FIELD NOTE #1: The "Healthspan vs. Lifespan" Distinction Your Doctor Probably Won't Bring Up

"Justin, if there's one thing that's for certain-sure, it's no good getting old." — my grandfather, Robert Zackham | age 99

Can you get up off the floor right now without using your hands?

Try it. Sit down on the floor, then stand back up — no hands, no knees, no furniture. Did you make it? Now picture yourself doing it at 80. Or 90.

That’s the healthspan gap, and it’s the whole game.

When I started this self-renaissance — my “selfaissance” — I hurled myself back into the gym with a training program from my twenties. In short order it handed me, in succession: a pulled left hamstring, a sprained right Achilles, turf toe, and plantar fasciitis. And that was after I’d torn my (second) bicep trying to move my son’s vending machine. Surgery followed, then three months of mostly sedentary rehab. I was in absolutely no shape to get into shape.

Getting healthy was killing me.

Here’s the distinction nobody drew for me: your doctor is trained to keep you alive. That is not the same as keeping you alive and well. The space between those two is where a lot of us quietly lose a decade.

Some numbers worth sitting with, from a 2024 Mayo Clinic study in JAMA Network Open:

• Globally, the “healthspan” gap between how long we live and how long we stay healthy has widened to 9.6 years.

• The United States has the largest gap of all 183 countries surveyed: 12.4 years.

• Women carry a gap 2.4 years wider than men — a 25% disparity — driven by neurological, musculoskeletal, and other chronic disease.

In the country that grossly outspends every other on earth for healthcare, the average person now spends more than a decade — the last decade — managing chronic disease. Diabetes, heart disease, dementia, the slow grinding purgatory that can dominate the final years.

Healthspan is how long you stay mobile, sharp, and in control — living the active life you want without your body making the decisions for you. The closer your lifespan and healthspan are aligned, the better you’ll be able to live while you’re still alive.

The reason your doctor doesn’t create this plan for you is training, not negligence. Modern medicine can perform miracles once something breaks: stent the artery, manage the diabetes, replace the hip. What it is not built to do is sit you down at 55 and say, “Your bloodwork’s fine for now, but your VO2 max is low for your age, your hip mobility has decreased drastically, and if nothing changes within the next five years you’ll spend your 70s accumulating medical appointments while your spouse has to help you into the bathtub at night.”

There’s no insurance code for that conversation. No prescription beyond, “Take this pill. Exercise more. Eat more broccoli.” So nobody has the talk with you — the plan to get you enjoying your life, for your entire life.

I’ve been having a version of the talk with myself almost daily. As I worked to get my blood tests “within range” — medicine’s way of telling you you’re not dying yet — I started reading health and longevity research and realized “within range” is a wildly low bar. “Within range” gets you to 76. It does not propel you to 90 with your hiking boots still on.

Peter Attia draws the line cleanly. Medicine 2.0 treats disease when it shows up. Medicine 3.0 prevents it from showing up 20 or 30 years early. I’m willing to bet that nobody is practicing Medicine 3.0 on you. You have to practice it on yourself.

You have to become the head coach of your own healthcare.

It’s a lesson I learned recently — and one that could have cost me far more than a torn bicep. More on that next week.

Once you start measuring healthspan instead of lifespan, the clock reads later than you thought, and the daily choices shift. The things I used to find boring — strength training, Zone 2 cardio, sleep, protein, sunrises — stopped being boring. They became the entire game.

Which brings me back to the floor. That sit-to-stand test you just tried isn’t a party trick. In a study of more than 2,000 adults, the people who needed both hands and knees to get up faced a markedly higher risk of dying in the years that followed than those who rose with ease. How you get off the floor says something the blood panel doesn’t.

I’m not anti-doctor. Mine is excellent, listens to my heart and lungs, reads my bloodwork, and refills my prescriptions. I just had to stop waiting for him to ask the questions I needed to be asking myself.

So, can you get up off the floor without your hands? And will you still be able to at 80 or 90?

The honest answer to the second question is the only one that matters. And it’s the one you get to change.

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SOURCES AND FURTHER READING

• Garmany A, Terzic A. Global Healthspan-Lifespan Gaps Among 183 World Health Organization Member States. JAMA Network Open. 2024;7(12):e2450241. (Free, open access — full paper: https://pmc.ncbi.nlm.nih.gov/articles/PMC11635540/)

• Mayo Clinic press release (same study, more readable): https://newsnetwork.mayoclinic.org/discussion/the-global-divide-between-longer-life-and-good-health/

• Peter Attia, Outlive — the Medicine 2.0 / 3.0 framing (intro chapter): https://peterattiamd.com/outlive/

• Brito LBB et al. Ability to sit and rise from the floor as a predictor of all-cause mortality. European Journal of Preventive Cardiology. 2014;21(7):892.

  https://academic.oup.com/eurjpc/article-abstract/21/7/892/5925784

• Sitting–rising test scores predict natural and cardiovascular causes of death in middle-aged and older men and women. European Journal of Preventive Cardiology, 2025. https://academic.oup.com/eurjpc/advance-article/doi/10.1093/eurjpc/zwaf325/8163161