Today, April 7, 2018, is World Health Day, an annual occasion to raise awareness celebrated on the anniversary of WHO’s founding. The intent is to draw attention to global health issues, and this year’s theme is Universal Health Coverage and how important it is to implement it on a global scale as soon as possible.
Healthy aging was the theme for World Health Day 2012, but we would still like to avail ourselves of the opportunity to emphasize how bringing aging under comprehensive medical control is an essential milestone on the way to a world where everyone can live longer and healthier lives—one of the very goals that WHO has set itself to achieve.
A step in the right direction
In official contexts, you often hear about “healthy aging” and how its achievement is a global priority. Like WHO itself points out in its World Report on Aging and Health 2015 (WRAH), this term is rather nebulous, largely lacking consensus on how to measure healthy aging or even define it [WRAH, p. 28]. Indeed, it might strike you as a jarring contradiction in terms; aging is a chronic process of damage accumulation at a cellular and molecular level that, over time, will push one’s risk of developing chronic diseases higher and higher and will ultimately result in death [WRAH, p. 25]. It’s difficult to imagine how such a process could ever be considered “healthy”.
However, for the scope of its report, WHO defines “healthy aging” as “the process of developing and maintaining the functional ability that enables well-being in older age” [WRAH, p. 28]. In the simpler terms of a WHO infographic, healthy aging is “being able to do the things we value for as long as possible.”
It is important to keep in mind that WHO defines “functional ability” as a combination of an individual’s intrinsic physical and mental capacities and the characteristics of his or her environment—that is, all the external factors that can have an impact on the life of an individual.
Whatever name we may give it, this definition describes an ideal that LEAF fully subscribes to; the whole point of healthy life extension is to preserve your health in full for as long as possible, allowing you to have a longer life filled with the things you love doing and the people you care for. We would like to draw attention to the fact that the concept of rejuvenation is fully encompassed in WHO’s definition of healthy aging, since comprehensive rejuvenation biotechnologies, assuming they work as intended, would eliminate the problem of the ill-health of old age altogether, allowing you to maintain your functional ability and well-being in older age.
WHO doesn’t yet talk of rejuvenation in its report on healthy aging, which, it suggests, may instead be achieved by changing the way we think about aging and older people, creating age-friendly environments, aligning health systems to the needs of older people, and developing systems for long-term care. It is probably too early for WHO to consider rejuvenation therapies as a crucial factor for the attainment of the highest standard of health for every human being, and successful early clinical trials will have to be completed first.
Regardless, it is definitely wise of WHO to consider healthy aging, as the organization has defined it, and its attainment to be priorities for the future; this is because its proposed measures represent a reasonable fallback plan should the advent of rejuvenation be delayed significantly and, more importantly, because this kind of public discussion may help ease and speed up the introduction of rejuvenation therapies once they become available. It is evident from provision 105 in WHO’s global strategy and action plan on aging and health that the organization would likely be supportive of rejuvenation therapies that achieve its concept of healthy aging and that its current plans are merely a sign of prudence rather than conservatism:
Finally, better clinical research is urgently needed on the etiology of, and treatments for, the key health conditions of older age, including musculoskeletal and sensory impairments, cardiovascular disease and risk factors such as hypertension and diabetes, mental disorders, dementia and cognitive declines, cancer, and geriatric syndromes such as frailty. This must include much better consideration of the specific physiological differences of older men and women and the high likelihood that they will be experiencing multimorbidities. This could also be extended to include possible interventions to modify the underlying physiological and psychological changes associated with ageing
Same objective, same reasons
LEAF and WHO share the same intent in this matter; and the reasons behind it are also the same. First and foremost, every human being has the right to the “highest attainable standard of health”, to use the words of WHO itself [WRAH, p.14, and also the WHO constitution]. The importance that WHO places on health itself, as opposed to simply longer lifespans, is made clear given that it switched from life expectancy at birth to healthy life expectancy at birth, or HALE, to measure the success of its efforts to support overall health and prevent all kinds of disease. Taken together with the promotion of UHC, this means, among other things, that its goal is to give older people access to basic medical services that prevent, treat, and control diseases in order to extend the healthy periods of their lives. It is important to note that the WHO definition of health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Healthcare that fully accomplishes this goal would place older people on the same physical, mental, and social footing as younger people.
A stereotypical view of older people is that their outdated mindset and failing bodies relegate them to the past and make them a burden in the present; we agree with WHO that humanity must move past these ideas, though it is undeniable that the poor health that all too often accompanies old age makes it difficult for elderly people to be an active part of the present, and it arguably would do so even if our society were much more age-friendly than it is today. It is equally undeniable that ill-health is a burden on patients and their families.
As we have reiterated many times, if rejuvenation biotechnology were available, the diseases of old age wouldn’t merely be delayed or mitigated; potentially, they could be comprehensively prevented altogether in a way that current prevention methods, such as having a healthy diet and exercising, cannot. In principle, this would allow people to maintain, throughout their lives, the same health as a young adult enjoys today, which pretty much is the highest attainable standard of health. Completely fulfilling the WHO definition of health would mean that a rejuvenated elderly person would be virtually indistinguishable from a typical chronologically young person, both in terms of physical and mental prowess, weakening the reasons behind age-based discrimination.
A more flexible framing
Up until now, human life has mostly followed a rather simple scheme: a learning period spanning from early childhood to early adulthood, a working life until retirement, and finally retiring without doing, or being expected to do, much at all, except perhaps looking after any grandchildren. This view is so ingrained in the public perception that retirement age is pretty much seen as a fairly unchangeable number somewhere between sixty and seventy at best, meaning that the idea of extended longevity is often associated with an extended period of retirement and increasingly bad health. However, WHO rightfully points out [WRAH, p. 10] how this framing is rather rigid and outdated and that learning is not necessarily something that can happen only early in life. Given good-enough health, people might make different choices than they do now, picking up new courses of studies or careers much later in life, and perhaps, if we are talking about comprehensive-enough rejuvenation treatments, even starting families at presently unconventionally late ages.
The 2015 report doesn’t neglect to mention the developmental and economic benefits that would derive from the achievement of healthy aging, as WHO defined it, on a global scale [WRAH, pp. 15-17]. In this conservative scenario, elderly people are still seen as contributing members of society in terms of their help in raising future generations, financial contributions through taxes, formal or informal participation in the workforce, et cetera. Thus, from this perspective, expenses to help achieve healthy aging are not seen as costs but rather as investments that may be outweighed from deriving benefits. One must also consider that failing to promote healthy aging may eventually result in a world population that is largely composed of elderly, disease-burdened people who are unable to contribute to society in any way and whose medical expenses to modestly mitigate the effects of their conditions will not yield any tangible benefits for the rest of society.
If we consider a less conservative scenario, for example, one where rejuvenation biotechnologies are widely available and able to extend both healthspan and lifespan by a decade or two—actually making 90 the new 70—we see that society would reap the aforementioned benefits for a prolonged period of time. Imagine what the benefits would be if rejuvenation biotechnology could make 90 the new 30.
For these reasons, we believe that once a fully effective anti-aging medicine is ready to leave the lab, what drives WHO to promote healthy aging and Universal Health Coverage for everyone may also drive the organization to do the same for rejuvenation biotechnologies. In the organization’s own words in provision 37 of the General Programme of Work draft 2018,
Ensuring healthy ageing is central to universal health coverage, just as it is to the other priorities of GPW 13. The number of people over the age of 60 is expected to double by 2050 and this unprecedented demographic transition will require a radical societal response. […]
Healthy aging as defined by WHO is mainly a set of preventative measures to delay the onset of, and mitigate the effects of, age-related pathologies; the reason why this is central to the development of UHC is primarily economic. UHC would be challenging to implement if the elderly people of the future, whose number is expected to significantly grow, were to be as burdened with chronic conditions as they generally are today—conditions whose management would have to be paid for by UHC. Preventing those conditions through the promotion of healthy aging would thus ease the financial burden on the system. As rejuvenation biotechnology would be a far more effective and comprehensive form of prevention, it would make more sense for UHC to cover rejuvenation treatments rather than palliative care and therapies that manage chronic conditions.
WHO’s director-general has said, “No one should have to choose between death and financial hardship. No one should have to choose between buying medicine and buying food.” That is, in a nutshell, the rationale behind Universal Health Coverage and one we wholeheartedly agree with. “Access to essential quality care and financial protection not only enhances people’s health and life expectancy,” reports WHO on its website, “it also protects countries from epidemics, reduces poverty and the risk of hunger, creates jobs, drives economic growth and enhances gender equality.”
We are convinced that the defeat of aging through medical intervention will bring similar benefits, and to paraphrase the director-general, we think that no one should have to choose between age-related death and financial hardship. This is why we hope that one day, rejuvenation treatments will be part of the Universal Health Coverage of the future; for now, we will keep pushing to get research groups the funds they need to make this technology happen.