We can control our health destiny. But some of us have more choice than others

We all know someone who has pickled their organs in a brine of alcohol, smoked their lungs black or had a diet like Donald Trump’s and still kicked into their 80s or beyond.

Similarly, many of us know people who make the right choices by their bodies and are still befallen by ill health.

It all begs the question: how much power do we really have over our health as we age?

A group of British academics attempted to answer this question in a report titled Living Longer, Better, published in May.

The report has sensible advice, such as:

• It is never too soon (or too late) to start practising responsible self-care.
• Wellbeing involves managing stress, a positive mindset, exercise, time with loved ones and a whole foods, plant-centric diet.
• Prevention beats cure.
• Health is something we co-create every day through thousands of small decisions that compound over time.

It also includes the sweet bedtime routine of one of the report’s authors, Sir Christopher Ball.

As he is falling asleep each night, the former university chancellor does a “gratitude exercise” by making an alphabetical list of things to be thankful for: “‘Andrew (my brother), air, avocados; babies, bay trees, broccoli; children, cherries, carrots’ – until I fall asleep, usually well before ‘Wendy (my wife), water, weather’.”

So why has this report by the Oxford Longevity Project (funded by nutraceutical brand Oxford Healthspan) been called “problematic”, “wrong” and, according to Associate Professor Phillip Baker, “ethically questionable”?

The criticism centres on this claim by Ball: “The main cause of the diseases of longevity is our own behaviour, our mindset and lifestyle. At least 80 per cent of the responsibility for ill health in old age lies in how we choose to live our lives. Choose wisely!”

In his efforts to live to 111, Ball took up marathon running when he was 67 to combat high blood pressure and then, after a triple bypass at 70, worked on cultivating a positive mindset and switched to a vegan diet. Last year, he ran 10 kilometres to celebrate his 90th birthday.

It’s inspirational stuff.

“The emphasis on prevention and healthy longevity is welcome and much needed,” says Associate Professor Susanne Röhr, from the Centre for Healthy Brain Ageing, UNSW Sydney. “The report is right to argue that lifestyle and environmental factors play a substantially larger role in determining health and longevity than many people assume.”

By some accounts, approximately 80 per cent of chronic disease and premature death could be prevented by not smoking, being physically active, reducing alcohol intake and adhering to a healthful dietary pattern.

One new study of more than 68,000 adults found that compared with people who had the healthiest lifestyles, those with an unhealthy lifestyle had a 54 per cent greater risk of developing colorectal cancer (CRC) 15 years later. Those with a high genetic risk of CRC who also had an unhealthy lifestyle were 82 per cent more likely to develop it.

Genes matter, but lifestyle matters more.

“For many conditions, genes often contribute no more than 5 to 10 per cent of overall risk,” says Professor Emmanuel Stamatakis, director of the Monash Brain Park at the Turner Institute for Brain and Mental Health.

This is good news, right? Our fate is not predestined, and we have choice in our outcomes – at least, some of us do.

Specifically, those of us lucky enough to live in lovely, safe neighbourhoods where there are parks and fresh air and access to good food. Poorer neighbourhoods have almost two and a half times more fast food outlets than wealthier ones; the life expectancy of Australians with the lowest socioeconomic status is up to 25 per cent less; and, currently, about 13 per cent of Australians experience food insecurity.

“Our ‘choices’ are shaped even before we’re born,” Baker says.

Suggesting our choices exist in a vacuum skips over the reality of many people’s lives, he says. “It just places the blame (and shame) on disadvantaged individuals rather than structures and systems.”

Röhr, agrees: “People do not make choices from the same starting position. Wealth is not equally distributed across populations, and neither is health.”

This is perhaps why health posturing has become a status symbol: wealth is one of the strongest predictors of longevity and wellness is an expensive, often exclusive pursuit.

We do have choice about our behaviours – some of us just have more choice than others. Or, as George Orwell put it: “All animals are equal, but some animals are more equal than others.”

And this was what the Oxford Longevity Project skimmed over.

“A more balanced and realistic perspective would be to view healthy ageing as a shared responsibility,” says Röhr. “Societies, governments and institutions have a responsibility to create the conditions that enable health. Individuals, in turn, have a responsibility to engage with those opportunities, make informed choices where possible, and take an active role in their own wellbeing.”

Baker has a few ideas about how to make this happen and truly empower people take charge of their health, but they would require different choices by the privileged few.

That includes redistributing power, money, and resources so that the conditions for good health, such as safe housing, quality education, healthy foods and representation in political decision-making are available to everyone.

For the rest of us – those of us who do have a little or a lot of choice – the report has a useful message, says Stamatakis.

“There is always something actionable to do to improve their health destiny.”

Make the most of your health, relationships, fitness and nutrition with our Live Well newsletter. Get it in your inbox every Monday.