“Health is a crown, worn by those who are well, and only seen by those who are sick.”
Although the attribution of this quote is unknown, there is a felt sense of understanding when we read it.
A feeling that each of us yearns to retain our crown of health for as long as is possible. Yet, when we try to define health, it seems to slip through our fingers like sand.
Why we wish for health can be thought of as our desire to live long lives, free of illness, with our cognition and ability to move intact. And with this high-quality time, to spend it doing that which adds the greatest sense of purpose and meaning to our lives.
Health therefore, becomes our quest to optimise the variables of lifespan, health span and soul span: the length of your life, the quality of your mind and body and the purpose you devote that time and body to.
As simple as it may sound, to live a long life you must try to avoid the things that are likely to lead to your death.
The key word here is ‘likely.’
It is ‘possible’ you could die from a meteor impact; it is just highly ‘unlikely’.
So, what then is likely to be the cause of your death?
Three things: heart disease, cancer or dementia.
There are of course many other things that could be your cause of death, but these are just the most likely. Furthermore, not all cases of these conditions are preventable, but many are.
Surprisingly, that is not exactly the right question to ask.
If you aspire to be a healthy 100-year-old, you must ask how did they die?
They don’t die from skydiving accidents or on their last ascent of K2. They generally die from the same things as everyone else does: heart disease, cancer or dementia.
The important point is that they get these conditions about 20 to 25 years later than everyone else.
The priority then becomes less about preventing these conditions indefinitely but more about delaying the onset of these conditions for as long as is possible.
What causes these conditions? Risk factors.
Specifically: high blood pressure, smoking, high blood sugars, high cholesterol and obesity. Yes, there are others, but these tend to have the greatest impact. Again, think probabilities.
Living longer then becomes more about avoiding and managing risk factors, as opposed to treating the chronic medical conditions of heart disease, cancer or dementia.
When it comes to heart disease most people understand this logic but what most people don’t realise is that obesity is related to 13 different types of cancer and is considered the second leading cause of preventable cancers. Smoking remains the biggest cause of preventable cancers.
How can you best address these risk factors and live a longer life?
If by age 50, you are a non-smoker, normal weight, moderately active, consuming modest amounts of alcohol and eating a quality diet you can add 12 to 14 years to your life.
As a percentage of your life, that is an exceptionally long period of time.
A common critique of the goal of living longer is that some people feel they would rather not if their quality of mind and body were to fail them first.
This assumes, however, that extending lifespan is always at the cost of reducing health span. We have all seen heart-breaking examples of this play out in our lives.
This tends to occur more often when we attempt to extend lifespan by more aggressively treating the medical conditions that are likely to lead to our death.
Once again, we must remember that the primary goal here is to delay the onset of any preventable medical conditions and to do this, we must focus on the risk factors for these conditions, not the medical conditions themselves.
When approached this way we ensure our bodies are as robust as they can be for as long as possible.
We engage in daily activity not just to manage our risk factors but also to ensure we can lift our grandchildren in the air when the time comes and to retain the cognitive capacity to engage with them in the way we would hope to do so.
It bears drawing attention to the fact that the risk factors for dementia are largely the same as those for heart disease. So, if retaining cognitive capacity is a priority, the pathway to this goal is mostly the same as it is for heart disease and potentially for many cancers.
The key takeaway is that extending lifespan and health span need not be traded off against one another. It is eminently possible to have both a longer and a healthier life.
A longer life, of sound body and mind, is simply a platform to pursue what is meaningful in life.
The degree to which a person lives a life of meaning is what might be referred to as ‘soul span’ or a person’s ‘why’.
There is no doubt that to do what is necessary to increase the likelihood of a long and healthy life is challenging but it is at least a relatively defined pathway.
The ‘why’, however, is something only each of us can answer. This ‘why’ is the reason we desire longer, healthier lives.
The key to a longer, healthier life then must always begin with the quest for one’s ‘why’.
While no blood test or scan can identify this for us, it should be the question we always seek to answer. And how we go about this is indeed the great work of our lives.
So, what is health?
Although no answer is perfect, it can be helpfully thought of as the optimisation of three parts: lifespan, health span and soul span.
For the first two of these variables there exists a relatively predictable approach to increase the probabilities of success. For the last of these, soul span, the key is unlikely to be found in a medical textbook but rather in a great piece of literature or art, the smile of your child or the brilliance of a sunset.
So, if you wish to wear the crown of health, thinking of these three components is a good place to start.
Dr Paddy Barrett is a preventive cardiologist at Blackrock Clinic, in Co Dublin. His work is focused on cardiovascular-disease prevention and medical-technology innovation