We all want to live long and healthy lives. Populations in blue zones – areas where people live significantly longer than the rest − also have significantly reduced rates of chronic diseases associated with ageing.

Blue zone populations can be found in Sardegna, Ikaria in Greece, Okinawa in Japan, Nicoya peninsula in Costa Rica, and Loma Linda in California.

With major advances in healthcare, medicine and technology in the recent decades, lifespan − the number of years lived − has increased dramatically, however, healthspan − the number of years lived in good health or free of chronic disease − has not improved at the same rate.

Nowadays, the average life expectancy in Malta is 84.3 years for women and 80.8 years for men; however, the number of years lived in good health is less at 68.5 and 68.9 years, respectively. This means that, on average, Maltese individuals are living 15-20 per cent of their life with a chronic health condition. In the ideal scenario, one would live the great majority of their life free of chronic disease and disability.

One of the reasons for the difference in lifespan and healthspan is that the medical model we practise is mostly reactive in nature – wait for something bad to happen and go and see your doctor who will investigate, also commonly described as sickness medicine.

Modern medicine (reactive medicine) is excellent at reducing diseases which need fast treatment when a symptom develops. Examples of reactive medicine include doctors prescribing antibiotics for a bacterial infection and orthopaedic surgeons fixing broken bones after a traffic accident. Reactive medicine is not as effective in the treatment of the chronic diseases of ageing. Very often, by the time symptoms of a chronic disease appear, that patient would have suffered a significant decrease in their healthspan they will not be able to recover.

Longevity medicine practitioners aim to reduce the risk of developing diseases of ageing and screen early for these diseases to improve outcomes, also known as wellness medicine.

So what are the chronic diseases associated with ageing? Eighty per cent of deaths in non-smokers above the age of 50 are due to four chronic diseases: cardiovascular disease, cancer, Alzheimer’s disease (and other neurodegenerative diseases), and metabolic diseases (diabetes and other related diseases).

The increasing gap between lifespan and healthspan suggests that modern reactive medicine is helping people to survive longer with disease and disability, rather than increasing good quality years of life.

Chronic diseases typically develop over many years − long before any symptoms appear

These chronic diseases typically develop over many years − long before any symptoms appear. This is where reactive medicine fails. Preventing the gradual development of these chronic diseases is the only way to preserve healthspan and a good quality of life.

Cardiovascular disease is the most common chronic disease and the number-one killer in the developed world. It includes heart attacks, strokes and heart failure, and is a result of plaque build-up in arteries which would have begun many years before. Similarly, neurodegenerative diseases such as Alzheimer’s disease is typically diagnosed many years after the irreversible changes in the brain have started taking place. Once symptoms of these diseases start to show, it is usually too late to do anything about it. In fact, the first sign of cardiovascular disease is sometimes a fatal heart attack.

This is where the importance of preventive medicine comes in − aiming to prevent the onset of these diseases and screening early for signs of disease in the asymptomatic phase when medical and lifestyle interventions can be most effective in maintaining healthspan. Ageing is one of the leading risk factors for most of these chronic diseases. Of course, we cannot prevent ageing, but what we can do is influence the way in which we age.

Many risk factors are modifiable. The most important lifestyle modifications we can make in order to increase our healthspan are those related to our nutrition, exercise, sleep, and stress management.

Metabolic diseases, such as type 2 diabetes, are on the rise, and perhaps most concerningly, in the young population. Maintaining a healthy weight, eating a balanced, nutritious diet, getting sufficient aerobic exercise and resistance training, as well as consistent, good quality sleep and practising effective stress management are all invaluable in preventing the onset of metabolic disorders.

Importantly, metabolic dysfunction is also a risk factor for cardiovascular disease, many cancers and neurodegenerative disorders. Adopting these lifestyle practices throughout our lifetimes increases the chances of us living a long life while maintaining our independence and functionality.

In addition to adopting better lifestyle practices and habits, screening early for diseases and appropriately prescribed medications or supplements, are also vital to increasing longevity by treating diseases long before they become unmanageable.

In the following longevity medicine features, we will be discussing the individual diseases of ageing starting with cardiovascular disease and how to prevent a heart attack.

Philip Borg is a longevity medicine specialist as well as a consultant interventional radiologist, and leads The Longevity Clinic at St James Hospital.