These places show how to have a longer and healthier life expectancy

Life expectancy in the US in 2022 has rebounded from pandemic lows, but remains solidly, and disconcertingly, below pre-pandemic levels. It is part of a longer-term trend in the US where life expectancy hit a peak in 2013 and has levelled off – and even declined slightly – since.

Most people pay only casual attention to life expectancy figures, but life expectancy is an important, albeit imperfect, measure of human flourishing. We may take it for granted now but, for almost all of human history, life for most people was astonishingly brief.

As recently as the late 1700s, life expectancy in England, certainly among the most advanced countries in the world at the time, was only in the mid-30s. The advancements of the 20th century and early 21st century, when more years were added to human life than in all of recorded human history before, stand among the most astonishing and valuable accomplishments of modern times.

It is tempting to think of the stagnation and decline in life expectancy as a uniquely American problem, and to a certain extent, that is true. Countries like Norway, South Korea and Ireland barely saw any decline in life expectancy during the pandemic; other countries like Singapore, Spain and Japan have seen extraordinary advances in life expectancy even as numbers in the US have stagnated.

But in a larger sense, the whole world does have a life expectancy problem: the years of Healthy Life Expectancy (HALE) as measured by the World Health Organization (WHO) have not kept pace with advances in total life expectancy, meaning that we are living both more years and more years in poor health.

Advances in human longevity and in healthy life span raise the potential for a stable and successful longevity economy, a notion spelled out in a new report from the World Economic Forum, Longevity Economy Principles: The Foundation for a Financially Resilient Future.

The opportunities for that longevity economy are threatened by lags in healthy longevity, which are particularly acute among poorer and underserved communities.

Since long life is a relatively new development, it is not surprising that we are not particularly good as a society in thinking about how to maximize it for all. In the 20th century, success in human longevity was largely the result of medical advancements with a great deal attributable to the decline in infant and maternal mortality.

We have thus tended to view healthcare as the critical variable in determining healthy life expectancy going forward. But while no one should minimize the importance of healthcare for all, other factors are determining healthy longevity outcomes today.

In the 21st century, the challenges of equitable longevity relate more to economic inequality, access to education and lifelong learning, the availability of social connection and how to keep an ageing population active, engaged and supported.

For the last year, the Century Lives podcast from the Stanford Center on Longevity has reported on communities in the US that overperform in terms of life expectancy and healthy ageing. The communities we visited are quite different from each other in geography and demographic makeup, but they share a common DNA: they all provide stability, human connection and social support across the life course.

Presidio County in Texas, for instance, is one of the poorest areas in Texas, but also one of the 10 longest-living counties in the entire nation. It’s a huge statistical outlier, but its success is not a mystery: it’s the result of strong family networks and multigenerational living that provides social support, connection and purpose for young and old alike. The fact that Presidio is 75 miles from the nearest US hospital has not hindered its remarkable health.

In an urban setting, Co-op City in the Bronx has vastly outperformed similarly situated neighbourhoods around New York City. The community, built as one of the largest workforce housing complexes in the country, has provided safe, affordable housing for almost half a century to middle-income families in an increasingly expensive metropolitan environment.

The result of this exercise in affordable housing has been economic security, the creation of strong social networks and stable lives – all of which have translated into longer, healthier lives in the largest naturally occurring retirement community in North America.

In truth, most places, not just the US, lack a coherent public policy effort to ensure that longer lives are purposeful and connected, and thereby healthy. Most fail to maximize the value that older adults can provide in the second half of life. It is a critical issue, perhaps even an existential one, that in an era of longer life and declining birth rates, we ensure that older adults have the opportunity to be both healthy and productive.

Fortunately, there are models of how we can rethink society for longer, healthier lives.

Singapore has focused on this question for some time and has invested heavily, for instance, in making inter-generational housing the norm and in creating lifelong learning programmes that support both job readiness and cognitive health. The country’s Queenstown Health District project, currently under development, is perhaps the world’s most comprehensive effort to support healthy ageing.

Singapore is not alone in this effort: Barcelona has pioneered Social Superblocks that provide supportive, walkable, and connected communities. Japan has been developing more flexible approaches to late-life work, including the use of artificial intelligence to support job matching and sharing. The connective tissue of all these projects is that older adults are not seen as ageing takers in society but as integral parts of the economy and communities.

The fundamental challenge of this new era of longer life is to ensure not that we just have more years, but that we have more productive, healthy years. As Singapore, Spain and even Presidio, Texas, show, that begins with ensuring stronger communities and supporting more purposeful lives.