Take home messages

Introduction

Life begins at birth and ends with death, but our actions can significantly influence the length and quality of our lives. Fatalism suggests that life and death are predetermined events. However, health research has contradicted this deterministic view by demonstrating the influence of lifestyle behaviours on disease incidence and mortality. It highlights the power of personal agency in shaping our life trajectories. By consciously modifying our behaviours, we can actively contribute to our health outcomes. Certain factors, such as genetics or unforeseen events like accidents and natural disasters, lie outside our sphere of influence. However, lifestyle factors, including dietary habits, physical activity, and stress management, play a pivotal role in determining our overall well-being and longevity.

Definitions of Lifespan, Healthspan, Aging, Age Acceleration and Related Terminology

The term "lifespan" or life expectancy denotes the entire duration of our existence, from the beginning to the end. "Healthspan," also referred to as disease-free life expectancy, active lifespan, functional lifespan, healthy aging period, non-disabled life expectancy, or quality life years, signifies the portion of our lives spent in robust health, devoid of chronic diseases or disabilities. Healthspan emphasises not just the length of our lives, but the quality and vitality of the years lived.

Aging is intrinsic to all living organisms and comprise complex biological process. Age acceleration refers to a situation where the biological age is advancing at a faster rate than their chronological age. Biological aging is ultimately characterised by the gradual decline in physiological functions, leading to a decreased ability to respond to stress, increased homeostatic imbalance, frailty and a higher disease risk. Aging manifests itself not only biologically but also through psychological and social changes, impacting an individual's health, functionality, and overall quality of life.

Global Trends in Life Expectancy: A Comparative Analysis of Singapore, the United States, South Africa, and Blue Zones

Different geographical regions display varying trends in life expectancy, each influenced by unique health challenges and policy responses. Singapore's life expectancy has increased, a testament to its efficient healthcare system, strong public health policies, and high living standards. In contrast, the U.S. faces a decline in life expectancy, largely due to lifestyle-related health problems, and specific crises like the opioid epidemic. Meanwhile, South Africa has seen fluctuations in life expectancy, with recent improvements primarily driven by enhanced management of HIV/AIDS, despite ongoing challenges in healthcare access and socioeconomic disparities.

This brings us to the intriguing concept of 'Blue Zones' – regions originally identified for their unusually high numbers of centenarians and marked with blue ink on maps by researchers Gianni Pes and Michel Poulain later popularised by Dan Buettner and National Geographic. Notably, Blue Zones surpass the already elevated life expectancies generally observed at the national level and include Okinawa (Japan), Sardinia (Italy), Loma Linda (California), Nicoya Peninsula (Costa Rica), and Ikaria (Greece). These 'Blue Zones' are distinguished not only by their longevity but also demonstrate the powerful role of diet, physical activity, and social engagement among the superagers.

Life Expectancy by Country

Note: approximated life expectancies, figures can vary over time due to various factors.

Understanding Risk, Causes and Protective Factors in Morbidity and Mortality

"Exposures" refer to factors or conditions that individuals or populations are subjected to. Epidemiological studies often investigate these exposures to uncover their associations with specific health outcomes to determine whether these exposures are related to risk, causal, or protective. Risk markers, indicative characteristics statistically associated with specific health outcomes but not necessarily causal, provide insight into potential vulnerabilities. Meanwhile, risk factors, elucidate conditions and behaviours directly linked to the onset of disease. Risk factors are broadly categorised as modifiable and non-modifiable. Modifiable risk factors, such as dietary choices or smoking habits, lie within our sphere of influence. In contrast, unmodifiable risk factors encompass aspects like age, gender, or genetic makeup that remain static. While there are pioneering attempts at modifying these, like gene-therapy, they currently come with a significant price tag with substantial risk without any guaranteed success. In contrast, protective factors offer glimpses into the resilience and fortitude that can safeguard against unwanted outcomes. We frequently encounter diverse causality patterns. In monogenic diseases, we observe direct and clear-cut cause-effect with an alteration in a single gene determining disease onset. While in multifactorial or complex diseases including non-communicable diseases such as diabetes, cardiovascular ailments, asthma, and kidney disorders there is an intricate interplay between our inherited risks and the environment around us. The latter group of diseases heavily features among the top leading causes of death in the world.

Top Causes of Mortality and Behavioural Modification

The top causes of morbidity (illness) and mortality (death) often overlap but are not always identical and fluctuate across countries and over time. Cardiovascular conditions as well as cancer, are common in both, as they are both highly fatal and can cause long-term illness. Some conditions, like mental health disorders and musculoskeletal issues, contribute significantly to morbidity but are not among the top causes of death. Conversely, some causes of death like accidents may not have a long-term morbidity phase. The following list are the top causes of mortality consistently highlighted by the World Health Organisation with potential behaviour modifications to mitigate these health risks.

Top Causes of Mortality and Modifiable Factors

Optimising Wellness through Lifestyle Choices to improve modifiable risk factors

Actively managing modifiable factors, which either increase the risk of disease or offer protection, is essential for improving health outcomes, extending lifespan, and enhancing the quality of life. Conversely, acknowledging non-modifiable factors is vital for targeted early screening and monitoring. This is particularly crucial for individuals with a high-risk profile, as it facilitates timely interventions and effective disease management.

The integration of modifiable health determinants is vital for optimal wellness. Preventive healthcare, including regular check-ups, screenings, and vaccinations, enables early detection and management of potential health issues. Prioritising mental health through stress reduction, self-care, and support is essential for overall well-being. Adopting a balanced diet reduces risks of obesity, heart disease, diabetes, and certain cancers, while regular physical activity counters risks associated with sedentary lifestyles, including obesity, heart disease, and diabetes. Physical activity also aids in managing blood pressure and cholesterol levels. Limiting alcohol and avoiding tobacco are crucial in preventing diseases, particularly cardiovascular and respiratory conditions. Managing blood pressure and cholesterol through lifestyle changes and medication is key to reducing cardiovascular disease risks. Good sleep hygiene is essential for preventing cardiovascular, metabolic disorders, and for maintaining mental health and weight. Building strong social connections can be accomplished by participating in community activities, nurturing existing relationships, and being open to new interactions, including using technology for maintaining distant relationships. Finding a sense of purpose can be achieved through self-reflection, setting personal goals, helping others, and continuous learning. Engaging in activities that align with personal values and interests, such as career fulfilment or hobbies, contributes significantly to a sense of purpose. Both strong social ties and a clear sense of purpose are cultivated through active participation, mindfulness, and consistent effort, lead to a richer, more fulfilling life and contribute to overall well-being and health and life satisfaction.

Integrative Synergy of Modifiable Health Determinants: Balancing Diet, Exercise, Blood Pressure, Cholesterol, and Other Healthy Choices for Optimal Wellness

The intertwined relationship of these modifiable determinants can independently decrease the risk of various diseases. Moreover, they interact synergistically, enhancing their combined beneficial effects on health. Stress management and good sleep hygiene work in tandem. Techniques like mindfulness, yoga, or cognitive-behavioural therapy can enhance sleep hygiene by easing anxiety and promoting relaxation. Simultaneously, adequate sleep can help manage stress levels by regulating hormonal balance, particularly the stress hormone cortisol that might also aid in reducing tobacco use when smoking is used as a coping mechanism. Sleep deprivation can lead to unhealthy food choices and overeating. Conversely, a balanced diet can enhance sleep quality by supplying nutrients that aid in producing sleep-promoting chemicals in the brain. Nutrition can facilitate tobacco avoidance, with certain foods potentially aiding individuals to quit smoking. In turn, refraining from smoking can improve taste perception, making healthy foods more appealing and promoting better nutritional choices. A balanced diet can aid stress management. Certain nutrients, like omega-3 fatty acids (a polyunsaturated fatty acid), magnesium, and vitamin C, can diminish cortisol levels and bolster the body's response to stress. Conversely, effectively managing stress can deter stress-eating habits and foster healthier food choices. Stress management, physical activity, social connections, and purpose of life - positively impacts the others. Also, reducing stress through physical activity can make social interactions more enjoyable, and strong social connections can provide motivation for regular exercise. Maintaining a healthy lifestyle can empower individuals to achieve their career aspirations, resulting in greater job satisfaction and contribute to a greater sense of purpose in life.

These interconnected determinants illustrate that improvements in one area often permeate into others, leading to a virtuous cycle that considerably boosts overall health. Recognising the importance of lifestyle medicine, which advocates the adoption of healthy habits like these, is gaining traction in preventing and managing chronic diseases.

Conclusion

Every life journey concludes with death, but extending both lifespan and healthspan is within our grasp. By addressing modifiable factors through proactive measures, we can influence our overall health and longevity, challenging the notion of a predetermined fate. Nations with lower life expectancies such as South Africa hold potential for transformative improvements by tackling risk factors and fortifying protective factors. Tailoring interventions to unique needs and cultural contexts, drawing insights from phenomena like Blue Zones, can pave the way for advancements in public health. Recognising the pivotal role of modifiable factors is paramount, offering opportunities for positive health trajectories. A comprehensive approach to health determinants—tobacco avoidance, stress management, good sleep hygiene, balanced diet, physical activity, and blood pressure and cholesterol management—is integral to a healthy lifestyle. Effective management requires concerted efforts, education, and behavioural changes.

In light of this, I urge health researchers, healthcare professionals, policymakers, and educators in the health sector to recognise their vital roles and intensify efforts in elevating life expectancy, particularly in regions where there is much room for improvement. On an individual level, I encourage everyone to enhance their lifestyles and make the most of the precious gift of life. By prioritising knowledge, making informed choices, and fostering environments that support healthy living and eating, individuals can maximise the benefits and contribute to a longer, healthier life. Embracing the transformative power of modifiable risk factors is an indispensable step toward achieving optimal well-being and relishing a fulfilling lifespan.

Reflections

Consider the top causes of death. Reflect on the behaviour modifications mentioned for each cause. How can you apply these behaviour modifications to reduce your own risk of developing these health conditions?

In the process of creating this work, the author employed ChatGPT 4 to streamline the text and to perform language editing.