Preventive Medicine Column
Dr. David L. Katz
A recent piece in the Wall Street Journal suggests that given the opportunity to live to be 120, a majority of people might well decline. The finding was derived from a Pew Research Center survey of a nationally representative population.
There are several potential reasons for this seemingly counter-intuitive finding. First, the poll respondents seemed to recognize the need to make some room for the subsequent generations. Of course, that problem might be addressed by global population control, but that consideration apparently did not figure into the conversation. Assuming we keep adding humans to the population, it is true that those of us already here need to get out of the way at some point. Even at the current life expectancies around the globe, there are a whole lot more of us coming than going, with potentially dire consequences.
Another reason, although not explicitly stated, was perhaps most indelibly captured by John Mellencamp in his lyrics: “oh yeah, life goes on, long after the thrill of livin’ is gone.” Survey participants indicated that living to 90 sounded good- and that is already a decade more than current life expectancy. But apparently by 91, many thought some of the thrill might be gone. Go figure.
But there is yet another reason that I think may be the most fundamental of all. We are only able to judge the hypothetical based on our actual experience, and our actual experience of aging is…that it pretty much sucks! I commiserate with my patients all the time that “getting older isn’t for sissies.”
We live in a culture where life expectancy has, indeed, been rising; but health expectancy has in no way been keeping pace. In global context, the “health span” in the U.S. (time spent living in good health) is remarkably bad, but as the global burden of chronic disease rises, other populations are regressing to our level rather than vice versa. We are adding years to life thanks to the prowess of modern medical advance, but we are surrendering ever more life from those years because of an enormous, and overwhelmingly preventable, burden of chronic disease. Nearly 80% of all chronic disease-heart disease, cancer, stroke, diabetes, dementia- could be eliminated by means already at our disposal. But those means are routinely neglected, because most of us know what, but almost none of us knows how.
The result is not merely the truly dire toll of epidemic obesity and chronic disease right now, but the clear and present indications of far worse to come. CDC projections indicate we are on the brink of bequeathing to our children not only a much more crowded world (no matter what our life expectancy), but one in which one in three Americans is diabetic. “Only” some 27 million Americans are diabetic now, and we are already wallowing in chronic disease and all but unmanageable costs. How ever will we pay the bills- in the currencies of both dollars and human potential- when over 100 million of us have a serious, costly, potentially disabling chronic disease beginning at ever-younger age?
Honestly, I don’t think we can. I also know we don’t have to. We could turn our latent knowledge into the power of immediate action, and slash our personal risk of chronic disease by 80%. If enough of us did this for ourselves and our families, the threat to the collective future of our children, and our nation, would simply disappear.
The survey respondents were asked about medical advances extending their lives to 120, and they said, for the most part, “no thank you.” But they were not asked about lifestyle practices extending their lives. Nor were they asked: how about if instead of just adding years to life, you could also add life to years- and live in an extended state of vigor and vitality? We look around and see people in their 40s, 50s, 60s, and 70s-let alone truly older people- with a massive burden of chronic disease. Perhaps we can’t even imagine what living with bodily vigor and mental clarity decades beyond that would be like. Lifestyle practices we control have the potential to let us find out.
Personally, I would like to live a good, long life-but “good” comes first for good reason. I want my full share of years in life, but if I had to choose between more years in life and more life in years, living with full vitality would come first. Chronic disease doesn’t just shorten our lives-it ruins them long before they end.
Whatever our reticence about living to 120, I bet it doesn’t extend to making the years we have rich and full and vital. To a remarkable degree, we can get there from here by using lifestyle as medicine. I would like to see the skill-power for getting there from here widely shared, and then- let’s repeat that poll.
Dr. David L. Katz