Fewer Checklists, More Pathways What An 80-Year Study Reveals About Longevity

by Howard S. Friedman and Leslie R. Martin

In 1921, Stanford research psychologist Lewis Terman gathered a group of 1,500 gifted California children for a long-term study on intellecutal leadership. Terman and his successors assessed the participants’ social, psychological and physical development over the course of eight decades.

Almost 70 years after the study began, research psychologist Howard S. Friedman discovered Terman’s work – and recognized that the accumulated data offered an unprecedented opportunity to answer a question that hadn’t been Terman’s concern: What complex interaction of personality traits, life choices, work histories, health-related behaviors and other factors determine healthy aging and longevity?

After two decades of further research, Friedman and coauthor Leslie R. Martin report their findings in The Longevity Project: Surprising Discoveries for Health and Long Life From the Landmark Eight-Decade Study (New York City: Hudson Street Press, 2011). The following excerpts highlight their critique of short-term “to do” list for health promotion and their emphasis on the ways individual character, social patterns and personal habits across a lifetime create varied pathways to longevity.  

What have we learned about how to stay healthy and what individuals can do? First, take a deep breath. Second, take a deeper perspective. The lives of the Terman participants revealed that it is not enough to focus on our bodies. Although individual bodies become ill, and doctors treat patients and not the friends and families of the patients, it is equally important to focus on families, work and social relations.

Our research findings point to the startling conclusion that many of the most cherished recommendations and policies about health are misguided. This eight-decade study of the successful paths to health and long life suggests that traditional approaches to healthcare and health promotion have some disquieting deficiencies.

Healthcare costs are exploding while overall quality of health is static. Many scientists predict that, for the first time, expected longevity will begin decreasing. They point to the failure of individuals to follow medical advice to exercise, lose weight, sleep enough, wear sunscreen, take it easy, eat right, be properly scanned, avoid illegal drugs and take enough prescribed pills on the proper schedules. We, however, are more optimistic. After spending two decades studying the lives of the Terman participants, we see ways to turn things around.

Our findings about long life are now being tested, bit by bit, by researchers using different people – those born in later years, in different subcultures and in diverse populations. Yet the pathways to long life seem very much the same. The most recent evidence suggests that the core findings from the Terman studies are very relevant to health today.

Policy makers and laypersons alike tend to make two major conceptual errors when thinking about health and longevity. First, people tend to overestimate the importance of family biology. Your height is heavily influenced by the genes you inherit from your parents, and your eye color is determined, but predicting your own health and longevity from that of your parents is mediocre at best. Sure, tendencies toward certain diseases run in families, and some diseases have clear genetic causes. This knowledge is helpful in choosing screening tests and having an idea which warning signs to watch for. But as a predictor of whether you will have a heart attack or live a long life? The experience of your relatives is not very precise at all. Your own life path matters more.

The second error about health which we’ve described in our research is the idea that we can make a major difference in health and longevity by giving people lists of health recommendations. If you hand most patients a list of life-altering changes, they will not make them.

The Terman participants who led long lives were never handed such a list. Yet they found their ways to healthy pathways. When a society’s approach to health is dominated by threats and diseases, it pushes us to focus on things going wrong inside the individual’s body – that is, on infections, blockages, genetic aberrations, and hormonal and chemical imbalances. Our doctors then try to repair the problems. As we have repeatedly noted, for an acutely ill person, or for someone in deteriorating health, this approach can often work wonders – therein are the miracles of modern medicine. However, this approach is only part of the story, and the roads to long life are ignored at our peril.

Using data derived from the more than 80 years of the Terman study, and collecting and creating new information about the participants’ lives, health, longevity and causes of death, we have discovered many things we did not expect. We came to see the sometimes complex but nonrandom pathways that link personalities, predispositions, behaviors, social groups, work environments, and health and longevity.

In contrast to finding penicillin for infection or a clot-buster for stroke, simple “cures” for unconscientious personalities, marital instability, exposure to traumatizing stress, social isolation, workplace failures, and social-psychological anomie and estrangement are unlikely to be found in the clinic. Indeed, because individuals and their social groups change over time, the challenges likewise evolve.

When John Kennedy became president, he immediately began emphasizing the importance of physical health and the role of the government in promoting fitness. Fifty-mile hikes became a fad. This was the same year that Terman participant Dr. Ancel Keys, featured on the cover of Time magazine, told Americans that they ate too much. Now, half a century later, most segments of the American population are not only more obese but are less fit than ever. This doesn’t mean that President Kennedy’s efforts were misguided or caused today’s problems. But it does suggest that such traditional approaches are often ineffective over the long term.

Over simplified recommendations may have made things worse. A while back, fear of fat emerged, as various well-meaning experts proclaimed the consumption of fat to be the big health hobgoblin. All sorts of low-fat foods were produced and marketed. Many people increased their carbohydrate intake instead. But fat and carbohydrate metabolism in the body is complicated, and it is not all that clear that a high-carbohydrate diet is healthy as a replacement. We are not sure of all the causes, but during the years since health advisers began preaching against the eating of too much fat, the levels of obesity among Americans have increased dramatically.

Many other examples could be given of where “do this” or “don’t do that” recommendations are overly simple checklists that later turn out to be too narrow, misleading or deadly wrong. Even when the recommendations are well-founded, lists of recommendations often fail to have the intended effect. If you make a typical list of New Year’s resolutions and head out on your own, you are highly unlikely to keep them over the long term.

Most societies allocate certain budgets of money and resources to strengthen the social fabric, economic potential and mental health of their citizens – programs for education, to prevent drug abuse, to help families, to provide parks, and to offer job training and other programs to lift people out of poverty. Different pots of money and resources are allocated to healthcare, to train doctors, build hospitals, research diseases, and provide health insurance or access to care. The implicit view is that most individuals will naturally stay healthy, but if by chance they get sick, then well-trained physicians should be able to treat them.

Our many years of study of the Terman participants have led us to a different conclusion. Our studies suggest that a society with more conscientious and goal-oriented citizens, well integrated into their communities, is likely to be a society of health and long life. Of course, this will be especially helpful if the community also has clean and safe air, water and food, and good schools and safe streets; but few appreciate the extent to which mental health is the close companion of physical health. And few fully grasp the importance of helping to develop the social patterns that let each individual find an appropriate way forward, step by step.

Excerpted with permission of the publisher from Howard S. Friedman and Leslie R. Martin, The Longevity Project: Surprising Discoveries for Health and Long Life From the Landmark Eight-Decade Study (New York City: Hudson Street Press, 2011); copyright © 2011 Howard S. Friedman and Leslie R. Martin.