Let’s conduct a thought experiment.
Two scientists announce breakthrough discoveries.
Scientist A develops an expensive treatment that enables people to live in good health until the age of 300.
Scientist B develops an inexpensive treatment that extends healthy lifespan by just a few years.
Which of them deserves the Nobel Prize?
Our intuition leads us to choose the first. After all, living in good health until 300 sounds like the ultimate scientific breakthrough.
But if that treatment is accessible only to a small fraction of the population, while the second improves the quality of life of millions of people, then the more modest innovation may ultimately have the greater impact on humanity.
This is precisely the point at which longevity ceases to be merely a question of medicine and becomes a question of mathematics.
To frame longevity through a mathematical lens, we must first define it quantitatively and agree on what exactly is being measured. Only then can we evaluate and compare interventions against the outcome we choose to optimize.
For most of the twentieth century, quantifying the longevity problem simply meant extending life expectancy.
Later, it meant extending healthy life expectancy, and more recently, the broader objective has become to extend our functional healthy years, not merely adding "disease-free years," but also preserving the ability to remain independent, active, and do what one values.
There are reasons for optimism. Life expectancy, healthy life expectancy, and functional healthy life expectancy—all these measures are rising at encouraging rates.
Geroscience, which is the science of aging, provides new insights into the biological mechanisms of aging. The hallmarks of aging are becoming increasingly understood, monitored, and used to develop interventions. Fortunately, the most effective interventions remain remarkably practical and familiar:
physical activity, adequate sleep, healthy nutrition, no smoking, muscle preservation, cognitive engagement, and social connection.
The most effective interventions for longevity are inexpensive. The enabling conditions are not.
Exercise requires safe spaces and time. Healthy food requires income and education. Sleep is shaped by stress and working conditions. Preventive care depends on health services. Social connection depends on community design.
What appears to be an individual choice is, in fact, strongly determined by the social system.
This is where the longevity question goes beyond medicine and enters the realm of systems design. The central challenge is no longer to discover new interventions, but to design mechanisms that enable people to adopt them at scale.
The objective function is no longer to maximize longevity, but to maximize equitable longevity.
The reality is sobering: there is no equitable longevity, and nowhere near enough effort to achieve it.
Healthy life expectancy differs by more than 30 years between countries such as Singapore and the Central African Republic. Even among older adults, healthy life expectancy at age 60 varies by nearly a decade across OECD countries. What make it more worrying is that by 2050, most (80%) older adults will live in low- and middle-income countries. It is these older people on whom we need to focus our efforts. Measuring the hallmarks of aging in low-income populations is likely to have a greater impact than in higher-income populations, who tend to adopt healthier behaviors even without targeted interventions.
Gender adds another layer. Women generally live longer than men, yet often reach old age with lower pensions and weaker financial security. Longer life does not necessarily mean a better society.
The inverse care law states that those who need care the most are often the last to receive it. Longevity innovation carries the risk of reinforcing this pattern. If innovation is not designed to diffuse broadly, it may create its own inequality mechanism: the faster the progress in longevity science, the greater the advantage of those already able to adopt its benefits.
Have We Been Optimizing the Wrong Objective Function?
From a social perspective, those who need longevity interventions the most are often the last to receive them. Moreover, the faster longevity science advances, the wider the gap becomes between populations in their ability to adopt its benefits, thereby increasing health inequality. Focusing primarily on healthy, affluent populations may accelerate innovation, but it does little to reduce the burden of disease among those who need these interventions the most.
From an economic perspective, the answer is less straightforward. It is no secret that health policy is shaped by powerful economic incentives, often prioritizing interventions that deliver visible short-term returns. However, prioritizing short-term returns does not necessarily optimize long-term system performance. The same principle applies to longevity. Even without invoking moral arguments, investing in equitable longevity is economically rational because investing where the baseline burden of disease is highest has the greatest potential to expand productive years of life, reduce future healthcare costs, and generate the highest long-term return on investment.
As Founding Dean of the Faculty of Technology in the Western Negev, I believe places facing the greatest challenges should become the first sites of the longevity revolution—not its waiting room. Equitable longevity transcends the individual. Its deepest meaning lies in recognizing that life itself—not only our own life—is worth extending.
In collaboration with Sapir Academic College.