THE OXFORD HEALTHY AGEING PARADIGM
Living longer is a very complex process for both the individual and for the population facing a significant increase in people in their 60s, 70s, 80s and 90s. .the Oxford Longevity Project stimulated a review of the scientific analysis of what is happening us as we live longer and what can be done about it
The Science base for Healthy Ageing
Our interpretation of the science is that the biological process of ageing is not a cause of major problems till the late 90s, although you need a bit of luck to avoid the diseases such as Parkinson’s that we cannot prevent or delay. There is now much clearer understanding of the relationship between an individual’s genetic inheritance and the social and physical environment to which they are exposed and have been exposed since birth, with the latter being much more important than the former for most people. Indeed there is now a new term, the Exposome for an individual’s environmental exposures, both physical and social, since birth. There are three processes other than ageing that are more important causes of the problems that occur more frequently as people live longer,
*Loss of fitness, physical and mental
*Disease, much of which is preventable being caused by modern risks such as diet and inactivity, and the disability that results is usually complicated by accelerated loss of fitness
*Social factors notably deprivation and ageism - negative beliefs and attitudes -
Here is a picture which summarises the knowledge about what is happening to us as we live longer and which influences both our lifespan and our healthspan or healthy life expectancy
The Evidence base for Healthy Ageing
Millions of dollars are being invested to find a drug that can slow the ageing process, an ‘elixir of life’, but so far without success and it remains a moot question just how much demand there would be for a drug that would help you live till 118 or 142, just two of the ambitions cited in the media. What most people want however is not an increase in life expectancy but an increase in healthy life expectancy and a reduction in the period of time at the end of life when one is dependent on others for the most basic tasks such as getting to the toilet on time. Fortunately there is strong evidence from research evaluating methods designed to influence the other three factors that they can be influenced which proves that healthy life expectancy can be increase even though the ageing process cannot be influenced. Even the risk of dementia can be significantly reduced.
Our standards for including knowledge about living longer better are based on the academic principleswhich underpin evidence based medicine and Oxford played a significant part in developing these methods. The first level of proof is a randomised controlled trials but the results from a single trial have to be interpreted with caution and the gold standard is the systematic review of the published research, for example the publications of the Lancet Commission on Dementia.
We need agreement on language
Tied into this is the need to be clear about the language being used and to work towards a consistent use of language and this in itself is very important in bringing about culture change, namely a change in culture from assuming that older people simply need more things done for them, the ageist culture, instead of being enabled to do even more for themselves and other people. The fight to change the Ageist culture is led by the Centre for Ageing Better and AgeUK but needs everyone to take action. This is a key change for people providing or receiving what is termed social care.
We need to focus on wellbeing as well as on disease
Furthermore there is now recognised that ‘health services’ are focused on diseases and that it is important to focus on wellbeing as being a condition that is not achieved simply by the effective prevention and management of disease. The term wellbeing is increasingly preferred to the term health because there are well substantiated ways of measuring wellbeing for example that used by the ONS. The importance of wellbeing is that
- It is an important outcome in its own right (1)
- Because the NHS is appropriately focused on disease is does not recognise or deal with problems that are primarily due to loss of wellbeing eg depression and may respond inappropriately for example by the prescription of anti-depressants to someone whose wellbeing problem is social
- Wellbeing is important to the NHS because people with a good level of wellbeing are more likely to
- Take preventive action
- Adapt better to the development of a long term condition with better outcome
- Make less inappropriate use of the NHS
The science is clear and the evidence is strong that we can live longer better. Effective clinical services have a very important contribution but the key factor is what each of us does not only to increase our own healthy life expectancy but also to influence the environment in which we live as a community. This needs a change in the mindset of individuals and society to create the healthy ageing culture and the publication in May 2026 of the report of The House of Commons Committee on Health and Social Care, chaired by Layla Moran titled Healthy Ageing will play an important part in this campaign because it emphasised that “Participants said that stereotypes from friends, family, society and internalised ageism created barriers to increasing physical activity:
“if we are told we can’t, then we won’t.” This has to change.
KEY REFERENCES
The scientific understanding of what is happening as we live longer is getting more clearly understood and the science of what is happening to us is developing fast, not only clarifying the fact that the genes we inherited from our parents are much less significant than the environment in which we grew up in and live in. A number of new concepts have developed recently including
- The emergence of the exposome, the effect of our social and physical environment, as being more important than the chromosome ,our genes, in determining healthy life expectancy for most common conditions and most people(2,3)
- That a sub set of the population called super-agers is now recognised and studied and that the key factor seems to be activity, physical and social, obviously with a bit of luck in growing up and living in a good environment which valued learning and free from the pressures of deprivation (4)
- That instead of on focusing on multi morbidity and disability it is more important to think of a person s 'intrinsic capacity’ defined by WHO as having five dimensions ‘locomotor, cognitive, psychological and sensory capacities, and vitality’ with vitality the WHO term for what others term ‘resilience’ or ‘reserve’(5)
- The need to view one’s personal development as part of a living system determined not by our genes but by our interaction with the physical and social environment which can influence all aspects of our development including the way in which our cells develop and function (6,7)
numerous cultural changes have altered interactions between our genes and our environments in ways that contribute to a wide range of health problems. These illnesses are mismatch diseases, defined as diseases that result from our Paleolithic bodies being poorly or inadequately adapted to certain modern behaviors and conditions. (8)
There are some diseases with a strong genetic component but for most of the common diseases an individual should not worry about what his parents suffered or died from but take action to reduce the risks of the modern environment
It is also essential to focus on wellbeing (1) on the quality of life as well as on life expectancy
By wellbeing we mean, how do you feel about your life, how satisfied you are. We do not mean external circumstances that affect your wellbeing. We mean the thing that ultimately matters : your inner subjective state – the quality of your life as you experience it , how happy you are
The environment is the main determinant of both wellbeing and healthy life expectancy and everyone should be given the same opportunity, irrespective of their polygenic pattern (9) many people affected by deprivation face barriers in finding the time and energy to act on this knowledge, a problem called ‘temporal inequity’ (10).
The mission is to enable all the individuals in a population to take action this shifting the whole population curve (11) rather than focusing on only one sub-section of the population
Muir Gray 1/7/26
REFERENCES
1. Layard R and de Neve J-E (2023) Wellbeing; science and policy
2. Argentieri A M et al (2025) Integrating the environmental and genetic architectures of aging and mortality
Nature Medicine
Volume 31 | March 2025 | 1016–1025
3. Woods T A et al (2025) Cities, communities and clinics can be testbeds
for human exposome and aging research
Nature Medicine
4. Smith D A (2024) A peek into the brians of super-agers
New York Times 29th April 2024
5. Beard J B et al (2022)
Intrinsic Capacity: Validation of a New WHO Concept for Healthy Aging in a Longitudinal Chinese Study
The Journal of Gerontology: Series A, Volume 77, Issue 1, January 2022, Pages 94–100,
6.Noble D (2025)
The cardiac pacemakers: A paradigm of robustness in evolutionary biology
J Physiol 0.0 (2025) pp 1–11
7. Noble R and Noble D
Understanding Living Systems
8. Lieberman, D. (2014) The Story of The Human Body.
Penguin Books.
9. Wald NJ and Old R (2019)
The illusion of polygenic risk prediction
Genetics in Medicine 21-1705-1707
10. Rohr S et al (2025)
Making time for brain health: recognising temporal inequity in dementia risk reduction
Lancet Healthy Longevity Volume 6, Issue 10, 100768,
11. Rose GE (2001)
Sick individuals and sick populations
Int Journal of Epidemiology 427-432
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