FOCUS FORWARD: Improving Lifespan and Healthspan in West Virginia and Beyond
By Dr. Clay Marsh
Chancellor and Executive Dean
West Virginia University Health Sciences
The West Virginia Public Education Collaborative and the Claude Worthington Benedum Foundation hosted “ Focus Forward: Long Live West Virginia” April 22, 2025, in Morgantown, West Virginia. An annual event, sessions are uniquely designed to link education and economic development. More than 550 attendees came together for the 2025 event to with meet with national, state and local experts and decision makers to explore the intersection of health, wellness and economic mobility while networking and forging meaningful connections. Dr. Clay Marsh shares a follow-up thought piece on how West Virginia, and the nation, can begin to improve health and longevity for the long-term.
Premise
To reduce rising healthcare costs and improve outcomes in West Virginia and the United States, we need to improve the health of our population. The U.S. has the largest population of citizens suffering from chronic health diseases, severely impacting both the length and quality of lifespan of its citizens. The World Health Organization reported that, even with gains in lifespan (the length of years a person lives) over the past 25 years, there is a growing gap of 9.6 years in healthspan ( high quality lifespan), compared to lifespan in the 183 countries the WHO oversees. Of note, the U.S. has the largest global lifespan to healthspan gap at 12.4 years. The U.S. ranks #48 internationally for lifespan of its population, while West Virginia ranks #49 in state rankings. Comparing lifespan by West Virginia county from the longest, Monongalia County, to the shortest, McDowell County, yields a 12-year difference (78 years for Monongalia County to 66 years for McDowell County). Improving the lifespan and healthspan of West Virginia residents is critical economically, socially, and medically.
Statement of the Problem
The U.S. spent $4.9 trillion on healthcare in 2024, equating to over $14,000 per person. Projecting healthcare spending in the U.S. using the current rate of growth, it is estimated that healthcare in America will cost $7.2 trillion by 2032. According to The Commonwealth Fund, despite spending over twice the yearly average of other Western countries on healthcare, the U.S. has the worst durable health outcomes for their citizens of all Western countries. To improve these metrics, a renewed focus on population health and wellbeing is critical. However, agreeing on a quantitative definition of health is problematic.
Health is defined by the relationship of chronological age to biological age. To establish the understanding for how to live long and vital lives, we will assess epidemiological studies that follow people who live well with maintained physical and mental capacity into their 80s and 90s to identify critical behaviors for long and healthy lives (healthspan). These studies include The Blue Zones; the Harvard Adult Development Study; The Longevity Project, and others.
The following strategies are important in long- and well-lived people (compendium of Longevity Studies) and appear to be factors that can reduce our biological age:
- Maintaining strong social connections and relationships.
- Maintaining purpose (a reason to get out of bed each day).
- A mindset of love, safety, curiosity, and abundance.
- Reduce chronic stress and find psychological safety in your life.
- Exercise that includes at least 2,800 steps per day with maximum benefit around 8,800 steps per day – with added resistance or strength training.
- Sleep averaging 6 - 8 hours per day.
- Avoiding processed sugar and ultraprocessed foods. More plant-based diet elements.
- Educational level – equates to a 2% reduction in early mortality per year of school completed.
We will also review studies that delineate drivers of accelerated biological age, including the Adverse Childhood Experience Study; Deaths of Despair and Hopelessness; University of California at San Francisco’s Stress and Health Research Program; The Impact of Social Isolation and Loneliness; as well as the impact of education on longevity.
The Opportunity of Our Time
“There are more things in Heaven and Earth, Horatio, than are dreamt of in your philosophy.”—Shakespeare
As a lifelong West Virginian and a physician who has spent decades studying what it means to live long and well, I often reflect on a simple but powerful question: What truly determines the length and quality of our lives?
In the United States—and especially in West Virginia—we are living longer than our grandparents did, but not better. On average, Americans spend over 12 years of their lives in poor health. This finding is more dire in West Virginia, as the gap in life expectancy between counties is as wide as 12 years.
These numbers represent a challenging reality, but they also present an incredible opportunity. If we understand the drivers behind this gap—and act on them—we can transform lives, communities, and generations.
A New Definition of Health and the Promise of Change
In 2024, we spent nearly $5 trillion on healthcare in the U.S., yet our outcomes continue to rank near the bottom among developed nations. We’re not getting healthier—we’re getting more reactive. We wait until people are sick to intervene, rather than investing in what keeps people well. This system is unsustainable, but it’s also an indicator that we need to refocus our efforts on the things that matter to health and wellness.
True health, wellness and well-being encompass meaning, connection, purpose, and equity. It’s about how we live, not just how we survive. We can no longer afford to separate healthcare from life itself.
Critical Research in the Factors That Age Us Prematurely
The greatest threats to our health are often invisible—and they often begin early in life. Here’s what the science tells us:
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1. Adverse Childhood Experiences (ACEs)
The Adverse Childhood Experience Study (ACE) engaged 17,000 respondents that were insurance recipients of Kaiser Permanente. Each of these individuals was given a 10-question survey about the impact of various childhood trauma on their lives and health. Of note, the questionnaire asked respondents to answer the survey questions as they remember from the age of 18 years and younger.
The average ACE score in America is 1.8, and at that score the risk of every chronic illness – cancer, heart disease, diabetes, suicide, overdose, obesity – is higher than for those with scores of zero. In the absence of intervention, as ACE scores increase to 4, the lifespan of the respondent can be reduced by up to 4.7 years. With a score of 6, a reduction of 20 years in lifespan can be experienced. In addition, the higher the childhood trauma score, the more likely respondents were overweight and obese. Of note, comparing the lowest life expectancy county in West Virginia to the longest-lived county in the country (Summit County, Colorado) discloses a 17-year difference in lifespan. This shows us why resilience and healing must begin early—and why trauma-informed care is vital to health systems.
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2. Deaths of Despair and Hopelessness
Long before the COVID-19 pandemic, we were facing another epidemic—what economists call “deaths of despair.” By 2018, 158,000 Americans died annually from despair-associated causes, which included suicide, overdose and chronic liver disease from alcohol use.
Two Princeton economists, Professor Anne Case and her husband and Nobel prize winner in Economics, Sir Angus Deaton, found that a group of 45-55- year-old, non-Hispanic Caucasians were dying at such a high rate that they reduced the U.S. life expectancy. These individuals received less education, having earned a high school diploma or less, and were dying at a rate not seen since the peak of the HIV/AIDS epidemic. Some drivers for these deaths included the lack of training for knowledge-based jobs, the loss of low skilled jobs in Appalachia and in the Ohio River Valley to lower cost overseas labor markets, and the increased cost of health care to employers and employees. While this epidemic started in Appalachia and the Ohio River Vally, the epidemic is now widespread in the U.S. today ( The Economist, Jan 6, 2024). This study demonstrates the power of hope and belief on health outcomes and lifespan. Of note, the difference between hope and optimism is that with hope, one is not only positive about the future but believes they possess the ability to positively alter their future life.
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3. Stress Perception and Lifespan
An important study on longevity was performed in San Francisco, California, led by the Nobel Prize winner Dr. Elizabeth Blackburn and behavioral psychologist Elisa Epel. In this study, researchers assessed women who were on average 38 years old, were well-educated, had a high standard of living and lived in San Francisco. The women were divided by their perceived chronic stress ratings into those with the highest and lowest scores, and their white blood cells were isolated and tested for biological age. Dr. Blackburn’s work focuses on studying telomeres, the caps on the ends of DNA that are clipped during each cellular replication. By measuring the length of these telomeres, Dr. Blackburn could estimate the biological age of the test subject.
The results were striking. Subjects with the highest intensity and duration of stress weighed significantly more than subjects with the lowest stress scores (BMI 28.6 vs 24) and had significantly shorter telomeres than women with the lowest stress scores. This difference in telomere length translated to a biological age of 9-17 years older in the most highly stressed subjects than in the subjects with the lowest stress scores. This is even more remarkable as the woman in this study had an average chronological age of 38 years old. The interpretation is that the simple perception of seeing one’s life as chronically stressful can drive accelerated biological aging and weight gain.
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4. Loneliness and Isolation
The former surgeon general Dr. Vivek Murthy conducted a listening tour of the U.S. before he became surgeon general for the second time and found that the epidemic of social isolation and loneliness was a serious and underappreciated medical issue in our country. Dr. Murthy considers loneliness a public health crisis, and he’s right. Loneliness can shrink lifespan by 10–15 years. It weakens the immune system, drives inflammation and disproportionately affects our young people, with 40–60% of 18–25-year-olds reporting being lonely.
Dr. Murthy pointed out that feeling chronically isolated and lonely impacts health in the same negative way as smoking 1 pack of cigarettes daily for 15 years. The impact is a reduction of lifespan by 10-15 years and of immune system function, while simultaneously increasing systemic inflammation, predisposing these individuals to infectious and chronic illnesses.
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5. Education’s Protective Effect
The same Princeton University researchers, Dr. Anne Case and Sir Angus Deaton, studied U.S. death certificates and found that Americans with a four-year college degree lived 8.5 years longer than those achieving only a high school degree. In comparing college graduates to those without a high-school degree, the lifespan gap widened to 11 years. A separate study found for every year one extends their education, the risk of premature death reduces by 2%. Thus, a college graduate would have a 32% reduced risk of premature death, while another person with a high-school education would only have a 24% reduction.
The reason for this protection is not clear, but it is interesting to speculate that reduced access to the best jobs may be at the core. West Virginia has the lowest workforce participation rate in the country and also has the lowest number of citizens with college degrees (24% of the population has a four-year degree, while the national average is 38%). A job is where many find their meaningful social connections, social capital, a sense of purpose and develop their view of the world. Educational levels impact lifespan by 8.5-11 years and those with lower educational levels struggle socioeconomically, are more likely to be obese and may suffer accelerated biological aging. Moreover, these changes may occur while individuals are in their teens, twenties, and thirties.
The Nervous System Trap
The sympathetic nervous system—our fight-or-flight and survival response—is stuck “on” in modern life. In everyday life, we’re overloaded by advertisements, headlines and stories that use negative stimuli, fear, and threat to grab our attention. This threat response was useful as we evolutionarily evolved, allowing us to escape potential life-threatening interactions with predators. Today, unregulated overactivation of the sympathetic nervous system underpins poor health and accelerated aging. To this end, our body’s nervous system is twice as responsive to threats as it is to happiness or joy. This is the reason why negative advertising is often used in political commercials, as we are drawn to negative and threatening messages.
The critical role of unbalanced activation of the sympathetic nervous system is almost certainly at the root of our health challenges in the U.S. Our constant stress response through activation of the sympathetic nervous system elevates blood pressure, weakens immunity, promotes weight gain, and accelerates aging.
But we can interrupt that cycle. We can practice presence over perfection, acceptance over resistance, and choose how we respond to the world around us. Through mindfulness, reflection, service, and community, we can return to our natural state of balance. Perhaps the Dalai Lama sums it up best by stating that, “the real path to joy is the recognition of the deep connection between all things and all peoples and service to others.”
Pathways to Healing – What the Blue Zones Can Teach Us
The world’s Blue Zones – Icaria, Greece; Okinawa, Japan; Sardinia, Italy; The Nicoya Coast of Costa Rica; and Loma Linda, California – are five areas where citizens live long and well. They rely on daily habits and deep connection as highlighted in the Blue Zone Power 9:
- Move naturally – walk, run, bike, swim.
- Maintain purpose and a reason for getting up each day – Ikigai in Okinawa and the Plan de Vida in Costa Rica.
- Downshift – develop routines to manage stress.
- 80% rule – stop eating when 80% full.
- Plant slant – more plant-based diet, small servings of meat when included.
- Wine at 5 – celebrate with family and friends.
- Belong – become part of a faith community.
- Loved ones first – family first.
- Right tribe – lifelong friend groups.
These principles align with the longevity research that is focused on the facets predicting long and good lives.
A Universe of Connection: The Science of Quantum Health
Quantum physics is a cutting-edge part of science that focuses on the subatomic world and identifies events that are outside of our sensory ability to measure. These quantum events seem more out of a futuristic fantasy film than the science that indicates the underpinning mechanisms of our universe and lives.
The most important finding in quantum physics is the one of interconnection between what we have viewed as separate, independent particles – the finding of quantum entanglement.
Quantum entanglement demonstrates that when a subatomic particle like an electron is cut into two parts and separated over vast distances, the activating one part induces precise movement of the severed partner faster than the speed of light. Every time. No matter how far the distance.
This is what philosophers and spiritualists have long suggested: we are all intimately connected. Modern physics gives us a powerful metaphor for life and health.
Quantum theory also tells us:
- We’re made of energy that appears as matter. In fact, the space in a room contains a swirling sea of energy, and it is likely that the energy existing in the room’s space is responsible for constructing the mass we see in the room.
- We perceive and experience only 0.00035% of the electromagnetic spectrum with our senses. A lot more is going on in our world than we can detect.
- Thoughts and attention shape reality. As energy beings, we interact with the energy in what we consider “air” or “empty space” to construct our visible world.
- All things are deeply and intrinsically connected. We are all part of an unbroken single whole, like the white light separated by the prism into many colors. These colors appear separate, but they are really just the white light.
These observations lead us to an interesting opportunity. If we interact with the ambient energy of the universe to make our world, then we can logically theorize that what we pay attention to becomes reality. When we focus on fear, we feed stress and accelerate our body’s aging. When we focus on love, connection, and abundance—we thrive and stay biologically younger. Even at the atomic level, we are not separate – we are one.
Putting It All Together – More Life In Our Years
We are statistically improbable beings living in a miraculous moment. We are all interconnected, which may account for the need for meaningful social relationships, belonging, and the safety we all seek in our life. In our existence as humans, we find our purpose, tribe, and relationships through our work, our community, and our relationships, which is enabled by our education.
- So, what does this mean for us, here in West Virginia and in the United States? To create a healthier West Virginia—and a healthier nation—the best longevity research leads us back to the lessons we learned at early ages:
- Be kind to others, treat them as you wish to be treated. We are all connected.
- Keep moving throughout your life – exercise is good for our body and mind.
- Make lifelong friends and continue to value them throughout your life. Community and belonging are the most powerful drivers of longevity.
- Maintain a reason for getting up in the morning, your purpose or “why”.
- Eat good and real food. More plants. Stop eating before you are overly full.
- See the divine in yourself and others. The more we see the same life force in all and in everything, the better our lives will be.
- Selfless service is the greatest gift that one can do for another and is the best expression of the abundance from which we are made.
- Believe in some higher organizing principle to your life. People who live long and well share the belief in a higher power to life.
- See your life as a grand adventure and practice more “being” than “becoming”.
- Vow to make each day and moment matter. If you do this, the ordinary will become extraordinary. More life in your years.
Your life—just as it is—is meaningful. Each breath, each connection, each small act of kindness adds light to the world. We are here for a reason. Science may call it improbability. I call it purpose. In the end, our purpose is not just about extending life—it’s about deepening it. Making each moment matter. Bringing our full selves to each day.
Let us move forward with humility, with wisdom, and with hope. Together, we can ensure that every West Virginian—and every American—has the opportunity not just to live long, but to live well.