Healthy longevity, or healthspan, refers to the years lived without disabling disease or loss of independence, as opposed to lifespan alone. In France, in 2024, a 65-year-old woman could expect to live another 23.6 years, 11.8 of them without disability; a man 19.9 years, 10.5 of them without disability (DREES). Narrowing this gap is the very purpose of prevention.
What is healthy longevity?
Healthy longevity is the part of life lived without lasting limitation in daily activities. The term healthspan contrasts with lifespan: living a long time and living a long time in good health are two distinct goals; the second does not follow from the first.
The World Health Organization (WHO) points out that by 2030, one in six people in the world will be aged 60 or over, and that the share of people over 60 will rise from 12% to 22% between 2015 and 2050. It also notes that “the proportion of life spent in good health has remained broadly constant, implying that the additional years are lived in poor health.” The most common conditions with age, according to the WHO: hearing loss, cataracts, osteoarthritis and back pain, chronic obstructive pulmonary disease, diabetes, depression, dementia.
In France, the reference indicator is disability-free life expectancy (espérance de vie sans incapacité, EVSI), calculated by DREES, the research, studies, evaluation and statistics directorate of the French health and social affairs ministries. It corresponds to the “number of years a person can expect to live without being limited by a health problem in the activities of daily living,” based on the limitations reported in the Statistics on Income and Living Conditions (SRCV) survey conducted by INSEE, the French National Institute of Statistics and Economic Studies. As a self-reported indicator, it measures perceived limitations, not a diagnosis.
What is disability-free life expectancy in France?
In 2024, at age 65, disability-free life expectancy was 11.8 years for women and 10.5 years for men, for a total life expectancy at that age of 23.6 and 19.9 years (DREES, Études et Résultats no. 1363, January 22, 2026). In other words, about half of the remaining years at 65 are lived with a limitation.
| Indicator | Women | Men | Source |
|---|---|---|---|
| Life expectancy at birth (2025, provisional) | 85.9 years | 80.3 years | INSEE, January 13, 2026 |
| Disability-free life expectancy at birth (2024) | 64.1 years | 63.7 years | DREES, ER 1363 |
| Life expectancy at 65 (2024) | 23.6 years | 19.9 years | DREES, ER 1363 |
| Disability-free life expectancy at 65 (2024) | 11.8 years | 10.5 years | DREES, ER 1363 |
| Years lived with disability after 65 (difference) | 11.8 years | 9.4 years | Calculated from the rows above |
Over the long term, disability-free life expectancy at 65 “has increased by 1 year and 9 months since 2008, for women and men alike.” But most of this gain predates 2019: since then, “the indicator has increased by only 4 months for women and 1 month for men.” The gap between women and men is also much smaller for disability-free years (1.3 years) than for total life expectancy (3.7 years): women live longer, but spend a larger share of those years with limitations.
The challenge, both collective and individual, is to bring the curve of healthy years closer to that of years of life: demographers call this the “compression of morbidity.”
What does prevention change for healthy longevity?
Prevention acts on both curves: it delays the chronic diseases that shorten life and those that limit it. The most telling data come from large cohorts.
In the United States, Li and colleagues (Circulation, 2018) defined, in two large cohorts of health professionals, five healthy lifestyle factors: never having smoked, a body mass index between 18.5 and 24.9 kg/m², at least 30 minutes per day of moderate to vigorous physical activity, moderate alcohol consumption and a good-quality diet (top 40% of a diet score). At age 50, projected life expectancy was 43.1 years in women combining all five factors versus 29.0 years in those with none, a difference of 14.0 years; in men, 37.6 years versus 25.5 years, a difference of 12.2 years. These are associations observed in a specific American population, not a guaranteed gain for an individual; they give the order of magnitude of the weight of lifestyle.
The WHO points out that most cardiovascular diseases, the leading cause of death worldwide, “can be prevented by addressing behavioural and environmental risk factors.”
Healthy longevity is not just about the heart, however. After 60, it also depends on organized screening programs, vaccinations, fall prevention, nutrition, hearing, vision and social connection, all topics that the prevention check-up explores at ages 60 to 65 and 70 to 75.
Which healthy longevity levers are proven?
The proven levers are those whose effect has been measured on concrete health events, in randomized trials or large cohorts: smoking, physical activity, diet, alcohol, weight, screening, and management of cardiovascular and metabolic risk factors.
| Lever | Practical benchmark | What the data say | Source |
|---|---|---|---|
| Not smoking, quitting smoking | Nicotine replacement therapy, support | “After one year without tobacco, the risk of myocardial infarction is halved”; quitting “increases life expectancy” | French National Health Insurance (ameli) |
| Physical activity | At least 150 minutes per week of moderate intensity; the equivalent of half an hour of brisk walking per day | 31% of adults worldwide were physically inactive in 2022 | WHO; ameli |
| Mediterranean diet | Vegetables, fruit, legumes, whole grains, olive oil, nuts, fish; ameli benchmarks: 5 servings of fruit and vegetables per day, fish twice a week, processed meats 150 g per week at most | PREDIMED trial: 7,447 participants aged 55 to 80, median follow-up 4.8 years, major cardiovascular events reduced (hazard ratio 0.69 with olive oil, 0.72 with nuts) | Estruch et al., NEJM, 2018; ameli |
| Alcohol | No more than 10 standard drinks per week and no more than 2 drinks per day | National guideline adopted by French National Health Insurance | ameli |
| Weight and waist circumference | BMI between 18.5 and 24.9 kg/m² in the Li et al. study; waist circumference below 80 cm (women) and 94 cm (men) | A common factor in diabetes, hypertension and cardiovascular disease | Li et al., 2018; ameli |
| Blood pressure, cholesterol, blood glucose | Measure, then decide with the doctor | Modifiable risk factors for cardiovascular disease and diabetes | ESC 2021; HAS |
| Organized screening programs and vaccinations | Breast cancer and colorectal cancer from 50 to 74 every two years; cervical cancer from 25 to 65; adult vaccine boosters | Secondary prevention: detecting early to limit disability | French National Health Insurance |
These levers reinforce each other: physical activity acts on blood pressure, blood glucose, weight, sleep and mood all at once. The articles on physical activity and diet and nutrition detail the French guidelines.
Longevity, biohacking and medicine: where is the debate?
The debate pits two logics against each other: biohacking, which self-experiments with interventions (supplements, fasting, hormone protocols, cold exposure, repeated testing) to “optimize” one’s aging, and preventive medicine, which only recommends what has a demonstrated benefit on health events. Our position is measured: curiosity is legitimate, measuring is not a problem in itself, but intervening must remain proportionate to the evidence.
Three remarks. First, for most interventions promoted in the name of longevity, there is, to our knowledge, no randomized trial showing an effect on lifespan or disability in humans; the data come from animal models, intermediate markers or observations. Second, access: since early 2026, the French press (franceinfo, “Le luxe de prévenir” [The luxury of prevention]; Maddyness, March 2, 2026) has been questioning check-ups costing several thousand euros that are not reimbursed, whereas the people furthest from the healthcare system are those whose healthy longevity is most threatened. Finally, history: Billaud and Guchet (médecine/sciences, 2015) point out that the great advances in health came from making care universal, and warn against the “utopian” dimension of the promises of personalized medicine.
This does not condemn personalized health. It sets a rule for it: a test or an intervention is justified if it can change a useful decision, at an acceptable cost, within the care pathway. This is quaternary prevention, which we develop in our personalized health section.
What do metabolic age tests measure?
“Biological age” tests compare your profile with that of a reference population and derive a gap with your actual age; they measure a trajectory, not a remaining lifespan. There are two families. Epigenetic clocks use DNA methylation, whose acceleration measured in the blood is associated with lifespan (Horvath and Raj, Nature Reviews Genetics, 2018). Metabolomic age applies the same logic to blood biomarkers measured by nuclear magnetic resonance; it builds on work such as that of Deelen and colleagues (Nature Communications, 2019): in 44,168 people from twelve cohorts, fourteen metabolic biomarkers predicted 5- and 10-year mortality better than conventional risk factors.
What these tests do not do: establish a diagnosis, provide an official standard, or guarantee that a favorable gap is protective. Their value, in our view: making visible, over several years, the effect of a lifestyle change in a person who has decided to act. Definition, evidence and limitations are detailed in our article on metabolic age, and the technique in NMR metabolomics.
What position should we take, as doctors?
Four points. Healthy longevity is built first with the proven levers, accessible to everyone and mostly free: not smoking, moving, eating Mediterranean-style, limiting alcohol, sleeping, screening for what should be screened. The reimbursed pathway provides the framework: the prevention check-up at the four key ages, 30 to 45 minutes fully covered (100%) by French National Health Insurance, leads to a Personalized Prevention Plan sent to the regular doctor. Personalized measurements have their place if they change a decision or motivate follow-up, never as an end in themselves. Finally, we do not promise “years gained”: cohorts describe populations; the only trajectory that matters is yours, followed with your doctor.
Key takeaways
- Healthy longevity (healthspan) is the part of life lived without limitation; in France, in 2024, at age 65 it was 11.8 years for women and 10.5 years for men, out of a life expectancy of 23.6 and 19.9 years (DREES).
- It has progressed slowly since 2019; the WHO observes that the share of life spent in good health remains broadly constant worldwide.
- The proven levers are smoking, physical activity, the Mediterranean diet, alcohol, weight, screening and management of cardiovascular and metabolic risk factors.
- Biohacking promises more than it proves; preventive medicine only intervenes on evidence, within the care pathway.
- Metabolic age tests measure a trajectory, not a remaining lifespan; they replace neither a check-up nor a doctor.
What Sokrate lets you do
The Sokrate service prepares your prevention check-up online using an adaptive self-assessment questionnaire covering nine health dimensions; a doctor writes and signs your Personalized Prevention Plan, which is sent to your regular doctor (médecin traitant) unless you object. The check-up carried out by an authorized professional is fully covered (100%) by French National Health Insurance, with no upfront payment. As an option, a metabolomic analysis of 249 biomarkers, interpreted by a doctor, lets you track your trajectory over time. Join the waitlist.