Healthspan is the period of life spent in good health. Global evidence now measures an average 9.6-year gap; in Spain it is roughly 12. Here is how to measure it and what can narrow it.
Healthspan is the number of years you live with full physical, cognitive and functional capacity. Lifespan is simply how many years you live in total. The difference between the two — what researchers call the healthspan-lifespan gap — represents the years spent sick, in chronic pain, dependent on medication or living with limitations that erode quality of life.
In Spain, that gap is roughly 12 years. According to Eurostat (2024), Spanish life expectancy stands at 84.0 years — the third-highest in the EU, behind Italy and Sweden. But health-adjusted life expectancy (HALE), per the WHO, sits at around 72 years. Twelve years of progressive decline. That figure should change how we think about health.
Quick answer: if you only look at lifespan, you ask "how long will I live?". If you look at healthspan, you ask "how many years will I live with strength, mental clarity, metabolic stability and independence?". That second question is what modern preventive medicine is built around.
What exactly is healthspan?
Healthspan has no universally accepted medical definition, but the most common research interpretation describes it as the period of life free from chronic disease or significant disability (Garmany et al., NPJ Regenerative Medicine, 2021). It's not just about being undiagnosed. It's about function: climbing stairs without gasping, remembering where you left your keys, sleeping well, holding a conversation without mental fatigue.
The WHO measures it through HALE (Health-Adjusted Life Expectancy), which adjusts life years for years lived with disability. Eurostat uses a similar concept: Healthy Life Years (HLY), measuring the years a person expects to live without severe functional limitations.
Peter Attia, author of Outlive (2023), distils it into a single question: "What state do you want to arrive at 80 in?" If your goal is living to 90 but the last 15 years involve diabetes, joint pain, cognitive decline and pharmaceutical dependence… is that really living longer?
The 12-year gap: data by country
Recent evidence has made this discussion more concrete. A JAMA Network Open analysis (Garmany and Terzic, 2024) quantified the gap across 183 WHO member states and found a global mean of 9.6 years lived with disease burden. Women showed, on average, a gap 2.4 years wider than men, largely driven by more years lived with noncommunicable diseases.
In 2025, the same authors published a regional analysis in Communications Medicine that adds an important layer: the gap is universal, but not uniform. Noncommunicable diseases account for 56% to 90% of total disease burden depending on the country; Europe is overrepresented among countries with smaller-than-expected gaps, while Africa shows the fastest gap expansion. For an individual, the translation is simple: it is not enough to say "I want to live longer". You need to know which systems — metabolism, muscle, brain, inflammation, sleep — are limiting your healthy years.
| Country | Life expectancy (years) | HALE (healthy years) | Gap (years with disease) | % of life with disease |
|---|---|---|---|---|
| Japan | 84.3 | 73.3 | 11.0 | 13.0% |
| Spain | 84.0 | 72.0 | 12.0 | 14.3% |
| Switzerland | 83.4 | 72.5 | 10.9 | 13.1% |
| Italy | 84.1 | 71.9 | 12.2 | 14.5% |
| Sweden | 84.1 | 72.4 | 11.7 | 13.9% |
| USA | 77.5 | 65.1 | 12.4 | 16.0% |
| EU average | 81.7 | ~70 | ~11.7 | ~14.3% |
Sources: Eurostat 2024, WHO Global Health Observatory 2019, Garmany and Terzic 2024/2025.
Look at the United States: not only does it have lower life expectancy than Spain (77.5 vs 84.0), it also shows the largest gap in the JAMA Network Open analysis: 12.4 years, roughly 16% of life. It spends over $4.5 trillion per year on healthcare — the most expensive system in the world — and has not managed to close that gap.
Why? Because most of that spending goes toward treating diseases that already exist, not preventing them. This is the core argument of longevity medicine: the problem isn't how much we spend, but when we act.
The five pillars of healthspan
In longevity clinics, healthspan is approached as a multi-dimensional system. Peter Attia (2023) proposes a framework of five areas that determine long-term functional capacity:
1. Metabolic stability
Insulin resistance is probably the single most destructive mechanism for healthspan. It precedes type 2 diabetes by 10-15 years, and throughout that window it's already causing vascular, hepatic and neurological damage. A 20-year follow-up study (Tabák et al., Lancet, 2009, PMID: 19465232) showed glucose levels begin rising 13 years before a diabetes diagnosis.
The biomarkers that capture this: HbA1c, fasting insulin, HOMA-IR, triglyceride/HDL ratio.
2. Cardiorespiratory fitness
VO₂max is the single most powerful biomarker for predicting longevity. A Cleveland Clinic study of 122,007 patients (Mandsager et al., JAMA Network Open, 2018, PMID: 30646252) found that each 1-MET increase in cardiorespiratory fitness is associated with 13% lower all-cause mortality. Individuals with "elite" fitness (>97.7th percentile) had a 5-fold lower risk of death compared to those with low fitness.
This is not a trivial finding. VO₂max predicts mortality better than smoking, hypertension or diabetes. And the encouraging part: it can be improved at any age with zone 2 training and HIIT.
3. Strength and muscle mass
The PURE study (Leong et al., Lancet, 2015, PMID: 25982160) followed 139,691 people across 17 countries for 4 years. The result: every 5 kg decrease in grip strength was associated with 17% higher cardiovascular mortality and 16% higher all-cause mortality.
Sarcopenia — the progressive loss of muscle mass with age — is not a cosmetic issue. It directly predicts frailty, falls, hospitalisation and death. It begins around age 30, accelerates after 50, and becomes a serious problem beyond 65.
4. Cognitive health
Cognitive decline doesn't start at 70. The neurodegenerative changes leading to Alzheimer's begin 20-30 years before the first symptoms (Jack et al., Lancet Neurology, 2013, PMID: 23391427). By the time frequent forgetfulness appears, significant brain tissue has already been lost.
What protects the brain: aerobic exercise (increases BDNF — brain-derived neurotrophic factor), quality sleep (the glymphatic system clears toxic metabolites during deep sleep), intellectual stimulation and social connection.
5. Emotional stability and social connection
The Harvard Study of Adult Development, the longest-running longitudinal study in history (started in 1938, with over 85 years of follow-up), found that the quality of personal relationships at 50 predicts health at 80 better than cholesterol, blood pressure or genetics (Waldinger & Schulz, 2023). Chronic loneliness increases mortality risk by 26-32% (Holt-Lunstad et al., Perspectives on Psychological Science, 2015, PMID: 25910392).
This pillar is the most overlooked in medicine, yet its biological impact is real: social isolation raises cortisol, promotes inflammaging and accelerates telomere shortening.
From population data to your case: what is limiting your healthspan?
The common mistake is turning healthspan into an abstract number: "I am missing 12 healthy years". Clinically, the useful question is different: which system is ageing faster in you? Two people with the same chronological age may have a similar expected lifespan and still lose health through different routes.
- If the bottleneck is metabolic, you look at HbA1c, insulin, triglycerides, ApoB, visceral fat and post-meal glucose response.
- If the bottleneck is muscle and function, grip strength, lean mass, leg power, VO₂max and sarcopenia risk matter.
- If the bottleneck is inflammatory, you need hsCRP, suPAR, IL-6, sleep quality, periodontal health, microbiome signals and chronic stress exposure.
- If the bottleneck is global biological ageing, epigenetic clocks and biological age can help, as long as they are interpreted alongside real function.
That is why healthspan connects so directly with the hallmarks of ageing: it is not a vanity metric, but a way to decide which mechanisms should be measured and prioritised.
Biomarkers that predict healthspan
If healthspan is what we want to optimise, we need ways to measure it. These are the biomarkers with the strongest evidence as predictors of healthy life years:
| Biomarker | What it measures | Optimal range | Key evidence |
|---|---|---|---|
| VO₂max | Cardiorespiratory fitness | M: ≥45, F: ≥38 mL/kg/min | Mandsager et al., JAMA 2018 |
| Grip strength | Global functional strength | >50th percentile for age | Leong et al., Lancet 2015 |
| HbA1c | Glycaemic control (3 months) | <5.4% | Tabák et al., Lancet 2009 |
| hsCRP | Systemic inflammation | <1.0 mg/L | Ridker et al., NEJM 2017 |
| ApoB | True cardiovascular risk | <80 mg/dL | Sniderman et al., Lancet 2019 |
| Epigenetic age (GrimAge) | Rate of ageing | ≤ Chronological age | Lu et al., Aging 2019 |
| Body composition | Muscle/fat ratio | M: 10-20% fat, F: 18-28% | Multiple studies |
| Vitamin D | Immunity, bones, mood | 50-80 ng/mL | Holick, NEJM 2007 |
At Progevita we measure over 50 biomarkers in every programme, including epigenetic clocks, biological age interpretation and mitochondrial function tests. The difference from a standard blood panel at your GP is that these markers don't look for disease — they look for trajectory. An HbA1c of 5.6% is "within normal range" by conventional standards, but it already signals pre-insulin resistance, and acting there can prevent 15 years of metabolic decline.
Can we close the gap?
The short answer: partially, yes. The honest answer: it depends on when you start and how much you're willing to change.
The interventions with the strongest evidence for extending healthspan are not experimental drugs or trendy therapies. They're the same ones science has been validating for decades:
Exercise: the most powerful intervention
A 2022 meta-analysis (Ekelund et al., British Journal of Sports Medicine) estimated that replacing 30 minutes of daily sedentary time with moderate physical activity reduces all-cause mortality by 17%. Strength training 2-3 times per week preserves muscle mass and reduces sarcopenia risk. Zone 2 cardio (conversational intensity, 150-300 minutes/week) improves mitochondrial function and VO₂max.
Nutrition: fuel matters
The PREDIMED study (Estruch et al., NEJM, 2018, PMID: 29897866) demonstrated that the Mediterranean diet reduces cardiovascular events by 30%. But beyond the generic concept of a Mediterranean diet, what matters for healthspan is: sufficient protein (minimum 1.2-1.6 g/kg/day after 40), anti-inflammatory nutrition, postprandial glucose management and avoiding ultra-processed foods.
Sleep: the nightly reset
Chronically sleeping less than 6 hours per night is associated with 13% higher all-cause mortality (Cappuccio et al., Sleep, 2010, PMID: 20469800). Deep sleep is when the brain activates the glymphatic system, hormones regulate and tissues repair. No supplement or treatment compensates for consistently poor sleep.
Stress management and social connection
This is not "self-help". Chronic stress elevates cortisol, promotes systemic inflammation, accelerates telomere shortening and impairs immune function. Autonomic regulation techniques (diaphragmatic breathing, cardiac coherence, meditation) have solid evidence for reducing hsCRP and IL-6.
Advanced longevity treatments
When the fundamentals are covered (exercise, nutrition, sleep, stress), longevity medicine treatments can amplify results. Intravenous NAD+ therapy restores levels of a molecule that drops by 50% between ages 40 and 60 (Massudi et al., PLoS One, 2012, PMID: 22870241). Ozone therapy activates endogenous antioxidant defences via Nrf2. Therapeutic plasmapheresis removes inflammatory proteins from blood plasma.
But none of these treatments replace the fundamentals. They're accelerators on a solid foundation, not shortcuts.
What a longevity clinic can do for your healthspan
The difference between "wanting to live better" and actually doing it usually comes down to structure. Having a medical team that measures your biomarkers, identifies your real risks, designs a personalised protocol and supports you for 12 months changes the odds.
At Progevita, the approach is exactly what we've described in this article:
- Diagnosis: over 50 biomarkers including VO₂max, body composition, epigenetic age, inflammatory profile (hsCRP, suPAR, IL-6), metabolic and hormonal panels.
- Personalised plan: not a generic package, but a protocol adapted to your results, age, fitness level and goals.
- Evidence-based treatments: NAD+ IV, ozone therapy, plasmapheresis, orthomolecular medicine, prescribed exercise — based on what your data indicates.
- 12-month follow-up: teleconsultations, plan adjustments, repeat testing to measure progress. It's not a 4-day stay and forget — it's a continuous process.
Programmes range from €1,650 (Optimization Path) to €2,850 (Perimenopause), with 4-7 night stays at the Balneario de Cofrentes (Valencia, Spain) — 200 hectares of natural surroundings with volcanic thermal waters at 40°C, 50+ medical professionals and over 120 years of history.
Frequently asked questions
What's the difference between healthspan and lifespan?
Lifespan is the total duration of life. Healthspan is the portion spent healthy, functional and independent. In Spain, the average gap is 12 years: 84 years of total life versus 72 healthy years (Eurostat 2024, WHO 2019).
How is healthspan measured?
At population level, the WHO's HALE (Health-Adjusted Life Expectancy) or Eurostat's Healthy Life Years are used. At an individual level, biomarkers like VO₂max, grip strength, body composition, epigenetic clocks, inflammation markers and metabolic function are combined to estimate biological age versus chronological age.
What's the most important biomarker for predicting longevity?
VO₂max. A Cleveland Clinic study of 122,007 people (Mandsager et al., 2018) found cardiorespiratory fitness predicts mortality better than smoking, hypertension or diabetes. Each 1-MET increase is associated with 13% lower death risk.
At what age should I start tracking longevity biomarkers?
Ideally from age 30-35. Many deterioration processes (insulin resistance, muscle loss, NAD+ decline) begin decades before symptoms appear. The earlier you establish a baseline, the sooner you can detect negative trends and act.
Can the healthspan-lifespan gap be reduced?
Yes, though not completely. The interventions with the strongest evidence are: regular exercise (especially strength + zone 2 cardio), Mediterranean diet, 7-8 hours of sleep, stress management and social connection. Longevity treatments (NAD+ IV, ozone therapy, plasmapheresis) can amplify these effects when applied on a solid foundation of habits.
How much does it cost to measure your biological age?
It depends on depth. A standalone epigenetic clock test can cost €200-400. An in-depth programme like Progevita's (50+ biomarkers, medical consultations, advanced diagnostics, treatments and a 12-month follow-up plan) starts from €1,470 with accommodation included.
Biohacking only makes sense when it improves healthspan, not when it collects data without direction. For that filter, read what biohacking really is and how to tell science from marketing.
References
- Garmany A, Yamada S, Terzic A. Longevity leap: mind the healthspan gap. NPJ Regenerative Medicine. 2021;6:57 (PMID: 34556664).
- Garmany A, Terzic A. Global Healthspan-Lifespan Gaps Among 183 World Health Organization Member States. JAMA Network Open. 2024;7(12):e2450241 (DOI: 10.1001/jamanetworkopen.2024.50241).
- Garmany A, Terzic A. Healthspan-lifespan gap differs in magnitude and disease contribution across world regions. Communications Medicine. 2025 (DOI: 10.1038/s43856-025-01111-2).
- Mandsager K, et al. Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Network Open. 2018;1(6):e183605 (PMID: 30646252).
- Leong DP, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet. 2015;386(9990):266-273 (PMID: 25982160).
- Lu AT, et al. DNA methylation GrimAge strongly predicts lifespan and healthspan. Aging. 2019;11(2):303-327 (PMID: 30669119).
- Estruch R, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. NEJM. 2018;378(25):e34 (PMID: 29897866).
- Ridker PM, et al. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease (CANTOS). NEJM. 2017;377(12):1119-1131 (PMID: 28845751).
- Sniderman AD, et al. Apolipoprotein B particles and cardiovascular disease. Lancet. 2019;393:350-360 (PMID: 30712900).
- Holt-Lunstad J, et al. Loneliness and Social Isolation as Risk Factors for Mortality. Perspectives on Psychological Science. 2015;10(2):227-237 (PMID: 25910392).
- Waldinger RJ, Schulz MS. The Good Life: Lessons from the World's Longest Scientific Study of Happiness. Simon & Schuster, 2023.
- López-Otín C, et al. Hallmarks of aging: An expanding universe. Cell. 2023;186(2):243-278 (PMID: 36599349).
- Massudi H, et al. Age-Associated Changes in Oxidative Stress and NAD+ Metabolism in Human Tissue. PLoS One. 2012;7(7):e42357 (PMID: 22870241).
This article is for informational purposes and does not replace individual medical advice. To design a longevity plan tailored to your profile, consult a qualified healthcare professional.
Want to know how many of your life years will be healthy years? Start with an in-depth assessment at Progevita — Balneario de Cofrentes, Valencia, Spain.