Bending the Opportunity Curve

In business, we look at things like addressable market size, competition, consumer adoption rates, up-front investments, cash flow, and earnings potential of business opportunities. We set targets and build plans to support the goals and measure progress at regular frequencies. As owners and managers, we know that plans and objective metrics help us get on and stay on track. It’s important; there’s money and careers on the line.

When it comes to lifespan and, more importantly, healthspan, these same owners and managers tend to bring their work home but not the habits they’ve learned to trust. Most aren’t even aware of the opportunity for an extra decade of quality life. It begs the question, what’s the point of all the effort we put into our careers? Is it just for the dopamine hits when we have a good quarter or the shot at owning an exotic car? We play the long game in business but the short game in personal health.

I am passionate about impartial data, free of the constant opinion and marketing-biased data thrust at us. The more data we gather, the more it can teach us and the more reliable the findings. Mortality data is about as impartial as it gets, and there’s no shortage of it. This story comes from over 40 million data points and has many stories within it, but I’ll try to keep this story simple and direct because it’s crucial and foundational. It’s also something many more of us should have internalized long ago. ?

We’re all living longer in every developed and developing country worldwide, with but one exception: the United States. It didn’t happen overnight, and it holds no political affiliation. It’s been a slow, steady slip in world life expectancy rankings over the last hundred years. Once in the top 10, the U.S. fell out of the top 50 about 5 years ago and sank even deeper during the pandemic. Arguably, the biggest crisis the US may be facing is the lack of awareness of how real our current public health crisis is. We’re far more consumed by healthcare costs than we are by health itself and the many benefits that a healthy population enjoys. Imagine if we hadn’t implemented lane markings, traffic signals, speed limits, seatbelts, and airbags and instead found ourselves consumed in endless debates about the price of car collision repairs. Prevention pays. We understand and identify with the acute risk of a 2-second fatal car crash, yet remain paralyzed in dealing with long-term human chronic crashes over decades despite overwhelming and compelling data.

The chart shows the percentage of deaths by age from 1950 to 2019. Americans weren’t keeping up with their peers but were still living progressively longer until 2000, when the 75-year-olds plateaued and then receded, followed by the 80-year-olds in 2010 and the 85-year-olds in 2015. In contrast, the 90, 95, and 100-year-olds continued to increase. You might be inclined to think that the 75 to 85-year-olds just shifted to the 90+ groups, and that would be nice, but unfortunately, the numbers don’t add up. ?

The US population falls into three groups: those living longer, those stalled, and, for the first time in modern history, those dying younger. A few are truly living longer. The rate of people living to 100 is 10.6 times higher than in 1950, and that’s got nothing to do with Boomers – this is rate, not headcounts. Similarly, there is a 12.0 times higher rate of people living to age 95. Today, there’s a 7.2% chance of living to age 90, a 4.7% chance of living to age 95, and a 0.7% chance of reaching 100.

These are examples of objective data, but if I asked you about your plan to support living your best life longer, you’d no doubt respond with a mix of subjective and non-specific metrics. Even most health-conscious people struggle to point to objective metrics beyond steps per day and exercise minutes per week. Keeping up with the Jones is how we tend to measure our health. That would be great if the Jones were all doing well, but the bar we’re measuring against is in steady decline relative to the global standard. If our health were our business, most of us would be surprised to learn that we aren’t doing nearly as well as we thought, mainly due to our tendency for subjective metrics when it comes to our health. Most will be confronted with the “closed for business” reality at some point, but likely far too late to have much impact on the outcomes.

In every crisis, there hides opportunity. Over sixty countries have surpassed the US in life expectancy, and there is a growing rate of Americans living past the age of 90. Others have discovered something, and we know it’s not genetics. It’s primarily epigenetics – the software that controls our genes. Our epigenome is highly responsive to both positive and negative influences and is the major determinant of our healthspan and lifespan. Some of my peers will want to point to the social determinants of health, but those are weak associations. Why? Because they are subjective measures and not causal.

Thankfully, there is no need to understand anything about genetics or epigenetics to begin setting a trajectory for living better now and living longer later. The first “what to do” is to start looking for objective metrics and stop comparing yourself to your peers. We can’t all be doing “well” when it’s clear we’ve been in a decades-long health recession. Think lemmings headed for the cliff. Don’t be a lemming.

It's the elements of lifestyle medicine and MEDAC that are best known and documented to bend the opportunity curve in your favor. They are devoid of gimmicks, quick fixes, and quacks, and instead based on studying millions of human outcomes over history. As exciting as the blue zones are to many people, those small populations are a drop in the bucket compared to what is known and practiced the world over. There are over 100,000 centenarians in the US today and over 60 communities with life expectancies over 90. Beyond age 95, longevity genes come into play, but far more of us could live much longer, healthier, and more fulfilled lives by trading subjective comparisons for objective measurements.

“I think I’m on the 90-curve, but my financial planner has me living to 95 to ensure I/we don’t run out of money.” That implies outliving 80% of your age peers, or in gambling terms, beating 1:4 odds. Keeping up with the Jones doesn’t get you there, even after removing society’s socioeconomically disadvantaged, smokers, and obese. It only nudges you above the median life expectancy of 78.8 but is still a decade short of your natural potential. The opportunity is even higher for those who will discover they have a few longevity genes.

Look once more at the chart at the age 95 and 100 curves. Human genetics haven’t changed, and they are living in a more toxic environment than those in the 1950s. Modern medicine has no doubt benefited some, but longevity is associated with less medical intervention, not more, leaving lifestyle at the top of the list of longevity causality.

Lifestyle, of course, isn’t one thing. It’s many things, and it’s personal. For all of us, it is grounded in a foundation of Mind, Environment, Diet, Activity, and Exercise (MEDAC), upon which we can build a framework that aligns with our culture and personal preferences. Objective measures of our foundations and our current framework quickly begin to raise opportunities for bending our healthspan and lifespan curve to where it should be naturally. I say naturally because it isn’t about hacks and cheating death. It’s far more about trading tiny habits that silently work together to steal years for new tiny habits that we know support longer, healthy, active living. It’s the basis for the WHEALTHSPAN philosophy and can-do approach to building toward a life filled with opportunities as we age instead of decades of loss.

What’s the one thing we could all do? Stop kidding ourselves with subjective comparisons and start choosing objective measures that lead us to the life we aspire to.

Scott Fulton is the author of WHEALTHSPAN and teaches Lifestyle Medicine and Aging at the University of Virginia and the University of Delaware, and is invited to teach concurrently at 50 colleges and universities in 2025.