the amount of days you live in good health - is more important than lifespan - the total amount of days you live. In this regard it seems the US at least, hasn’t got its priorities straight.

Source: WHO 2021 data via Jeff Nobbs

US healthcare policy is a thorny topic, but suffice to say we’re not prioritizing the right things if people’s healthspan is falling (the above chart showing the US as the only developed country to see a decline in healthy life expectancy, was data before Covid). I imagine the numbers are worse now.

A healthy, fulfilling life, right until the end.

I would suggest that an overriding goal of society, and of politicians, is to help citizens live a fulfilling, healthy life right to the end. Devoting resources to the problems faced by an aging society is certainly better than ignoring the demographic entirely as has been the case for too long. However, to use Peter Attia’s analogy, it’s running around catching eggs falling from the sky, not figuring out why they’re falling in the first place. It’s too late to worry about aging when you’re already there. Instead of today’s siloed approach to aging (which is often siloed still further), longevity suddenly becomes everyone’s business, with all that implies.

The time to start is before you’re born

Instead of addressing the problems of an aging society uniquely by addressing older people, let’s instead change the conversation and make it about maximizing “healthy longevity”. This starts before you’re born - cigarettes and alcohol can indeed damage the baby’s longevity prospects. Similarly, in mid-life, people need to develop and sustain good habits, especially as a stressed ‘sandwich generation’ leaves them little time and resources to themselves. And also in mid-life, if people’s jobs are taken away by AI, they need help and support reinventing themselves, and avoiding the path of decline.

Three ‘intervention points’ to change the system

The sketch below lays this out in a simple fashion. We intuitively want the path in yellow - better quality of life, less of a decline and a fast, dignified end. To get this we need to intervene throughout life, ideally with everyday healthy choices driven by smart ‘behaviour change’ models. But we can simplify the approach with these three intervention points: Early Life, Mid Life and Late-Life (the traditional aging intervention).

Fleshing out what goes into these as systems intervention points is a job of a research project and needs providers, partners, researchers, innovators, capital providers and above all committed politicians (hello California and South Australia…).

I don’t think politicians today (and businesses) who are leery of the aging agenda are thinking of aging in this lifecourse manner. Laura Carstensen at Stanford has developed a new Map of Life which is along these lines and needs more recognition and adoption in influential circles. The more that this lifecourse thinking goes mainstream in research, business and politics, the better.