We can replace a hip, restart a heart and read a tumour's genes. So why are we still getting sicker?
It's a fair question, and it deserves a better answer than "people should eat more vegetables". The honest answer is that we are comparing two different things. Modern medicine is astonishing at what it was built for, and most of what is wearing us down was never its job.
So before the five steps, let's look at what the numbers say. It changes which of those steps you'll take seriously.
Are we sicker?
In 2018, more than half of American adults, 51.8%, had at least one of ten diagnosed chronic conditions, among them high blood pressure, arthritis, diabetes and heart disease. More than a quarter, 27.2%, had two or more.
Be fair about that number. We live longer now, and old age brings these conditions with it. We also test more, and a diagnosis has to be found before it can be counted. So "sicker" is partly a side effect of getting a lot right.
What doesn't flatter us is how the extra years are spent. The Harsh Truth About Aging: Decline or Longevity?, linked below, puts it plainly: on average, about nine years of life go by in poor health, around a fifth of the total. We have added years to the end, and many of them aren't good ones.
What medicine did, and what it didn't
Medicine deserves its due. When researchers added up the proven effects of medical care on American life expectancy across the 20th century, treatment by treatment, they arrived at roughly five years, with perhaps two more within reach. Those authors also stress the vast amount of pain and disability that care relieves without adding a single day. If you are having a heart attack, you don't want a walk in the woods.
Five years is a great deal. But the average American lifespan rose by more than 30 years over that century, and about 25 of those are credited to public health, the plain work of keeping people from falling ill in the first place.
In 1900 infections led the American list of killers: influenza and pneumonia, tuberculosis, and infections of the gut. Cancer was down around eighth. Heart disease has now held first place for many decades. Medicine was built to fight an enemy that came from outside you, and it won a lot of those fights. What replaced them grows slowly, from the inside, over decades of ordinary days.
The same story shows up when you look past the death certificate. Heart disease is what gets written down. In 2004 a team from the US Centers for Disease Control and Prevention asked what was behind those deaths, and for the year 2000 they arrived at three leading causes. Tobacco came first, at 18.1% of all American deaths. Poor diet and physical inactivity came next at 15.2%, and alcohol third at 3.5%.
A later and much-repeated estimate put behaviour at about 40% of premature deaths and shortfalls in medical care at about 10%. Reviewers later called the method behind those numbers obscure and tried four others. Medical care came out anywhere from 0% to 17%, and behaviour from 16% to 65%, which is a wide range, but they settled on about 10% for care. The direction is what counts. A pill arrives after the decades of daily decisions, and it can't undo them all.
The hearts that show it
There is a way to see what a different life does, and it is a CT scanner carried into the Bolivian Amazon.
The Tsimane live by hunting, gathering, fishing and farming. In a study of 705 adults aged 40 and over, 85% had no calcium in their coronary arteries at all, and only 3% had a high score. Among those over 75, 65% still had none. Infections are a heavy burden there, and they aren't short of inflammation. Yet those arteries are the cleanest ever measured in any population. There isn't a standing desk among them.
Don't read that as a diet tip. What their plates lack matters as much as what is on them, and 8 Smart Ways to Fight Cognitive Decline with Food has how much of their food is starch, and why that isn't keto. They also spend the whole day on their feet. It is the whole life that does it, and no one has a trial of that. But it does tell you what arteries can look like when they're left alone.
Moving country shows the same thing from another side. Among men of Japanese ancestry, heart disease was lowest in Japan, higher in Hawaii and highest in California. California has many advantages. Apparently not this one.
In a study of 3,809 Japanese Americans in California, those who kept most closely to a traditional Japanese way of life had heart disease as low as in Japan, and the most Westernised had three to five times as much. The usual risk factors didn't explain the difference, so diet and smoking aren't the whole of it. How you live with other people may count as well.
Then there is Cuba. An economic crisis in the mid-1990s left the whole country eating less and moving more, and the average person lost 5.5 kilograms. Diabetes and heart disease fell rapidly. When the crisis passed and the weight came back, diabetes prevalence more than doubled, and diabetes deaths rose by 49% between 2002 and 2010. That's a link across a whole country and no recommendation for an economic crisis, but it shows how quickly these diseases can answer.
How much of it is up to you
Here is the part medicine can't do for you. Your Genes Aren't Your Destiny, linked below, has the 23,153 Germans followed for about eight years: those with four plain habits in place went on to have 78% less chronic disease than those with none. Redefining Aging: What We Can Learn from the World's Longest-Lived People has the American version, where five low-risk habits at 50 went with about 14 more years of life for women and 12 for men.
It also shortens the bad years. When 1,741 university alumni were followed from 1962, those with higher risks from smoking, weight and lack of exercise had twice the lifetime disability of those with lower risks. In the low-risk group, disability arrived more than five years later. Better habits didn't just add years. They pushed the illness into fewer of them at the end.
Those are links, and healthier people find habits easier. But they're big enough to act on, and you don't need to change everything to get on the right side of them. If you smoke, that comes before all five. It sat at the top of that list of causes, and no step below will outweigh it.
And if you're thinking it's too late, The Harsh Truth About Aging has strength returning even at 96.
Find out where you stand first. High blood pressure and rising blood sugar usually give no warning, and both are cheap to measure. A number in your hand beats a feeling that you're probably fine.
So here are the five.
1. Eat food
The old saying "you are what you eat" holds up better than most old sayings. So much of the modern diet comes in a packet, with sugar and refined starch where the nourishment used to be.
Build the plate on meat, fish and eggs, and let the rest be real food cooked by someone you know. Why Eating Well Isn't Enough Anymore has what the body can't get from plants. Benjamin Bikman's argues that one hidden problem, insulin resistance, sits behind much of it. Swap the sugary snack first, because it's the easiest to spot, and a boiled egg is a very good replacement. It also comes with no ingredients list, and a does a batch without a pan to watch.
2. Move every day
It doesn't have to be intense, and it doesn't have to be a workout. It helps if you like it, because you'll have to keep doing it for the rest of your life. Go for a walk with someone. That counts twice.
The Harsh Truth About Aging has the tests worth taking: your grip, your walking pace, and how long you can stand on one leg. Do that one near a wall. A is a cheap way to work on the first. Take them now, and see where you stand.
3. Put the phone down
Screens crowd out people, sleep and quiet, in that order. Eye-Opening Benefits of Unplugging: How Taking Breaks from Screens Can Transform Your Life has what the best test found, and why the time you win back matters more than the break itself.
Use that time for the people you love. Keep a phone-free hour at the end of the day, and spend it with someone in the room.
4. Sleep
Sleep is when the body does its repairs, and without it the diet and the walking both work less well. How Chronic Sleep Deprivation Affects Your Brain has the hard part: you can't feel how much you're losing.
Keep the same bedtime and the same alarm all week, weekends included. Keep the bedroom dark and cool. Stop the caffeine, and leave the heavy meal for earlier.
5. Get outside
The Invisible War Inside Your Body (And How to Win It) has the 36 city dwellers sent out to a place that felt natural, whose cortisol dropped by about 21% an hour more than the time of day explains. The best return came at twenty to thirty minutes. You don't need a mountain. A park will do, and so will a garden.
Morning is the best time for it, because the light sets your clock too, which helps with step four.
Progress, not perfection
Medicine is there for the day you need it, and be grateful for it. Everything before that day is yours. Progress is more important than perfection, and a tomorrow is built from a lot of ordinary todays.
You will miss days. How to Rewire Your Brain and Change Limiting Beliefs has the test: it took about 66 days for a new habit to turn automatic, with a huge range, and one missed day barely mattered.
As for which one first, take the one you'll actually do. The best step is the one that's still there next month.
It also helps not to go alone. 10 Powerful Tips for Choosing the Right People to Surround Yourself With has the 3,722 couples: when one partner had just quit smoking, 48% of the men and 50% of the women quit too, against 8% of those whose partner carried on. Getting more active spread the same way.
If you are already being treated for something, none of this replaces that treatment. Talk to a qualified health professional before changing anything prescribed, and do the five alongside it.
Tonight, pick one of the five, and decide exactly when you'll do it tomorrow.
Blaming your parents? Your Genes Aren't Your Destiny: How Much of Your Health Is Up to You — what a gene score measures, genes against habits, and whether it can be turned back.
Want the years at the end to be good ones? The Harsh Truth About Aging: Decline or Longevity? — your grip, your walking pace, standing on one leg, getting up from the floor, and why it's never too late to start.
Know someone who says the pills have it covered? Send them this, and take them for a walk.
Disclaimer: This article is general information. For advice about your own health, talk to a qualified health professional.
Affiliate Disclosure: This article contains affiliate links. As an Amazon Associate, All For Life earns from qualifying purchases, at no extra cost to you. We only link to products we would recommend without the commission.
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