The Italian proposal to incorporate healthy longevity into the public health system marks a shift in approach that goes far beyond increasing life expectancy. An article published in the journal Aging outlines a roadmap for the Italian National Health Service (SSN) to begin measuring and promoting the population's functional health as a healthcare goal, based exclusively on scientific evidence and avoiding the premature adoption of technologies or therapies that have not yet demonstrated real clinical benefit.
Italy could become one of the first countries to officially integrate the concept of healthspan —the years lived in good physical and cognitive health— into its national health system. The proposal, developed by an international group of researchers and published in Aging, aims to progressively transform a healthcare model focused on treating disease into one that prioritizes preserving people's functionality and autonomy throughout their lives.
The initiative arrives at a particularly relevant moment for the country. Italy has the oldest population in the European Union: 24.1% of its inhabitants are over 65 years old, and the average age will continue to rise to around 51 years by 2050. However, this increase in life expectancy has not translated into an equivalent number of years lived in good health.
In 2023, life expectancy reached 85.4 years for women and 81.4 years for men. However, healthy life years were 69.6 and 68.5 years, respectively. This means that women spend an average of 15.8 years and men nearly 13 years living with significant limitations, disability, or loss of autonomy.
The authors stress that this gap does not necessarily equate to years with diagnosed diseases, but it does reflect one of the main challenges facing modern healthcare systems: prolonging life is no longer enough if those extra years do not preserve quality of life.
From treating disease to preserving function
The document proposes that longevity medicine should not be considered a new medical specialty, but rather a cross-cutting framework that integrates advances in geroscience, personalized medicine, prevention, digital monitoring, and healthcare innovation..
The goal would not be to replace disciplines such as geriatrics or primary care, but to complement them through early identification of unfavorable aging trajectories, reducing multimorbidity, disability, and dependence before they emerge.
In addition to the biological processes of aging, the work reminds us that functional health is deeply shaped by factors such as:
- Physical inactivity.
- Inadequate nutrition.
- Environmental pollution.
- Socioeconomic inequalities.
- Social isolation.
- Polypharmacy.
- The digital divide.
- Territorial differences in access to healthcare.
According to the researchers, the Italian health system remains predominantly hospital-based and reactive, while prevention receives a relatively small share of resources, and funding models continue to reward treating disease more than reducing long-term risk.
Five priorities for building a longevity-oriented health system
The article identifies five strategic lines to progressively incorporate healthy longevity into the public system.
Validate biological age biomarkers
The researchers consider epigenetic and proteomic biomarkers and other tools designed to estimate biological age promising. However, they insist that these must remain in the research domain until they demonstrate that they truly improve patient-relevant outcomes and that their use is safe, reproducible, and cost-effective.
Create interoperable digital platforms
The proposal includes integrating electronic health records, wearable devices, wearables and home sensors into platforms capable of providing continuous monitoring of people's functional status.
The success of these tools should not be measured by the amount of data collected, but by indicators such as reduced hospitalizations, maintained autonomy, and improved quality of care.
Modernize clinical trials
The document advocates for adaptive Bayesian clinical trials to more quickly evaluate nutritional interventions, physical exercise, cognitive programs, or pharmacological treatments.
Primary endpoints would no longer focus solely on disease but would include aspects such as resilience, onset of multimorbidity, disability, or mortality.
Incorporate explainable artificial intelligence
Artificial intelligence could help identify people at higher risk of functional decline, provided that algorithms are transparent, externally validated, respect privacy, and undergo regular audits to detect potential biases.
The authors make clear that AI must act as a clinical support tool and never replace medical judgment.
Reform medical training
The medicine of the future will require professionals better trained in healthy aging, functional assessment, prevention, management of patients with multiple conditions, and rational deprescribing when possible.
The work also calls for more rigorous public communication that distinguishes interventions backed by scientific evidence from the commercial promises proliferating around the longevity market.
Science before expectations
One of the article's most forceful messages is that biological plausibility alone is not enough to introduce new technologies into public healthcare.
The authors explicitly reject the immediate implementation of biological clocks, geroprotective drugs, predictive algorithms, or artificial intelligence tools without first demonstrating clinical utility, safety, equity, and economic benefit for the system.
In other words, any innovation must meet the same level of scientific rigor as any other medical intervention.
Italy as a laboratory for longevity medicine
The work brings together researchers from some of the most recognized institutions in aging and longevity research, including the National Institute on Aging, Stanford University, University of Miami, IFOM, Italy's National Research Council, and the European Research Institute for the Biology of Ageing.
Among the signatories are leading researchers such as Luigi Ferrucci, Fabrizio d’Adda di Fagagna, Marco Demaria, Vittorio Sebastiano, and Camillo Ricordi, alongside epidemiologist Matteo Fiore and Nicola Marino.
The project's proponents believe that Italy has unique conditions to become a national-scale testing ground. Its high proportion of aging population, a universal healthcare system, a strong scientific community, and marked regional diversity make it possible to assess whether a model focused on preserving function can improve the health of the entire population.
The goal is not to offer every citizen a biological clock or experimental therapies, but rather to build the necessary infrastructure to identify which interventions truly help preserve autonomy, prevent multimorbidity, and generate value for both patients and the healthcare system.
The proposal represents one of the most ambitious attempts to date to move longevity medicine from the research sphere into public policy. If it succeeds, it could serve as a reference for other European healthcare systems facing the same challenge: not just living longer, but ensuring those years are lived with greater health, independence, and quality of life.
