As a history buff, I have watched nearly every one of Ken Burn‘s epic documentaries on American history.

One scene that stands out to me is from the opening reels of the critically acclaimed series The Civil War showing grainy footage of President Franklin Roosevelt’s 1940 address at the 75th anniversary of the battle of Gettysburg.

As the camera pans the crowd at this historic event, I was surprised to see significant numbers of Union and Confederate war veterans in attendance, men who were in their 80s and 90s marching in the parade, then sitting up straight and listening intently as the President dedicated a monument to them and their fallen comrades.

“How could so many of them still be alive?” I thought to myself. After all, the average life span at the turn of the 20th century was barely fifty years.

And yet here was a group of men born prior to 1850, long before pubic sanitation, vaccines, and the life-extending technologies of modern life, men who endured the untold hardships of America’s most violent conflict, and still appeared healthy and vital 75 years later.

Thanks to a recently published book by one of the leading voices in the emerging field of longevity science, there is a perfectly reasonable explanation.

Fast Death versus Slow Death

The book, Outlive: The Science and Art of Longevity by Dr. Peter Attia, has become a runaway bestseller endorsed by virtually every thought leader on human performance and wellness. It is a field guide to not only increasing our life span but our health span as well, meaning not just surviving in our old age but thriving in the process.

As Dr. Attia points out in the opening chapter, prior to 1900, while life expectancy indeed hovered somewhere south of age fifty, most people were likely to die from “fast” causes: accidents, injuries, and infectious diseases of various kinds.

And some, like those Civil War veterans in the film, lived incredibly long lives and then died quickly.

Since then, however, slow death has supplanted fast death. The majority of us, in fact, can expect to die somewhere in our seventies or eighties mostly from “slow” causes. Dr. Attia writes:

Assuming that you’re not someone who engages in ultra-risky behaviors like BASE jumping, motorcycle racing, or texting and driving, the odds are overwhelming that you will die as a result of one of the chronic diseases of aging that I call the Four Horsemen: heart disease, cancer, neurodegenerative disease, or type 2 diabetes and related metabolic dysfunction.

Furthermore, Dr. Attia points out that, although life spans have increased dramatically in the last century, if you subtract deaths from the major infectious diseases (cholera, typhoid, tuberculosis, dysentery, diphtheria, etc.) that were almost completely eradicated by modern public sanitation and antibiotics in the early 1900s, mortality rates have declined very little in the last 120 years.

While I found this surprising, Dr. Attia offers a compelling explanation:

Modern medicine is oriented around and has been far more effective against fast death vs. slow death. It has an amazing ability to save lives and restore full function to broken bodies, even reviving patients who were nearly dead. But we have been markedly less successful at helping our patients with chronic conditions, such as cancer, cardiovascular disease, or neurological disease, evade slow death. We could relieve their symptoms and often delay the end slightly, but it didn’t seem as if we could reset the clock the way we could with acute problems. Despite all the resources directed at chronic diseases like cancer, heart disease, and Alzheimer’s, progress has been less than stellar…

Indeed, since President Richard Nixon’s War on Cancer declaration in 1971, death rates have barely budged. The same is true for Alzheimer’s and type 2 Diabetes.

To me, it is shocking to think that, considering humanity’s massive technological and economic progress together with the exponential increase in information since the turn of the 20th century, we have made so little progress in something as fundamental as how long human beings live.

And life span is only part of the equation. There’s a massive difference between life span—the amount of years in our lives, and health span—the amount of life in our years.

Today, we have the ability to keep people breathing much longer than in the past, but often with little or no quality of life. The additional years Americans now live thanks to medical technology is more of a slow death when you consider that, for many, those years are consumed with extended hospital stays, painful therapies, costly medications, and confining nursing care facilities.

But we were not created to live this way. As we approach our 60s and 70s, our goal should be not just to live longer, but to live longer while flourishing–in other words, live long…die quickly.

The biggest impediment is our modern lifestyle, which is marked by sedentarism, comfort addiction, and a medical and insurance system that’s focused on sick care versus health care.

The World Health Organization estimates that one-fifth of the world’s population spends their final 16 years suffering from chronic disease.

In light of these sobering statistics and facts, how can we slow down the aging process, avoid the slow death inflicted by the “4 Horsemen”, and die quickly—the way our life spans were meant to conclude?

That’s what Outlive, Dr. Attia’s manifesto on how to live long and die quickly, lays out in a detailed but understandable manner.

And in my next post, I will share my three biggest takeaways from this life-changing book.