driving, or some other aspect of daily life. By the age of 60, graduates are in significantly better health than non-graduates. At 85, over half of graduates are still living happily, with no functional limitation.27 We will see in Chapter 5 that some highly educated people also seem to have ‘cognitive reserve’, which can be protective against Alzheimer’s.
It is not clear exactly why education is so vital. Some experts argue that education is formative. It may make us better at planning, and exercising self-control, which may feed into healthier lifestyle choices. It also affects the kind of jobs we do. Lower-skilled jobs can be physically taxing, emotionally stressful and – it turns out – bad for health.
The legendary Whitehall II Study of British civil servants,28 led by the epidemiologist Sir Michael Marmot in the early 2000s, found that staff doing the lowest skilled jobs, like messengers and doorkeepers, had a mortality rate three times higher than permanent secretaries and top managers. They also had far higher levels of cortisol, the stress hormone associated with coronary heart disease.29 Marmot’s findings may seem counter-intuitive, but they make sense. Senior executives may work longer hours and face gruelling decisions, but support staff have lower social status, far less control over their working environment and probably a longer commute.
Life has never been fair. But as we live longer, less-educated and poorer people are becoming ‘Old-Old’ earlier than richer and more educated ones, and the gap is widening.30 Professor James Nazroo, at the University of Manchester, has found that when they turn 80, the richest third of Britons is only just beginning to experience the limitations that people in the poorest third have been suffering from 70.
Narrowing that gap, providing people with more equal life chances, must surely be one of the most important social justice missions of our times. The rich and well educated already know some of the secrets to making the most of Extra Time – and there are more in this book. But unless we spread that knowledge to everyone, we will all be the poorer.
One country is leading the way. The Japanese government has set itself an explicit aim of ‘extending Healthy Life Expectancy more than the increase of Average Life Expectancy’ through its Health Japan 21 initiative.31 Ministers are working to actively combat what they call ‘lifestyle-related diseases’ with detailed targets for everything from salt intake to blood pressure levels, to the number of steps people take every day. Different provinces run programmes encouraging people to stay fit, reduce their smoking and drinking, and to take care of themselves.
These schemes are getting traction. The average Japanese man gained an entire extra year of healthy life between 2013 and 2016 (women gained six months).32 This was a win for Extra Time, since life expectancy at birth rose by nine months for men and six months for women in the same period.33
These schemes build on the strong Japanese tradition of self-reliance. Many Japanese people I have interviewed do not want to be a burden to their children as they age, nor do they expect the state to do everything. They are willing to try and ditch bad habits. If other countries emulate this approach, tackling behaviour throughout the life course, not just at the beginning or the end, we might close the gap.
You’re Only as Old as You Feel
Spring Chicken, a British start-up which sells home gadgets to the elderly, conducted a survey which asked: ‘What age do you feel – on the outside, and on the inside?’34 Most people between 50 and 90 reported feeling a few years younger than their actual age on the outside, but considerably younger on the inside. The older the respondents, the bigger the gap. Eighty-year-olds in the survey reported that they felt about 50 years old on the inside. Are they delusional, or might they just be on to something?
‘People will say things like, “I still feel 30, it’s just my knees are letting me down,”’ says Anna James, who founded the business after a fruitless and frustrating search for gadgets to help her father, who is 74 and has Parkinson’s. Her father now works in her business and tests out products, yet even he refuses to see himself as needing help. In 2017, James realised her father was getting to the point where he was going to need an electric wheelchair, but he wouldn’t consider it. ‘You’ve got to battle with the psyche,’ she says. So she asked him to test out electric wheelchairs and write a blog about his favourite model. Eventually, the time came. ‘Could I borrow that wheelchair for a few weeks?’ he asked. ‘He took it on a cruise with my mother,’ she says, ‘and ended up selling one to another guest on board!’ This was a man who was still young and dynamic inside – and able to make a sale.
Reasons to Be Cheerful
Extra Time has given us an entirely new stage of life: the stage of the ‘Young-Old’. We need to catch up with this new reality, stop lumping everyone from 60 to 100 together, and accept that it is normal to be vibrant and capable in your seventies. Media editors should take a look at how they portray ‘pensioners’, and question whether they are falling for a narrow narrative about youth. Governments must raise retirement ages in line with life expectancy and make this explicit: as part of signalling that the average lifespan has changed. And all of us need to challenge our own attitudes. Prejudices we build up against the ‘old’ will only hurt us when we reach that stage ourselves.
One vital question is what proportion of the over-60s will be ‘Young-Old’, thriving and capable like stewardess Bette Nash, and how many will be ‘Old-Old’, needing care, like her sister. On the answer to that question rests the future of our economies and the cohesion of our societies. If there are too many ‘Old-Old’, our welfare states and healthcare systems will be overloaded and younger generations will bear the burden. But if we can help people to stay healthy and productive, if we can abolish prejudice, we could see a new era of extended middle age, with most people staying vital almost to the end.
Later in this book I describe breakthroughs in genetics and neuroscience which may transform the youthspan, elongating our ‘Young-Old’ period and limiting the ‘Old-Old’. But we don’t have to wait for those. We already hold two of the keys in our hands to improving our Extra Time: diet and exercise.
If exercise and diet was a pill, we’d all be taking it
WHAT IF THE KIND of ageing we dread is not, in fact, normal? What if our modern accumulation of chronic diseases, followed by a prolonged twilight zone, are largely a consequence of Western habits, which have distorted the true path of biological ageing?
It’s generally assumed that how we age is down to luck and genetic inheritance. But for most of us, genes write only 20 per cent of our fate. The other 80 per cent is down to environmental factors: what we eat and drink, how stressful our lives are, whether we live amid pollution, whether we exercise (and how often).
This means that we already hold many of the keys to Extra Time in our own hands. Decades of research show that we don’t have to succumb to deterioration from the age of 50, our arteries and joints gradually stiffening, and puffing our way into chronic disease. We can fight to stay relatively youthful right up until 90, and even reduce our risk of dementia, by eating better and becoming far, far more active. A raft of studies around the world have, in fact, identified exercise as the single most powerful predictor of whether we will age well.1
‘Miracle Cure’,
