Healthspan: how to add healthy years, not just years

Lifespan is how long you live. Healthspan is the part of it you spend in good health. Public health agencies measure it as healthy life expectancy: the World Health Organization’s HALE counts the average number of years a person can expect to live in full health.

The gap between the two is time lived with illness or disability. In its World Health Statistics 2024, the WHO put global life expectancy in 2021 at 71.4 years and healthy life expectancy at 61.9 years: roughly nine and a half years lived in less than full health. That gap, not just the total, is what healthy aging tries to shrink.

An analysis of two large US cohorts (Li and colleagues, Circulation, 2018) defined five low-risk factors: never smoking, a healthy weight, at least 30 minutes a day of moderate to vigorous activity, moderate alcohol intake and a high-quality diet. At age 50, people with all five had a projected life expectancy about 14 years longer (women) and 12 years longer (men) than people with none.

A follow-up by the same group (BMJ, 2020) looked at years lived free of diabetes, heart disease and cancer. At 50, women with four or five factors could expect about 34 disease-free years, versus about 24 with none; men, about 31 versus 24. These are observational studies: they show a strong association, not proof that each habit on its own causes those years.

Other public sources point the same way:

The National Institute on Aging (NIA) says it is important to get three types of exercise as you age: aerobic (endurance), muscle-strengthening and balance; stretching also helps you keep your flexibility. For adults 65 and older, the CDC recommends at least 150 minutes a week of moderate activity (for example, 30 minutes on 5 days of the week), muscle-strengthening activities on at least 2 days a week, and activities that improve balance. If you can’t meet that yet, be as active as your abilities and conditions allow.

Balance matters more than it sounds: according to the CDC, 1 in 4 adults 65 and older report a fall each year, and falls are the leading cause of injury in that age group. See mobility vs flexibility for the difference and simple exercises to start with.

The US Preventive Services Task Force (USPSTF) gives an A or B grade only to services with a clear benefit. Some of the most relevant to healthy aging:

• Blood pressure: adults 18 and older.
• Colorectal cancer: ages 45 to 75.
• Mammography: every 2 years, women 40 to 74.
• Cervical cancer: women 21 to 65.
• Prediabetes and type 2 diabetes: adults 35 to 70 with overweight or obesity.
• Lung cancer: a yearly low-dose CT from 50 to 80 with a 20 pack-year smoking history, if you smoke now or quit within the past 15 years.
• Osteoporosis: women 65 and older, and younger postmenopausal women at higher fracture risk.
• Statins to prevent heart disease: adults 40 to 75 with a cardiovascular risk factor and a 10-year risk of 10% or more.
• Hepatitis C: adults 18 to 79.

Your exact list depends on your age, history and risk factors, and your primary care doctor decides what applies to you; if needed, we give you a lab order for a lab near you. Already have numbers? Learn how to read your lab results.

“Longevity medicine” is a label many clinics use, but the tools with strong evidence are the ones preventive medicine already uses: exercise, not smoking, controlling blood pressure and cholesterol, and getting the screenings recommended for you.

The biology of aging is an active research field, but there is no good evidence that NAD boosters, peptides or rapamycin add healthy years in people. A 2023 review found that NAD+ precursors raise NAD+ levels in the body, but that their effect on how the body actually functions is unclear. A 2024 systematic review of rapamycin found only 19 human studies: some aging-related measures (immune, heart and skin) improved and others did not, and the review looked at those measures, not at years of life.

We do not recommend taking hormones just to slow aging. According to the FDA, testosterone products are approved only for men who have low testosterone together with an associated medical condition. If you have symptoms, book an evaluation: the doctor decides whether a treatment is appropriate for you.

According to World Bank data, life expectancy at birth in Puerto Rico was about 82 years in 2024, after dipping to about 79 in 2022. We did not find an official healthy-life-expectancy figure for the island, so we don’t quote one.

The same habits apply here, with one local twist: heat. Walk or exercise early in the morning or around sunset, drink water before you feel thirsty, and learn the signs of heat exhaustion and heat stroke. A daily walk on the beach or a waterfront promenade counts.

If you have heart disease, diabetes or uncontrolled high blood pressure, or symptoms such as chest pain or pressure, shortness of breath, dizziness or fainting with exertion, talk to your doctor before starting vigorous exercise. With chest pain, severe shortness of breath or fainting, call 911.

If you are in Puerto Rico, you can book an online visit: the doctor reviews your history and medicines and helps you start safely. You need to be physically in Puerto Rico during the visit.

If healthy aging is what brought you here, read what a longevity retreat can and cannot do, and how our retreat fits in.