Mind the gap. Healthspan-Lifespan and how to extend the good years
By: Dr. James Aw, Chief Medical Officer, OMERS
June 15, 2026
Younger people are getting cancer. Men die earlier than women. Chronic diseases are on the rise, and living longer doesn’t always mean living well. Can we close these gaps and extend the healthy years?
The average life span gap between men and women is around six years in the western world. In the USA (2023) male life expectancy is around 76 years old compared to 82 for women, and while life expectancy in Canada is nearly back to pre-pandemic levels, men have a 63% higher risk of all-cause mortality than women for multiple factors. Men tend to engage more in harmful and risky behaviours (smoking, excessive alcohol, poor diets, accidents, drug-related mortality) and are less likely to see their doctors for preventive care and routine visits. Men have a higher disease burden than women from heart disease, diabetes, liver disease and non-reproductive cancers. Women have biological advantages for longevity through their estrogen hormones (antioxidant, anti-inflammatory, heart protective), stronger immune systems and longer telomere lengths (improved cellular longevity and reduced age-related diseases).
Healthspancan be defined as the healthy years free from major chronic disease and functional decline. These are the healthy years of optimal mental and physical functioning. Lifespan is the chronological years from birth to death.
The Healthspan-Lifespan gap is widening
The Healthspan-Lifespan gap (years lived with disease or disability) is rising. A study of 183 WHO member states found an increase of 13% of years lived with disease or disability between 2000 and 2019 and the United States has the largest Healthspan-Lifespan gap (12 years). Women live longer than men, but they have more years in poor health. Non-communicable chronic diseases include cardiovascular disease, cancer, diabetes, lung disease and mental health. Younger people are getting cancer earlier in life because of worsening obesity trends, poor lifestyle habits and environmental factors. For the elderly, advances in medical science have prolonged lifespan, but the quality of life is not necessarily improving. Dementia, risk of falls and lack of social support negatively impact happiness, life satisfaction and the ability to live independently.
In a perfect world, we would want to compress morbidity (years with disease) by extending our health span (active and productive years) in addition to longevity (living a long life). Longevity is a big business these days, with lots of exaggerated health claims to improve wellness. But what actually works?
Which interventions have the most human evidence to improve the Healthspan-Lifespan gap?
Lifestyle interventions with the most human evidence include exercise, caloric restriction (weight management) and combining regular healthy behaviours (moderate physical activity, Mediterranean diet, avoiding risky substances like alcohol and tobacco). Exercise that combines aerobics, resistance, balance and flexibility training improve functional capacity, resilience, disease-free years and extends lifespan (decrease all-cause mortality by 30-35%). Women particularly benefit from resistance training to lower overall mortality. Caloric restriction has been shown to slow the pace of biological aging by improving biomarkers of immune function, muscle quality and cardiovascular risk.
Seven hours of sleep nightly predicts a longer lifespan. Too short or too long sleep has been associated with increased morbidity and mortality. One study found that severe sleep disturbances were associated with up to six fewer years of good health.
Humans are social beings. Social connectedness is associated with reduced mortality risk and extended healthspan comparable to other modifiable lifestyle risk factors like inactivity, obesity and smoking. Social isolation and loneliness have been linked with a 33% increased risk of all-cause mortality. Relationships affect the quality of years lived. Studies have also found that optimism and having a higher sense of purpose were associated with lower overall mortality and decreased future cardiovascular risk.
Certain prescribed medications have been shown in human trials to improve lifespan. GLP-1 receptor agonists (semaglutide, tirzepatide) protect multiple organs via weight loss (15-18%). SGLT2 inhibitors (empagliflozin, canagliflozin, dapaglifozin) can reduce cardiovascular death, heart failure, chronic kidney disease and all-cause mortality in diabetics and non-diabetics. Metformin has been shown in observational studies to reduce all-cause mortality, cancer and dementia in diabetics. More well-designed studies on whether metformin can reduce aging effects in non-diabetics are coming (TAME – targeting aging with metformin trial).
For women, menopausal hormone replacement therapy initiated near menopause onset (ages 50-59) has been associated with a 30% reduction in all-cause mortality, decreased fracture risk and improved quality of life. Women with premature menopause also benefit from hormone replacement before age 50.
Sauna bathing for frequent users (four to seven times weekly) has been shown in observational Finnish studies to lower sudden cardiac death, cardiovascular deaths and lower all-cause mortality.
Which interventions have moderate evidence?
Intermittent fasting and time-restricted eating can improve healthspan through weight loss (3-5%) and improve metabolic lab work (HbA1C and lipid levels). It is unclear if long-term effects on lifespan are from caloric restriction or timing of meal periods.
Animal (mice) studies have shown that rapamycin and senoloytics (dasatinib + quercetin, fisetin) supplements lead to increased lifespan in mice, but there is no human healthspan or longevity data (yet).
Which interventions have weak evidence?
Human studies are limited and mixed on NAD+ boosters (NR, NMN), resveratrol supplements and telomere lengthening supplements (TA-65, astragalus extracts). There have been reported safety concerns for the kidneys with chronic resveratrol use.
Hyperbaric oxygen therapy has been linked to increasing telomere length in small studies and cold-water plunging and cryotherapy health effects (mitochondrial function) are temporary.
Which interventions have no human evidence for the Healthspan-Lifespan gap?
Longevity clinics are promoting peptides (BPC-157, TB-500, epitalon, CJC-1295/ipamorelin) based on preclinical data on tissue repair and neuroprotection in animal studies, but no human trials on long term efficacy or safety have been done. Growth hormone for anti-aging is also based on mice studies and professional medical associations do not support the use of these hormones for anti-aging. Testosterone replacement therapy is only recommended for symptomatic men with low levels, but it is not useful as an anti-aging intervention.
So, how can we close the health gap?
Start healthy habits early and be consistent. Regular physical, mental and social fitness routines will extend the healthspan of your future self. Avoid risky behaviours (tobacco, excessive alcohol), eat nutritious meals, sleep well, stay physically active and get regular health assessments and screening with your physician. Older adults should focus on maintaining brain health, balance/mobility and social networks. Don’t chase shiny objects (latest trends) and fact check the “experts” (social influencers), but stay curious, open-minded and have fun with others. Always think ahead (lifespan) but live in the moment (healthspan)!
For those who want to read more!
Biological Versus Chronological Aging: JACC Focus Seminar | JACC
Cardiovascular Aging and Longevity: JACC State-of-the-Art Review | JACC
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