Improving human – and planetary – healthspan

Modern medicines have an important role in the survival of people with chronic diseases, but less so in improving healthspan – as well as having environmental, social and financial consequences.

Until the middle of the last century, a doctor was consulted only upon infliction with a specific disorder, and knowledge regarding the cause of the disease, the means of transmission or the means of prevention was sketchy at best and a flight of fantasy at worst. Extraordinary advances in public health and medicine have increased life expectancy as well as knowledge on a wide range of diseases, but the outlook is not all rosy for improving healthspan – prolonged life is accompanied by the incidence of chronic diseases.

Global warming, degradation of the environment, rising pollution, lifestyle- and age-related chronic diseases as well as emerging diseases are harming human lives at a large scale. Studies have reported that more than 65% of individuals who are above 65 years of age have two or more chronic diseases, but the current medical approaches in the US along with several affluent countries to treat chronic diseases, rather than ploughing more funding into prevention, are highly impacting global environmental development and planetary health. In short, they are not efficient, viable or equitable. Similar problems are now being observed in low-income countries as well, increasing poverty and inequalities.

Longevity.Technology: This is the view of Fontana et al who argue in PLoS Med in favour of transdisciplinary research and clinical priorities for better health – a focus on prevention, rather than “finding new molecular targets for the development of biotech and pharmaceutical products” [1]. The authors hold that very little is invested in mechanism-based preventive science, medicine and education and that “overly enthusiastic expectations” regarding the benefits of pharma research for disease treatment could impact and distort not only medical research and practice but also environmental health and sustainable economic growth.

They argue: “Transitioning from a primarily disease-centered medical system to a balanced preventive and personalized treatment healthcare system is key to reduce social disparities in health and achieve financially sustainable, universal health coverage for all [1].”

Modern medicines enable people to live longer but not healthier lives. In addition, they have been reported to have major financial, environmental and social consequences. Several epidemiological, pre-clinical and clinical trial data have indicated that most chronic diseases can be prevented with nutritional and lifestyle changes, so the move to a personalised, preventative approach will improve the healthspan and longevity of individuals.

Studies have reported that the incidence of cardiovascular disease (CVD) and obesity-related cancer has been increasing in recent birth cohorts. However, according to WHO, at least 80% of CVD and diabetes and 40% of cancers are preventable. Studies with rodents and monkeys have shown that optimal nutrient intake protects against cancer, CVD, diabetes, obesity, frailty and brain aging. These adaptations in humans can protect against the mentioned diseases along with liver and kidney diseases. Additionally, avoidance of smoking and excessive alcohol consumption, cognitive training, improving sleep duration and quality, and reducing stress can help in the improvement of physiological characteristics.

The epigenetic theory of disease can be a reason why the current medical approach receives little success [1]. The preconception parental environmental factors which include fitness, diet, metabolic health and mental health can impact the risk of chronic disease in children as well as influence epigenetic heritage. Studies have suggested that the first 1000 days of life shaped by maternal diet can influence the health trajectory of the newborns for their entire life. However, the chances of curing non-communicable diseases that begin early in life are low since interventions by clinical medicines occur at a later stage.

Although medical sciences have been quite effective in treating morbid conditions, they are responsible for 3% to 10% of CO2 emissions. Moreover, 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 can raise serious concerns for human and environmental health.

Furthermore, the globalisation of agriculture has led to soil erosion and degradation, deforestation, groundwater depletion and the release of toxic materials from chemical fertilisers. Nitrogen fertilisers and livestock emissions are reported to bring about the emission of about 15% of greenhouse gas and 20% to 30% of PM10 and PM2.5. Also, the production of high-density poultry and pigs can lead to the development of new viral strains with zoonotic as well as antibiotic-resistant bacteria [1]. Although these are capable of harming human health, the involvement of the medical community in mitigation efforts is found to be limited.

Even though healthier lifestyles and food changes are considered to have an impact on the prevention of chronic diseases, little research and no unifying framework exist to transform the concepts into a theoretical or operational body. The current Coronavirus Disease 2019 (COVID-19) pandemic has also highlighted not only infection control, but also the health of the people in general.

Therefore, the first focus must be the prevention of a disease, the second must be control of the disease, and the third should be improving the longevity and well-being of individuals. Integration of health literacy to education is considered key since it can shape health and well-being across the lives of people. Schools and universities must not only focus on mechanistic knowledge but also practical skills on the mechanisms and interventions that link diet and other lifestyles 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.