Epistemic Status: This text was part of my application to Charity Entrepreneurship, so it was done in a relatively short time-frame. I decided to write about Longevity, simply because it is the field I have done the most independent thinking on, not necessarily because I believe it is the most effective. I do believe though that it is currently too early to tell and more investigation - especially with a longtermist lens - should be done. It could also be a massively ambitious project that can easily absorb large amounts of funding. 

Delaying Aging

The problem of aging

Today, every person alive spends on average 9.2 years^[1] before the end of their life in a frail and disease-ridden state: caused by e.g. cancer, Alzheimer’s or COVID-19^[2]. This end-of-life morbidity is primarily caused by one underlying process: biological aging. Aging has many second and third-order effects, ranging from changing the workforce dynamics of industrial nations^[3], increasing injustice between rich and poor^[4], to directly increasing health care spending and hindering GDP growth^[5]. But at its core, it is the largest ongoing humanitarian crisis, one that will only grow worse with many developing countries entirely unprepared for an aging population. 

Scale

About 30% of all disease-adjusted life years (DALY) can be attributed directly (like Alzheimer’s or stroke) or indirectly (like falls) to aging.^[6] Aging is therefore not only the most common cause of death, it is the single biggest cause for human suffering. This number will only increase the more developed the world becomes. In theory, the DALYs averted per increased year of healthspan will approach 8 billion, or rather 1 times the population. This could make aging science, basically multi-purpose preventative medicine, the most cost-effective human health intervention - even excluding all flow-through or long-term effects.

Current work in the field 

The scale, tractability and profitability of aging research has been recognized by many state and private actors. The Bank of America estimates an industry market cap of 600 billion $ in 2025 . Directly targeting aging is pursued by about 50 labs and 150 companies (estimated by the author), with a significant increase in funding since the start of the COVID pandemic.^[7] This is good news for increasing the chance of medical breakthroughs but makes it more challenging to find opportunities for altruists. 

Possible tractable interventions

As outlined above, direct work on accelerating medical breakthroughs seems at least in principle covered by other actors. But this ignores that there are already known interventions worth distributing and that at least according to historical precedence eventual breakthroughs will not necessarily be distributed quickly, widely, fairly or efficiently. Therefore, one can still expect to find a lot of low-hanging fruits worth pursuing, for example:

Incentivising exercise

The only proven intervention that can increase average healthspan by multiple years is high-intensity exercise.^[8] But those who would benefit the most, poor and older people, are most excluded by the private market, especially in developing nations. Possible campaigns include public outreach, lowering taxes for exercise providers, incentivising more infrastructure and programs that reach the uninsured.

Fighting smoking 

Smoking not only kills due to an increase in the likelihood of lung cancer, it also increases the rate of Alzheimer’s and diabetes, as it accelerates biological aging.^[9] Any work in this field can be used to demonstrate the malleability of aging to public officials. 

Summary

Similarly to how the germ theory of disease led to the discovery and implementation of many simple interventions like washing hands or vaccines, the theory that aging-related diseases are actually aging-caused, might lead to the next big jump in global life expectancy. Accelerating, distributing and incentivizing this research might therefore yield many possible cost-effective programs.

[In case you are interested, in the end I didn't make it into CE, but this work test was not the last round.]

1. ^{^}

   Garmany, A., Yamada, S. & Terzic, A. Longevity leap: mind the healthspan gap. npj Regen Med 6, 57 (2021).

2. ^{^}

   Santesmasses, D., Castro, J.P., Zenin, A.A., Shindyapina, A.V., Gerashchenko, M.V., Zhang, B., Kerepesi, C., Yim, S.H., Fedichev, P.O. and Gladyshev, V.N. COVID-19 is an emergent disease of aging. Aging Cell (2020). 

3. ^{^}

   Germany’s population by 2050. Results of the 11th coordinated population projection (2006).

4. ^{^}

   Office for National Statistics, Health state life expectancies by national deprivation deciles, England: 2017 to 2019 (2021).

5. ^{^}

   Scott, A.J., Ellison, M. & Sinclair, D.A. The economic value of targeting aging. Nat Aging 1, 616–623 (2021).

6. ^{^}

   Global Burden of Disease (2019)

7. ^{^}

   Longevity investment 2021: from Seed to SPAC (2021).

8. ^{^}

   Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Netw Open. (2018).

9. ^{^}

   Mamoshina, P., Kochetov, K., Cortese, F. et al. Blood Biochemistry Analysis to Detect Smoking Status and Quantify Accelerated Aging in Smokers. Sci Rep 9, 142 (2019).