Healthy longevity for all: A blueprint to maximise equitable health and wealth
KEYNOTE ADDRESS AT UK SPINE
CONFERENCE 28 JUNE 2022
The general trend has been that we’re living longer – but life expectancy has begun to stagnate in the UK and is actually falling in the USA. In the UK, we spend a fifth of our lives in poor health – and the poorer you are, the greater the proportion of your life spent in poor health. We must close the gap of the almost 20-year difference in healthy life expectancy between the richest and the poorest.
In the year 2000, health spending in the UK represented 27 percent of day-to-day public service spending. By 2024, it is set to account for 44 percent. 44 Percent! The NHS spends vast sums treating people whose conditions are avoidable - and by some estimates 40 percent of its costs go on treating preventable conditions. The burden of just one preventable disease – cardiovascular disease – costs society over £18 billion.
This needs to change – and is the burning platform for all of us at this conference. We need to shift sickcare to a new model. We need to get to a place where we’re healthier for longer. Compressing morbidity is still a major challenge, but as we are seeing with research on the biology of ageing, there are common pathways in major chronic diseases that lead to multiple morbidities that you might be able to manipulate or influence.
The pandemic has been helpful to highlight that a geroscience approach, targeting ageing processes to prevent multimorbidity, is an important element to improving healthspan and compress morbidity.
The Life Sciences Vision published last year outlines 7 critical healthcare missions that government, industry, the NHS, academia and medical research charities can work together on at speed to solve – from addressing ageing to tackling dementia.
This was the first time that research in the science of ageing was deemed a priority. To spur collaboration in this area, and to achieve these missions it was fantastic to see the launch of UK Ageing Network being led by Richard Farragher and friend Lynne Cox, here at the conference who I know well from working with her, especially in connection with the All-Party Parliamentary Group for Longevity.
One of the 11 groups in the Ageing Network is the Cognitive Frailty Interdisciplinary Network (CFIN) looking at the emerging discipline of brain capital - being explored by Lynne Corner and Nic Palmarini at the National Innovation Centre for Ageing, or NICA, both of whom I will be working closely with ahead in my new role at NICA to promote the discipline of Healthy Longevity ahead.
It is an incredibly exciting time to be working in ageing science, particularly as it may be possible not only to treat age-related diseases at cause, but also to take a preventative approach- which I am passionate about.
At the heart of improved health and wellbeing is a deep, integrated understanding of the fundamental mechanisms that contribute to maintaining health across the full life course. And this will only be possible if we change how we conduct ageing research, both by bringing together scientists from many disciplines with the public, clinicians, policymakers and industry.
And this means more than drugs to target the underlying biology of ageing. We need to look at the entire exposome, that describes all the factors that influence our health and ageing trajectory, including behaviour, environment and lifestyle.
There is so much we can do now of course that will have a dramatic impact on our healthspan. Walking 20 minutes a day has been shown to have a dramatic impact – Most of you will know the research published in 2015 (in The American Journal of Clinical Nutrition) that found that a brisk 20-minute walk every day could reduce risk of death by upwards of 30%.
Research by RAND showed that this simple activity would generate not only health benefits but economic benefits too. According to their study, if every adult between ages 18 and 64 walked an extra 15 minutes a day, the world economic production would see an increase of about $100 billion, every year. Even for inactive people over the age of 40, introducing 20 minutes of jogging every day could give them an extra 3.2 years of life.
Blood pressure control is another example where a simple intervention could have a massive impact. In the last few months I have received two text messages from my GP to ask to get my blood pressure checked-if we had the whole population getting their blood pressure checked and receiving support on how to reduce their blood pressure, in one swoop we would wipe out a significant so-called silent killer of many people- and this data could drive a colossal amount of research on the risk of high blood pressure and how to offer the best intervention to reduce it at both individual and population health levels.
So why aren’t we doing these most basic of things that could have such a dramatic impact on our health - and wealth? Simple. Human behaviour is complex and changing behaviour tough. We need to make it easy to keep healthy and well. And cheap. We need the right environments to make the best choices. The simple fact is that if it is not easy or cheap or woven into the fabric of our daily lives, hopes and dreams it won’t happen.
We are always looking for the quick fix, the miracle cure, indeed, a pill that could ‘cure’ all of our ills, indeed, even ageing itself.
We need the hope too. Sometimes it is the simple hope that a quick fix will work. I was struck by a JAMA article tweeted out by Eric Topol last week that said that more than half of adults take dietary supplements; In 2021, people in the US spent an estimated almost $50 billion on dietary supplements and the dietary supplement industry spent about $900 million on marketing. Most of these supplements have no evidence whatsoever that they improve health. I have to confess I am a bit of a sucker too, taking quite a few supplements myself (though like to think of myself more as a guinea pig…not a victim of marketing). I am only human. We are all only human. And we will come back to this point in a bit.
What companies are selling are quick-fix hopes, not necessarily solutions that work. I admire the work that Brian Kennedy is doing in Singapore, using ageing biomarkers to evaluate the efficacy of supplements to increase our heathspan- a rigorous evidence-based approach that is sorely needed in this space.
He also argues that simple things will make a huge difference. There is a lot of hype in longevity research - No single drug or molecule yet can outdo the effects of a bad lifestyle or being in the poverty trap- if you do not eat healthily and you don't sleep or exercise enough or are stressed through financial worry and loss of hope, 10 years or more of your life is at risk.
More or less, 25 percent of our rate of ageing and lifespan is determined by genetics (except for supercentenarians who have genetic advantages- the source of much research at the moment, including by Nir Barzilai, leading the TAME metformin trial).
The other 75 percent is lifestyle. 75% down to lifestyle shows how we live really matters. Mindset, movement, nutrition, environment, stress, rest, and connection are some of the foundational elements that either speed up or help to slow the rate of ageing.
Brian Kennedy says this too, and he was one of the 30 experts I interviewed for my book published a year and a bit ago- Live Longer with AI. Every single one of the experts I asked about what they do to keep healthy and well boiled down to very simple things, mainly connected to lifestyle- but passion and purpose was also central.
Now, hope can be a by-product of taking a pill but our sense of purpose cannot be bought or sold. Some of you will know the epidemic of ‘deaths by despair’, that Angus Deacon talks about in connection with the US opioid crisis. Loss of hope, loss of purpose, loss of meaning in life, leads to premature mortality.
Psychological ageing is under-explored and my colleagues at NICA are exploring ways to increase societal brain health and brain capital.
So-called ‘psychological age’ has been described as your chronological age in a healthy state without mental illness or depression, stress, anxiety, how do you feel in the context of your life, and in the context of your biological health.
Psychological ageing has been a topic of high interest to Alex Zhavoronkhov, Founder of Insilico Medicine and Deep Longevity, a friend and colleague and who I interviewed for my book too. He has been doing ground-breaking work in AI-driven drug discovery and ageing biomarker research.
As we know, biomarkers of ageing can accurately quantify the human ageing process using various biological data types, commonly referred to as the "ageing clocks", and are among the most important recent advances in the field of longevity research.
Together with Peter Diamandis, the founder of XPRIZE and Singularity University, Alex and his Deep Longevity team published in late 2020 the first AI-powered psychological ageing clocks to analyse and interpret psychosocial factors in ageing.
This work looks at how your state of mind and psychological state affects the ageing process. We know that humans are born, develop, reproduce, take care of their young, and then gradually decline and die. However, humans are conscious intelligent species and change their behaviour, priorities, beliefs, and attitude, during life.
Laura Carstensen at Stanford developed the Socioemotional Selectivity Theory, or SST, which shows that the perception of time plays a fundamental role in the selection and pursuit of life goals and can be manipulated too to affect behaviour.
Applying this SST theory, Zhavoronkov and Diamandis developed psychological ageing clocks on large independent datasets and discovered that higher subjective age (the SubjAge clock) is very predictive of all-cause mortality. People predicted to be five years or older than their chronological age have a much higher chance of dying.
They also showed how SubjAge can be manipulated therapeutically to make patients feel younger and thus reduce their mortality risk. For example, developing openness to new experiences can reduce SubjAge prediction by seven years.
They concluded that a person’s mindset may determine the decisions that ultimately affect their overall health. This concurs with other recent studies that show a sense of optimism has been linked to increased healthspan. Being optimistic decreases psychological age.
Zhavoronkov and his Deep Longevity team has just published a paper in ageing with Harvard researchers on enhancing future well-being with AI and are working on a follow-up study on the effect of happiness on physiological measures of ageing.
Just a small personal anecdote conned to this work on psychological ageing. I was speaking about how much joy I get from dancing with Greg Bailey, CEO of Juvenescence, at a recent Longevity conference.
He said the best way not to age is to [quote unquote] ‘pretend you are 30: listen to that music from 30 years ago’. He referenced the 'Counterclockwise' experiment that Harvard Professor Ellen Langer did way back in 1979. The study looked at what effects turning back the clock psychologically would have on an older adult’s physiological state. The stated research question was, ‘If we put the mind back twenty years, would the body reflect this change? The experiment showed, yes. Changing thought patterns can slow ageing.
All this points to the need for solutions that work not only on the biology of ageing but the psychology of ageing too. This is what NICA are doing and will lend huge insight and evidence too into why tacking ageism is so important. Ageing stereotypes influence the ageing process itself, and this is why ageism is such a barrier to living longer well. Ageism keeps on coming up as the biggest challenge we face to really embrace the longevity dividend that people like Andrew Scott, talks about, the author who wrote the incredibly successful book, The 100-year Life.
Andrew Scott together with Harvard Professor David Sinclair recently published their study in Nature- showing that a slowdown in ageing that increases life expectancy by 1 year is worth $38 trillion dollars. That’s a lot of potential. And alot of potential wasted if ageism gets in the way.
We need solutions that are easy and accessible to everyone and which gives people hope and allows them to follow their purpose, their reason for keeping alive- and not to be a victim of ageism.
I am not sure that ageing research in animal models will reveal much on the link between our physiology, our sense of optimism, hope, purpose, and reason for being, which the Japanese call ‘Ikigai’. This is the test to see what works at a basic physiological model that will play out in human studies ultimately measured in increased healthspan. Yes, we are animals, but no, we are not quite like them. We have emotions, belief systems, need for meaning and a higher order of purpose in life that extends beyond just a survival instinct and need to reproduce- that does separate us I think, from nematode worms and mice.
What seems easier to understand is that health needs to embrace the revolutions that have already come to other aspects in our lives, like banking and shopping – we are used to convenience and choice, and ever more so- so health needs to be as easy for doctors to order a blood test as it is for people to order UberEats on your phone.
I obviously have a huge interest in data and AI. In some ways, health data is unlike other data. For some individuals concerns about privacy are bigger when it concerns our personal medical data for example. But our financial data is also very private too. Shouldn’t accessing health data to help our health be as easy as accessing our banking records to help with our finances?
Health data is plentiful, especially since most data we generate in our lives will affect or relate to our health in some way. This is gold stuff for biomarkers in ageing research. This is why Alzheimer’s Research UK initiated the Early Detection of Neurodegenerative Disease study (or EDoN) with the Gates Foundation- using digital biomarkers via smartwatch to detect diseases like Alzheimer’s years before the symptoms of dementia are evident.
Most will know that a digital biomarker is a quantifiable indicator of a person's physiological and/or behavioural state captured via any number of connected devices, including wearables (such as, smart watches, blood pressure monitors, or multi-sensor patches), implantables (like pacemakers, continuous glucose monitors), and IoT technologies (such as smart devices in the home, including voice assistants, gait monitors, and pollution sensors).
Today dementia is diagnosed when symptoms like memory loss start. To have the best chance of halting the disease, we need to intervene decades earlier, when the disease first starts to take hold. Digital biomarkers can detect and measure our mood, our memory and the way we move, sleep and interact. Subtle variations in these behaviours could provide vital clues to the presence of disease in their very earliest stage.
This is the holy grail of ageing research- to delay the ageing process and ward off dementia, indeed, maybe even find a cure. But also to unravel the complexities of what underpins and links all chronic diseases where age is the biggest risk factor.
Thanks to AI, we are getting increasingly powerful tools to unravel these complexities. Scientists at DeepMind and the University of Washington recently published their deep learning-based methods to analyse protein folding— the building blocks of life. We know that misfolded proteins can be devastating—causing health problems from sickle cell anaemia and cancer, to Alzheimer’s disease.
Deciphering protein folding is bound to illuminate an entire new area of biology we haven’t until now been able to study or manipulate. With these new AI tools, scientists could solve haunting medical mysteries while preparing to tackle those yet unknown. It sets the stage for better understanding our biology, new preventative health approaches, informing new medicines, and even inspiring synthetic biology down the line.
Of course, AI relies on data, and lots of it. We know the NHS has some of the most valuable health data in the world. This raw information has vast economic and societal potential. There’s no better proof of this than how we harnessed data to deal with the pandemic.
But raw data is not powerful on its own. It must be collected, cleaned, and curated, and of course stored and managed securely. Then it must be made available in trusted and secure platforms, to enable it to be shared and re-used. The concept of Trusted Research Environments (or TREs) has been outlined in Ben Goldacre’s recent review (along with 180 recommendations) that has fed into the latest iteration of the NHS and Care Data Saves Lives Strategy published this month.
The idea is that for the same cost as digitising one hospital, this can be applied instead to investing in a coherent approach to data curation via TREs, and a small number of secure platforms, to unlock all the untapped potential in NHS longitudinal datasets.
However, the NHS dataset is only a small part of the story in health, and represents the bit of our life journey when we need help, usually when we are ill. What about the 80% of our determinants of our health that lie outside of our health and care system? How do we collect, curate and connect this very important health relevant data, and also link it to our public sector data?
Our Future Health, led by Andy Roddam, is an important step forward. Most of you will know that it has been set up recently to recruit 5 million healthy volunteers in a major health study which aims to predict who will get ill in their later years even before they show symptoms. Geared to be the UK’s largest ever health study, Our Future Health will track people throughout their lives to come up with new ways to prevent, detect and treat diseases such as dementia, cancer, diabetes, heart disease and stroke. By having such a large pool of participants researchers hope to be able to paint a picture of people’s health before they become ill and as they are diagnosed.
The private sector is already in this space of course with consumer and tech companies experimenting here. Biogen and Apple recently announced they were experimenting with how to use handsets to track cognitive function over time and identify mild cognitive impairment- similar to what Alzheimer’s Research are doing with the EDoN trial.
Apple iPhones for example, can monitor your mobility and sleep patterns now but one day soon may be able to detect early signs of mental health deterioration like depression through typing patterns and typos on your phone or tablet.
This takes health data into the realm of what is often called ‘emotion AI’, passively gauging how you’re feeling, using various data points, including facial expressions, to understand emotions. Already, emotion AI is being used both experimentally and commercially within cars to detect drowsy drivers like I saw at the Goodwood Need for Speed car festival on Sunday. [By the way, I though it interesting that there was a whole future lab on health at this car event. Along with Bucattis and Ferraris were robotics, sensors and motion capture technologies being explored for future health applications- everything from mood detection, cognitive function, gait analysis to falls detection.]
The fact that big tech and now automotive technologies are getting so invested in health shows its potential from a commercial perspective. But the value of health is far bigger than that from a societal perspective.
The global pandemic has shocked the world into realising how closely our health is linked to our wealth. We need to see health now as a national asset to invest in to maximise societal wealth.
This means that attention from all stakeholders in health including government, public and private sector, must focus more on prevention rather than cure, far earlier in people’s lives, while addressing the wider determinants of our health and wellbeing.
System change is needed to focus on health as an asset to invest in, not as a cost in an increasingly unsustainable healthcare system buckling under the burden of poor health driven by growing health inequalities and ageing populations. The UK government is applying its Levelling Up policy agenda to increase healthy life expectancy and reduce health & wellbeing disparities as key pillars to drive economic growth ahead.
The health and economic fall-out from the pandemic and latest demographic trends present cities and countries with challenges, but also opportunities if we harness all the understanding of what makes people healthy and keep them healthy for as long as possible.
‘Longevity Cities’ is a strategic initiative developed by the NICA, National Innovation Centre for Ageing, and supported by the World Bank, that is rooted in the principle of 'health is the new wealth'.
The first Longevity City is being trialled in Newcastle, and is acting as the template for cities around the world, including Milan, Tokyo, Barcelona, and Hamilton in Canada. The Longevity City template is based on two key principles: one, that shared prosperity and wellbeing needs meaningful engagement with citizens, across the generations, and two, inequalities need to be addressed. Importantly, Longevity Cities are focused on all ages, across the lifecourse, and not limited by more traditional notions of ‘healthy ageing’ that only focus on improving old age.
The aim is to create environments that make it easy for people to follow healthier lifestyles well before old age, enabled by infrastructure, services and policies that also influence the social determinants responsible for 80% of our health.
Longevity Cities are experimenting with tools and technologies through the ‘Internet of Caring Things’, IoCT, initiative funded by NICA, North of Tyne Combined Authority and deep tech innovation organisation CPI. Local residents and 600 businesses in the region are involved.
The goal of IoCT is to work with local people and businesses to build a world-class innovation ecosystem, testing out technologies and devices on the high street, in day-to-day touchpoints – social activities like dining, shopping, walking etc. The idea is that connected objects and cognitive systems will be designed to actively care for people, enhance their physical and mental wellbeing, by understanding and measuring their day-to-day interactions – what really matters, what people really care about, what makes them feel good.
The IoCT project will help to develop NICA’s methodology called ‘Ageing Intelligence’® - capturing and analysing data to understand human behaviour and applying consumer insights into the development of future products and services that will make it easier for people to keep healthy and well and be looked after in ways that are most meaningful to them.
For example, one of the main causes of hospitalisation for older adults is falling at home. We already have smart watches, which measure falls and call emergency numbers. However, once you fall, you have fallen. The IoCT is looking at why a person falls and how we can prevent falls in the first place through predictive technologies and alert systems. The motion capture technologies used in gaming for example, could be harnessed in falls prediction and prevention.
Going back to so-called ‘emotion AI’ the IoCT project will use technology to understand how people are feeling, and from this feeling understand if we can help them live a healthier and longer life. Machine learning can analyse data to show correlations between things that at first glance appear to be completely disconnected. For example, is the frequency with which people do their gardening or mow the lawn an indicator of wellbeing?
For IoCT to work at scale, we need residents to engage who are also happy to share their data. The underpinning architecture also needs to be interoperable and trustworthy.
This is what myself and colleagues have been addressing through the development of the Open Life Data Framework (OLDF), which was published in November 2021 with the support of George Freeman, Science and Innovation Minister. The Framework takes learnings from Open Banking, which created an open standard to facilitate data sharing and portability between banks and which fuelled the development of a fintech ecosystem benefitting consumers.
The Open Life Data Framework aims to create the enabling conditions for public and private sectors to share data for public benefit, while ensuring public trust.
Sharing health-relevant data held within the private sector could help enhance and level-up health- key missions of the Levelling Up agenda.
The Open Life Data Framework also supports the Government’s agile regulation agenda to create a pro-growth trusted data environment and initiatives like Smart Data, where the Government has already committed to legislate to enable schemes offering the ability for individuals to share data held by private companies with trusted third parties to help them make sense and use that data in innovative ways.
Ultimately the Framework aims to inform interoperability standards that will support innovation and perhaps one day become the underpinning architecture to create a healthy longevity ‘scalebox’.
IoCT can trial new technologies and mobilise data for AI in exciting areas like biomarkers in longevity research, enabling the UK to demonstrate global leadership in digital regulation with robust global standards to become the world’s tech testbed. This all forms part of what George Freeman has been talking about in the Times over the last week to realise UK’s ambition to be a global science and tech superpower.
Really looking ahead, and maybe through funds from ARIA (the new Advanced Research Invention Agency) for example, OLDF could underpin the development of a UK-wide Healthy Longevity Mission, becoming a core element of the government’s plans to launch Innovation Missions incorporating the potential of AI solutions to tackle big, real-world problems in climate and health.
Critically, the Framework can inject new thinking on health outside NHS & Care that really needs to enter the policy frame for the National AI Strategy and National Data Strategy.
Also, too, the newly updated Data Saves Lives NHS & Care Data Strategy, including 1) informing fair-value commercial agreements; 2) inputting into the value-sharing framework to support the health system in delivering good data partnerships and 3) shaping data and API infrastructure to enable wider data sharing across public and private sectors to improve personal health records and shared care records.
The Open Life Data Framework could test out key principles set out in the government’s Plan for Digital Regulation to actively promote innovation by regulating digital technologies through an outcomes-focused approach, supported by robust evidence.
The Framework could underpin NICA’s Internet of Caring Things and other exemplars to become part of a series of ‘Living Labs’, that are currently being trialled in the energy sector, to provide a real world setting for the testing of new products, providing a clear evidence-based approach, and allowing for the testing of innovative technology in a controlled environment, and, crucially, yielding outcomes data to show how co-creation and engagement with industry, consumers and citizens builds trust - which is the most important output of effective digital regulation.
From an international perspective, these Healthy Longevity Living Labs could evolve into cross-border sandboxes evolving into a global network of Longevity Cities to improve the ease of doing business and the sharing of innovative tech with international trading partners.
The Data Framework also provides the underpinning mechanism to help employers, businesses and investors in their role to improve health and reduce health & wellbeing disparities in Levelling Up plans.
This is the focus of my work at Business for Health (B4H)- and we are working with the Confederation of Business Industry (CBI) to develop the Business for Health Index, which has the support of Chris Whitty our CMO and funding from the Health Foundation.
The Business for Health Index is aligned to the ONS Health Index and is intended to measure the positive and negative health impacts of employers, businesses and investors in three key areas: 1) direct impact on employee health; 2) secondary impacts via products and services and 3) contribution to community and societal resilience.
We are developing the methodology and metrics to incentivise and measure business contribution to increases in healthy life expectancy and reductions in health and wellbeing disparities- goals enshrined in the Levelling Up policy plans.
We are taking a steer what has guided the climate change agenda and net zero targets with the ambition to bring “Health” into ESG-driven investment, that is, “ESHG”.
An ESHG framework focussed on equitable health outcomes will help the business and investor community drive positive change and impact as part of Healthy Longevity Innovation Mission, through long-term strategic projects that reduce the risk factors that can damage health, like unhealthy food, poor work, pollution, and poor housing, and are incentivised and measured by their impact on positive health and wellbeing outcomes.
A significant opportunity exists to leverage institutional capital and pension funds with more zeal, especially with new freedoms in the pipeline for pensions funds (that George Freeman has been talking about) to invest in higher-risk innovation areas and which could be incentivised through ESHG investment approaches.
At a recent Bidwells event on how to help UK become a science superpower, someone remarked that combining the top 8 Local Authority pension funds in the UK, for example, adds up to £328 billion and these pension funds are searching for ESG-led investment projects in net zero, levelling up and sustainability. Local Authorities control planning consent and are responsible for delivering net zero and sustainability/ESG, yet no-one is presenting investible proposals to them.
This presents a significant opportunity- why not create ESHG funds for matching long-term patient capital into these strategic projects in the Healthy Longevity Innovation Mission, such as Longevity Cities and IoCT enabled by regulatory reform and data infrastructure and standards crucial to help the UK become a science superpower?
In closing, my message again is we must have a greater focus on prevention to reduce demand on the NHS and care system. A greater focus on the 80% of the determinants of health that lie outside our health and care system is needed to drive system change for sustainable health and prevention.
The goal of society should be to maximise health measures, not just economics measures, to benefit everyone. Tackling health inequalities between people and places, and the wider socio-economic and structural inequalities that drive them is therefore central and requires a whole systems approach involving multiple interventions.
As part of this, it is about harnessing the developments we are seeing in longevity science and data innovation to maximise access to healthier longer lives to everyone. Insights from genetics, biological, behavioural, environmental and financial data are currently under-utilised and there are significant opportunities to use AI and multimodal learning to predict disease and incentivise healthier living through harnessing such ‘life’ data.
Technologies like AI will continue to converge countless areas of research across the life course. Better use of public data and private data combined with digital tools and an understanding of wider determinants of health will give us the ability to better identify risks and help the people most in need, before they become patients. We need to harness scientific innovation and collaboration and leapfrog old models of healthcare with new ones that achieve healthy longevity for all.