Today, global average life expectancy stands at 73.4 years, marking almost a decade of progress since 2000.1 If this momentum persists, individuals born in this millennium can expect to celebrate their 100th birthday.2 Despite notable gains in life expectancy, the corresponding increase in healthspan—the years lived in good health—lags behind, with our later years often characterised by chronic illness and cognitive decline.
In November the inaugural Global Healthspan Summit, hosted by the Hevolution Foundation, took place in Riyadh, Saudi Arabia, bringing together over 2,000 scientists, innovators, entrepreneurs, policymakers and thought leaders to delve into pivotal questions confronting the future of ageing societies. Topics covered included the untapped opportunities of healthy ageing, as well as the emerging interventions, technology, policy changes and investments required for a future where we live long healthy lives.
Rebranding ageing as an opportunity
Ageing brings many stubborn prejudices and a persisting narrative of ageing as a social and economic burden. While breaking down some of these misconceptions, John R Beard, Irene Diamond professor and director of the International Longevity Center at Columbia University, shared the example of economic measures such as the old-age dependency ratio—a ratio of the number of older dependents to the working-age population—that reinforce negative perceptions and overlook the meaningful contributions of older adults in our society. In the US and Europe, older adults contribute an estimated 7% of GDP through paid work, volunteering and caregiving.3 The older population may also be an untapped force for economic stability and innovation. In the US, the number of entrepreneurs over 50 has doubled since 2007.4
Living longer may also force us to retire the word retirement. With a projected lifespan stretching towards the century mark, we can expect our working life to be extended by an additional 20-40 years. This will reframe how we think about education and work, embracing flexibility and lifelong learning. Reasons for staying in the workforce also go beyond economics. There is increasing evidence that working past retirement age reduces the risk of health problems such as heart disease and dementia while also providing mental stimulation and social engagement.5
Embracing older people as valued members of society requires dismantling negative stereotypes and shifting the public narrative about the benefits of longer lifespans to individuals, societies and the economy.
Healthy ageing is necessary for a healthy economy
In his opening dialogue, Mehmood Khan, the CEO of the Hevolution Foundation, pointed out that “the majority of healthcare costs in the developed world, and soon in the developing world, are driven by ageing and age-related diseases”; yet ageing and healthspan science remains acutely underfunded. For example, the US spends approximately $305bn annually treating Alzheimer's disease, a figure expected to surpass $1.1 trillion by 2050.6 Adding to this financial pressure, the US Centers for Disease Control and Prevention estimates that heart disease and stroke cost the country $363bn per year in healthcare expenses and lost productivity. Diabetes incurs an estimated annual health and economic burden of $327bn, while the costs attributed to arthritis and related conditions equate to over $303bn annually.7 While the country spends billions treating the symptoms of ageing, less than 1%, or $337m, of the US National Institutes of Health's annual research budget goes towards understanding the biology of ageing.8
Addressing the root causes of ageing may offer a larger return on investment than targeting individual diseases. Investing in healthy ageing not only reduces healthcare expenditure—a population that lives better for longer also stimulates economic growth. According to data from the US, a one-year increase in healthy life expectancy is worth almost US$40trn in healthcare saving costs and productivity gains.9
The world's demographic structure is undergoing a transformative shift, with the population over 60 expected to double to 2bn by 2050.1 Delayed action will result in reduced quality of life and additional years lived in ill-health, all while young people take on the responsibility of caregivers for family members.
Shifting focus from intervention to prevention
According to the US National Council on Aging, a non-profit advocacy group, more than 80% of adults aged 65 or older are living with two or more chronic conditions.10 Declining health in older age does not need to be the status quo. The majority of chronic diseases are preventable. However, despite a clear imperative and opportunity to optimise health before the onset of disease, spending on prevention among OECD countries is less than 3% of total health expenditure.11
Creating a healthier future where people live longer requires healthcare systems to move beyond reacting to short-term acute illness and treating disease to proactively addressing chronic conditions and sustaining long-term health. Proven lifestyle interventions that prevent the onset and development of chronic disease and extend lifespan include routine exercise, a healthy diet, smoking cessation and social connection. Recent advances in risk prediction models and data generated through wearable devices provide an opportunity for a more holistic and targeted approach to prevention that empowers people to take ownership of their health.
Saudi Arabia and the wider Middle East region are uniquely positioned to capture the shift towards preventative medicine. With almost 60% of the region's rapidly growing population under the age of 30, changes made today to prevent the onset and development of chronic disease and support healthy ageing will have far-reaching benefits on the healthy longevity of future populations in the region.12
Creating an environment that supports healthy ageing
The environment we live and work in also shapes our health as we age. Speaking at the Global Healthspan Summit, Andrea Britta Maier, co-director of the Centre for Healthy Longevity at the National University of Singapore, said that “while we cannot yet engineer our genome, we can engineer our environment.” Beyond the design of cities and communities to support healthy lifestyles, often overlooked elements, such as light and noise exposure, also influence our biology and how we age.
Hanan Balkhy, director for the WHO Eastern Mediterranean Region, stated that “70% of healthcare issues are managed outside of the healthcare sector,” underscoring the necessity for multisectoral action and accountability in shaping population health. Reflecting on Saudi Arabia's goal of increasing the life expectancy of Saudi individuals from 76 in 2020 to 80 years by 2030, Tareef AlAama, the Saudi deputy minister of health for curative services, told the Summit that involving all sectors through a “health first” or Health in All Policies approach is key to making sure that public health interventions are enforceable, implementable and sustainable.
Unlocking the science of ageing
“If you want to send a man to the moon, you need to understand the laws of physics—if you want to have a moonshot for ageing, you need to understand the fundamental principles of ageing,” said David Gems, professor of biogerontology at UCL's Institute of Healthy Ageing, during a discussion exploring the challenges translating scientific discoveries to clinical applications in Geroscience. Although ageing is a universal process and the most significant risk factor for many chronic diseases, conditions and disability, it is also a complex process with many contributing genetic, environmental and socioeconomic factors.
Geroscience, the science focused on the biology of ageing, is an evolving field. Many uncertainties surround the biological mechanisms and determinants of ageing. Recent studies from animal models and emerging evidence in human populations indicate that the rate of ageing can be slowed and possibly even reversed.13 Unravelling the determinants of healthy ageing will be critical to enhancing our understanding and accelerating the advancement of technologies and therapeutics that target not only age-related diseases but also the root causes of ageing.
Bridging the gap between theoretical and real-world application
Although the science of ageing was previously a nascent field, we are seeing rapid development in technology and therapeutics with the potential to extend healthy lifespan and redefine healthcare. Artificial intelligence (AI) is helping to optimise clinical trials and accelerate the development of anti-ageing interventions.14 Large-scale genome programmes are helping to identify the genetic factors associated with extending lifespan. Emerging gene therapies promise to slow or reverse the effects of ageing.10 We have also seen advances in Alzheimer's research, with multiple clinical trials currently underway on a vaccine to treat and prevent the brain disorder.15
Translating discoveries in the science of ageing to patient benefit at scale is expensive, timely and high-risk. Building an ecosystem and supporting scientists and startups in the first mile of developing therapies and technologies that target the root causes of ageing is critical. However, the potential returns of investing in a healthy future are gaining recognition. The longevity industry attracted over US$3.8bn of venture capital investment in 2021.16 Last year, the UK government announced a £98m (US$123m) funding pool to support innovation in healthy ageing.17 Hevolution has committed US$250m to propel advancements in the healthspan field. A substantial step in this direction is the announcement of a US$101m fund by Hevolution in collaboration with the XPrize Foundation during the Global Healthspan Summit. The fund aims to support research with demonstrated potential to extend human life and enhance health during ageing.18
Closing the gap between healthspan and lifespan necessitates collaborative efforts spanning science, investment, technology and policy. Discussions at the Global Healthspan Summit drew parallels to the covid-19 response, revealing both the potential achievements of mobilising stakeholders around a common goal and the glaring global health inequities in access and distribution.
Democratising access to healthspan science
Although ageing is universal and lifespan is increasing globally, not everyone is experiencing the same gains in longevity. Poverty is the primary determinant of health and lifespan, with data from the US and the UK highlighting a 20-year disparity in healthy life expectancy between the wealthiest and the poorest segments of the population.19,20
By 2050, 80% of people over 60 will live in low- and middle-income countries (LMICs). Additionally, LMICs are undergoing population aging at a faster pace than Europe or North America.21 Addressing the needs of growing and ageing populations within the context of under-resourced health and social care will require affordable, cost-effective and scalable interventions. A commitment to equity in the pursuit for extending healthy lifespan requires a diverse research pool and the infrastructure to distribute advances in ageing science to all corners of the globe.
The global shift towards an ageing population has profound implications on health systems and many other aspects of our society, including labour and financial markets. Advances in ageing science and technology hint at a future where living beyond 100 becomes the norm. Consequently, there is growing recognition that improving healthspan is a valuable and necessary pursuit. The UN's Decade of Healthy Aging (2021–2030) underscores the need for collaborative efforts to enable longer, healthier lives, while 12 of the 17 Sustainable Development Goals (SDGs) emphasise the well-being of older adults.22 The UK and Singapore have committed to adding five healthy life years to their populations.23,24 Reducing premature deaths from chronic disease is a key pillar of Saudi Arabia's national development agenda, Vision 2030.25
Addressing the needs of ageing societies and capitalising on the opportunities afforded by populations enjoying additional years of good health will require a paradigm shift in how the world views ageing, policy adjustments that promote healthy ageing, healthcare systems prioritising prevention and investment, and global collaboration to accelerate the advancement of therapies and technologies with the potential to benefit all of humanity.
References
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