Longer Living Does Not Mean Healthier Living: Change Is Needed

In today’s Mexico, the risk of longevity is greater than the risk of early death. But that does not mean that the last third of life will be spent in good health. A significant and growing divide still exists between life expectancy and healthy life expectancy. The extraordinary advances in public health and medicine that have increased life expectancy as well as knowledge on a wide range of ailments still give no room for  optimism as healthspan remains unchanged. Today, prolonged life is accompanied in Mexico by a growing incidence of chronic diseases.

Highly technified, modern medicine enables sick people to live longer lives. Unfortunately, this  has major financial, environmental, and social consequences. On the other hand, several epidemiological, pre-clinical and clinical trial data demonstrate how most chronic diseases can be prevented with nutritional and lifestyle changes, so the move to a personalized, preventative approach should contribute to improve individuals’ healthspan.

The World Health Organization (WHO) says in the 2015 report on aging and health, that transitioning from a primarily disease-centered medical system to a balanced preventive and person-centered healthcare system is key to reduce social disparities in health and achieve financially sustainable, universal health coverage for all.

In Mexico, studies have reported that the incidence of cardiovascular disease (CVD) and diabetes has been increasing in recent birth cohorts. However, according to WHO, at least 80 percent of CVD and diabetes and 40 percent of cancers are preventable. Experimental and epidemiological evidence shows that optimal nutrient intake protects against cancer, CVD, diabetes, obesity, frailty, and even cognitive impairment. Additionally, avoidance of smoking and excessive alcohol consumption, cognitive training, improving sleep duration and quality, and reducing stress can help in the improvement of intrinsic capacity.

Although medical sciences have been quite effective in treating disease, they are responsible for 3 percent to 10 percent of CO2 emissions. Furthermore, over the last 20 years, consumption of both old and newer medications by older individuals to treat chronic diseases has resulted in a 10- to 20-fold increase in aquatic levels of pharmaceutical residues and by-products. These residues are now also being detected in crops that are irrigated with reclaimed water, freshwater and marine organisms, and soil which is amended with wastewater treatment products. This increase in bioaccumulation raises serious concerns for human and environmental health.

Even though healthier lifestyles and food changes are known to have an impact on the prevention of chronic diseases, little research and no unifying framework has been developed to transform the concepts into an operational strategy. Besides, the current COVID-19 pandemic has highlighted not only the need for better pandemic screening and control, but also the need to improve health systems’ performance and the living conditions of people in general to lessen the impact of infectious diseases. COVID-19 has shown us our vulnerabilities, which are related mainly to a couple of closely interrelated issues: inequality and multimorbidity. COVID-19-related challenges are already a hindrance and will likely continue to hamper progress on healthy aging for many years. Mitigation strategies will have to be worked out in advance in the context of community education and delivery of care services using digital education, telemedicine and within COVID guidelines, keeping the local context and situation in view. Existing healthcare infrastructure overburdened by the pandemic will have to be judiciously refurbished. 

Therefore, in this context, health systems and the health industry should shift their business model to prioritize disease prevention. Next, improve awareness and control of prevalent disease, and thus contribute to the improvement of healthspan and the well-being of individuals. Besides, the impact of education on health has been long overlooked; today, we are well aware that integration of health literacy into education programs is key since it can shape health and well-being along people’s life course. Schools and universities must not only focus on mechanistic knowledge but also practical skills on the mechanisms and interventions that link diet and other lifestyle components to human and planetary health. Efforts must be made to reduce health inequalities globally so that improving healthspan and the overall well-being of individuals is achieved.

To move forward, a current initiative is key: the Decade of Healthy Ageing, which is a global collaboration that brings together diverse sectors and stakeholders, including governments, civil society, international organizations, professionals, academic institutions, the media, and the private sector to improve the lives of older people, their families, and communities. The initiative focuses on four domains: changing how we think, feel and act toward age and aging; developing communities in ways that foster the abilities of older people; delivering person-centered integrated care and primary health services responsive to older people; and providing older people who need it with access to long-term care. Four enablers are critical to this initiative: engaging directly with the voices of older people; leadership development and capacity-building at all levels; connecting all stakeholders; and strengthening research, data, and innovation. The decade, its action areas and enablers lay out a solid framework to foster healthy aging around the world. 

Notwithstanding this initiative, stronger efforts will have to be made into converting a theoretical framework into practical and measurable actions. To date, progress has been limited and further delayed by priorities imposed by the pandemic, which, paradoxically, has also increased attention on aging issues.