Aging is not a uniform process. Some people stay active and independent even in very old age, while others experience rapid declines in health and autonomy. These differences are not explained by biology alone. They depend on risk and protective factors that accumulate throughout life, such as cardiovascular disease, hearing or vision loss, and low education on the risk side, or good cognitive performance, functional ability, and wellbeing on the protective side.
The impact of these factors depends not only on individual behaviors but also on broader social and environmental conditions. Healthy aging is facilitated by access to safe environments, preventive healthcare, and educational opportunities, whereas structural barriers such as socioeconomic inequality, weak democratic institutions, and fragile health systems can restrict these benefits and make healthy aging unevenly distributed across populations.
To better understand how these individual and social factors interact, our team analyzed data from more than 160,000 people in 40 countries across four continents, in a study recently published in Nature Medicine. We developed a measure called the biobehavioral age gap (BBAG), which estimates a person’s biological age based on protective factors such as good cognitive performance, preserved functional ability, and higher education, and risk factors including heart disease, hypertension, diabetes, hearing or vision loss. We identified the factors that accelerate or delay aging, and how inequalities across regions shape these trajectories.
The results revealed marked regional disparities. Participants living in disadvantaged contexts and lower-income countries showed more accelerated aging, reflecting the effects of socioeconomic inequality, weaker democratic institutions, and limited access to protective resources such as quality education and preventive healthcare. These findings highlight serious challenges, but they also point to opportunities for action, since many of the factors associated with aging can be modified.
Among the protective factors, functional ability stood out as one of the strongest, since maintaining independence in daily life is key for autonomy and quality of life. Education and cognitive performance also showed a powerful protective role; engaging in cognitively stimulating activities, pursuing learning at any age, and developing new skills can help maintain brain health. Other modifiable elements, such as physical activity, management of cardiovascular risk factors like high blood pressure, cholesterol, and diabetes, and early detection of hearing and vision problems, further demonstrate that healthy aging is within reach when individuals have the resources and environments to support these behaviors.
However, individual actions alone are not enough, especially in contexts where inequality, environmental hazards, and weak health systems make healthy aging a privilege. Public policies and strong institutions are needed to create the conditions that allow personal efforts to succeed. Expanding access to quality education at all ages, investing in preventive healthcare that manages conditions like hypertension or diabetes early, and reducing risks such as air pollution can make healthier lives possible for many more people. Democratic institutions are equally important because they help ensure fair resource distribution, protect vulnerable groups, and support long-term planning so that the benefits of healthy aging are shared across entire populations.
Our findings highlight that slowing the pace of aging requires coordinated action. At the individual level, preserving functional ability, staying physically and cognitively active, and managing cardiovascular and sensory health are key strategies. At the collective level, societies must create environments that make these behaviors possible and sustainable. Bridging personal efforts with social responsibility is essential to ensure that longer lives are also healthier and more equitable.
The poster figure was created by ChatGPT with oversight from the authors.