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The health span: life span gap

This is an excerpt from Prescribing Movement as Medicine by Kevin Carr.

When longevity is discussed, the focus often is on life span: the total number of years from birth to death. By that measure, the story looks good. Over the past century, people have added decades to the average life through cleaner living conditions, safer food and water, improved sanitation, vaccines, antibiotics, and emergency medicine. Thanks largely to medical advances over the past century, global life expectancy has reached 71.4 years (68.9 for men, 74 for women). In the United States, the averages are even higher: 73.7 years for men and 79.1 for women (World Health Organization, 2024a).

These are remarkable achievements. A child born today is far less likely to die from pneumonia, influenza, or a contaminated water supply than at any other time in human history. If someone is injured in a car accident or suffers a heart attack, emergency medicine can stabilize and save them in ways that were impossible just a few generations ago. By nearly every measure, modern medicine has been extraordinarily successful at extending life.

But life span alone does not tell the whole story. The more important and often overlooked measure is health span: the number of years lived in good health, free from chronic disease and disability. By this metric, people are failing. While people are living longer, they are not necessarily living better.

This contrast is especially stark in the United States, which has the largest health span–life span gap in the world. On average, Americans spend 12.4 years—nearly 30 percent more than the global average—living with chronic disease, pain, and dependence (Garmany and Terzic, 2024). Much of that gap is bridged not by improving underlying health, but by medications that manage symptoms rather than address root causes. The U.S. healthcare system has excelled at extending life span, but it has fallen short in helping people live healthier lives. Figure 1.1 demonstrates the gap between health span and life span.

In the United States, 68 percent of adults take at least one prescription drug daily, and 26 percent take four or more (CivicScience, 2024). Many of these medications are essential and even lifesaving, stabilizing heart conditions, controlling infections, or easing severe pain. But the majority are prescribed for lifestyle-related conditions such as high blood pressure, high cholesterol, type 2 diabetes, chronic pain, and depression (Fuentes et al, 2018; Safer, 2019).

These conditions are largely driven by how people live via their diets, activity levels, sleep, and stress. In many cases, they can be prevented, improved, or even reversed through consistent exercise, better nutrition, and healthier daily habits. Yet instead of addressing the underlying behavioral and lifestyle drivers, the modern healthcare system leans heavily on pharmaceuticals to manage symptoms.

This dependence comes at a cost. The widespread use of multiple medications, known as polypharmacy, increases the risk of dangerous interactions, side effects, addiction, and ballooning health care costs (Maher et al., 2014). As chronic diseases accumulate, many individuals are prescribed multiple medications to manage symptoms, creating a cycle in which treatment focuses on controlling disease rather than preventing it or reversing it.

Medication will always be a critical part of health care, but the potential to reduce people’s dependence is immense. With the right lifestyle interventions, many of the most commonly prescribed drugs could be delayed, reduced, or avoided altogether.

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