The average American’s lifespan is about 80 years, but their healthspan, the number of years they live free of disease or disability, is only about 64 years. Several interventions and policy changes can help close this 16-year gap.
By Paul Cerrato, MA, senior research analyst and communications specialist and John Halamka, M.D., Diercks President, Mayo Clinic Platform
Public officials often boast about American longevity. And in fact, if one compares life expectancy in the U.S. today, which is about 80 years, to life expectancy in 1900, which was about 47.3 years, it is impressive. But these statistics only tell part of the story. Currently, the last 16 or so years of a person’s life are too often filled with chronic pain, endless trips to the doctor, and a long list of prescription medications. That's not exactly what older adults envisioned when they look forward to their “golden years.”
Even more unsettling is the fact that while the U.S. has one of the best healthcare systems in the world, its healthspan-lifespan gap is larger than that of any of the other 182 member states of the World Health Organization. While life expectancy across the globe increased by more than six years in the last two decades, the largest healthspan-lifespan gaps were observed in the U.S., Australia, and New Zealand, according to a report from Mayo Clinic. (FIGURE 1)
How did we get to this point? Garmany, et al. referred to it as the disease paradox. Modern medicine has found ways to address most of the infectious diseases that killed our forefathers and to reduce acute mortality from non-communicable diseases like heart disease and cancer, saving patients from immediate catastrophe but not really curing them. The result is a generation of chronic sufferers.
The healthspan-lifespan gap is also influenced by the prevalence of mental and substance use disorders and musculoskeletal diseases. In addition, we have become victims of our own prosperity. The abundance of relatively inexpensive food, coupled with an endless collection of labor-saving devices has turned the nation into couch potatoes who can’t resist all the mouthwatering ads for ultra processed foods. The result has been an epidemic of obesity, diabetes, and hypertension.
Of course, there are other factors contributing to this gap. Health insurance in the U.S. is fragmented, leaving coverage gaps for many. The nation is still focused on sick care while preventive services are undervalued, and too little attention is being paid to the social determinants of health.
For example, CDC estimates that preventable disorders make up more than 75% of U.S. healthcare expenditures, yet the nation spends less than 5% on public health programs and related services that are “designed to prevent and control disease and injury rather than to treat the downstream consequences of these conditions.”
(Source: Garmany A, Terzic A. Global Healthspan-Lifespan Gaps Among 183 World Health Organization Member States. JAMA Network Open. 2024; 7:e245041)
Solving the healthspan-lifespan dilemma requires changing the way clinicians and the public think about aging. The actor Clint Eastwood, now in his 90s, summed up the way forward: “Don’t let the old man in.” It means refusing to believe in the normalization of decline. When patients start to develop cognitive or physical signs and symptoms, clinicians shouldn’t assume they simply reflect the normal deterioration of organ reserve that occurs over time.
Put another way, “healthcare systems, quality metrics, and reimbursement models [need to] shift beyond disease-based outcomes toward prioritizing function, prevention, and preservation of independence.”
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