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The future of longevity

An expert in living longer and better says changes in our DNA written by our environments can explain why people born in certain regions are more likely to make it to 90 or beyond.
Man and woman walking outdoors in the woods
What are the factors that contribute to a long life? | iStock/Giulia_Schiavi

Guest David Rehkopf is an expert in population health who says that where we live is one of the strongest influences on how long we live. While we know diet and health care are important, it has been tough to tease out what about these places allows people to live longer and healthier lives. By examining environmentally induced changes in DNA, we may be able to more quickly and more accurately quantify what aspects of environments promote longer, healthier lives, Rehkopf tells host Russ Altman in this episode of Stanford Engineering’s The Future of Everything podcast.

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[00:00:00] David Rehkopf: Costa Rica's done really well and then does things as a society that get them beyond the US in terms of life expectancy. And so that was the thing that motivated me from the beginning to start thinking about Costa Rica. Is like, wow, what are they doing? What are these sort of outlier countries doing that people can live so long there even though they don't have as many resources?

[00:00:26] Russ Altman: This is Stanford Engineering's The Future of Everything, and I'm your host, Russ Altman. [00:00:30]

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Today David Rehkopf will tell us that some people in certain locations around the world live longer than the rest of us. One of them is Costa Rica, but it's not just about beautiful beaches and low stress. There are a multitude of factors that contribute to a long lifespan, and there are aspects of the environment and lifestyle [00:01:00] that literally change the DNA of these folks. It's the future of longevity.

Before we jump into this episode, a reminder that if you enjoy the podcast, please take a moment to rate and review it. It will help fellow listeners discover it and understand what the show is all about.

There are several places around the world where people just live longer on average than most other places. These places provide a great opportunity for scientists to study the [00:01:30] factors that contribute to a long life. Is it stress, diet, lifestyle, genetics, work environment? It's probably a complex mixture of all of these, but dissecting out what's important in each of these factors might contribute knowledge that can help all of us live longer, more happy lives.

David Rehkopf is a professor of Epidemiology and Population Health Medicine, Pediatrics and Sociology at Stanford University. He studies the determinants of longevity [00:02:00] in the population. He combines work on clinical trials, observational studies, and qualitative interviews to understand what is different about people who live longer. This includes biological studies of their DNA, looking for both the genetic effects and the ways in which the environment might be changing the DNA.

David, you have studied areas where people live a long time. What are these places and how do you find out what are the key factors that drive this [00:02:30] longevity?

[00:02:30] David Rehkopf: Yeah, so there's been a few places around the world and there's been some ups and downs in that over the years. So there are these kind of infamous studies back in the seventies, um, that were published in National Geographic. Where people thought, uh, the Ecuadorians in Bel Baba lived a long time and folks in Pakistan, and then ends up, there was a lot of sort of errors there. And so now as part of this kind of more modern era, uh, this guy, Michel Poulain, Gianni [00:03:00] Pes, a few others, started looking in places where we actually had pretty good data. Um, and so one of those was Costa Rica where I focused. Another is Okinawa, Japan, Icaria Greece, um, and this, uh, mountainous region in Sardinia.

And the data was pretty good there. And they found, you know, after a lot of more robust statistical testing that uh, a lot of people were living to a hundred, living longer there. And so I got interested in this, uh, as a postdoc, uh, working with Will [00:03:30] Dow. So I did my postdoc, uh, up at Berkeley. Uh, and he had this project with, uh, Luis Rosero Bixby from, um, from Costa Rica to really dive into this data in a cohort study. So rather than just that mortality data that was out there for a while, they did really an intentional sampling, collected a lot of data on people, and then did this oversampling of folks, uh, above the age of 95. And an oversampling to kind of enrich their data and people in this Nicoya region where [00:04:00] people, uh, you know, the data showed people were longer. So we've been working with this sort of more detailed cohort data.

What then I brought to it as a postdoc, and I've worked with them over the last 10 years on, is more kind of biological measures. So looking at DNA methylation, looking at telomere length to try to get into some of these biological pathways underlying, uh, longevity.

[00:04:21] Russ Altman: So I definitely wanna get into that. But the first thing that somebody that I think everybody has heard and seen the graphs where the amount that a [00:04:30] society spends on healthcare doesn't necessarily predict the amount of longevity, uh, or even good health when went alive that those populations will have. And um, so we've all seen that. And I think the first question I wanna ask is, is that because the, we spend the money differentially. And so it actually is the case that if you're actually benefiting from all that money. You do live longer and it's just the folks who don't benefit from that money who are bringing down the averages. Or is it [00:05:00] actually much more complicated than that and actually nobody's really doing well with all that spending.

[00:05:05] David Rehkopf: Yeah, that's a super interesting question. Um, and so it's that pressed and curve, right? Where, um, you can think about it as an aggregate or individual. So there both things are going on. As a society, um, there's this Preston curve that like the higher the GDP per capita, um, you know, the higher the longevity. And then there's this inflection point and you can kind of fit a two slope model to it, where [00:05:30] then things kind of level out. Um, so a lot of what just development for a country, um, buys. Um, in terms of sort of base the basics of healthcare.

[00:05:41] Russ Altman: Right.

[00:05:41] David Rehkopf: Um, nutrition, you know, um, lack of

[00:05:43] Russ Altman: Clean water.

[00:05:44] David Rehkopf: Clean water, all that gets you up to this certain level of life expectancy. And then it's kind of like flat. And the interesting thing, you know, that we've done and where Costa Rica is, is looking at the outliers on that relationship. So, Sorry, I'm doing a lot with my hands here. [00:06:00] Uh, but, uh,

[00:06:01] Russ Altman: it's okay. It's all good. People can imagine all of this in the podcast world.

[00:06:05] David Rehkopf: Yeah. So Costa Rica is this overachiever outside of that curve where they have a longer life expectancy, you know, they have about one fifth, the GDP per capita, GDP of the US. They're beyond the life expectancy of the US and so, after this sort of lower level of development, which, uh, you know, a lower level of GDP Costa Rica's done really well and then [00:06:30] does things as a society that get them beyond the US in terms of life expectancy. And so that was the thing that motivated me from the beginning to start thinking about Costa Rica is like, Wow.

What are they doing? What are these sort of outlier countries doing that people can live so long there even though they don't have as many resources?

[00:06:48] Russ Altman: So I'm sure you won't be surprised because you've I'm sure had dinners and parties. So the first thing we all think of is, of course you live longer in Costa Rica. It's such a chill, [00:07:00] pleasant area. And so there's low stress or no stress.

[00:07:03] David Rehkopf: Yeah. Yeah.

[00:07:03] Russ Altman: Uh, I'm gonna guess it's not just that.

[00:07:06] David Rehkopf: Yeah, absolutely. You know, and I start a lot of my presentations with like, A slide of like the turquoise water and the beach in Costa Rica, because that's e exactly where everyone goes through.

Like, yeah, I'd live forever if I could like chill out on the beach. Right.

[00:07:20] Russ Altman: I would even take my medication if I'm living in Costa Rica.

[00:07:24] David Rehkopf: But Right, it's not that simple. Uh, for one thing, the people in Costa Rica and this sort [00:07:30] of higher longevity region are actually up in the mountains. Um.

[00:07:33] Russ Altman: Ah.

[00:07:33] David Rehkopf: You know, a little relatively poor. It's kind of not along the beaches there. And then, um, there's a lot of really beautiful beaches, like all over the world. Right?

[00:07:42] Russ Altman: Right.

[00:07:42] David Rehkopf: And people don't live, you know, a lot as long a time. So definitely I think the stress is part of it. You know, it's something we're super interested in. It's like pretty hard to measure. It's, um, you know, we have some measures in our data. I think there's some pretty good reasons to think [00:08:00] that's a part of it. You know, certainly we can get into this a little bit later, but the telomere length stuff where we see these differences, you know, uh, stress has been shown to affect, uh, the sort of average telomere length. So we think that might be a poss a possibility. But yeah, still nothing like super solid on knowing how much of a role stress plays.

[00:08:20] Russ Altman: Do we know if the, um, if these folks who live a long time, if their kids move to LA, do the kids live a long time or do they adopt the LA [00:08:30] stress levels and just have a typical American lifespan?

[00:08:33] David Rehkopf: Yeah, very good question. And in Costa Rica, um, and Nicoya, we have to,

[00:08:38] Russ Altman: why would you leave? I understand that the

[00:08:40] David Rehkopf: Yeah, yeah, exactly.

[00:08:40] Russ Altman: The end might be

[00:08:41] David Rehkopf: very low here.

[00:08:43] Russ Altman: Yeah. Well, um, so people do leave and we can't say for sure if those people are different and are driving it. But what's interesting is, the people who are born in Nicoya and leave don't have longer, uh, longevity.

[00:08:56] David Rehkopf: The people who are born in other parts of the, uh, Costa Rica and [00:09:00] moved to Nicoya don't have longer longevity. The people who are born there and stay there and die there have longer longevity. So that was this very interesting clue to us. And this is worked done by, by Luis Rosero Bixby. Um, that there's something about. Being there in early life through your whole life and that complete dose that matters. And these are these kind of clues to the complexity of the problem is it's not like this thing you're born [00:09:30] with and it's just this magic thing and maybe your genotype. You get lucky with your genotype or there's something about early life environment, but it's also not just something you're doing when you're 80 years old. So it's a combination of these things that come together to form that longevity.

[00:09:43] Russ Altman: Okay. So let's dive a little bit into the biology 'cause you've mentioned now telomeres, and I think you said the word epigenetics, and so we're gonna have to do some definitions for people who don't think about these all the time.

[00:09:54] David Rehkopf: Yeah.

[00:09:54] Russ Altman: Tell me about some of the biological evidence and take us through how we should think about this and what this tells us [00:10:00] about the, at least the biological factors of longevity.

[00:10:03] David Rehkopf: Yeah. So it's, um, you know, the reason I got interested in it is kind of twofold. One is just to add another dimension to the story of saying like, You know, there, uh, there's always any type of data. There's pros and cons, and so the more times you have different types of data that are aligning to support a particular hypothesis, the better off you are. So if you can show some consistency with some of these pathways we know are associated longevity, it just gives us [00:10:30] stronger story.

And then secondly, you know, when you get to kind of really specifics with DNA methylation or even with telomere length, it can help support. Different exposures that we know have kind of a particular molecular signature. So it can kind of narrow down the possibilities as well. So the first thing we started looking at was, um, telomere length, which is, uh, a, um, a sequence of nucleotides at the end of chromosomes that every time a cell [00:11:00] divides, uh, becomes shorter and we can assay for that overall population, that overall average. We wish we could look at, you know, Uh, the technology was there at a population level to look at the exact length for different chromosomes. We don't have that yet. It's just sort of too expensive to do at scale. So we look at these averages, but it gives us, you know, some idea of, you know the overall turnover in cells and the differences in cell types associated with aging, um,

[00:11:26] Russ Altman: Yes.

[00:11:26] David Rehkopf: In the population. So we looked at that and we found, [00:11:30] um, you know, controlling for age, controlling for a lot of different demographics that, uh, there was a longer telomere length in the high longevity Nicoya region. And so then we kind of interrogated and tried to explain why that might be.

[00:11:43] Russ Altman: So, uh, that's fascinating, but you said that uh, every time the cell divides, you lose a little bit of your telomere. So are we thinking that their cells are dividing less or that for some reason when they divide, they take off a little bit less of a little chip of DNA from the ends?

[00:11:59] David Rehkopf: Yeah, [00:12:00] that's a good, uh, a good question. So the thought is more, um, the latter that the cells are just dividing less, and you know, in this case we're using white cells from drawing blood. Um, so it's, um, you know, particular types of cells, it's all tissue specific. And so, um, a lot of what's going on there, we think, and then from some of the methylation work supporting this, is that there's, uh, there's been less exposure to sort of immune, um, um, [00:12:30] you know, less needing to respond to immune sort of assaults on the system over the life.

[00:12:35] Russ Altman: Oh wow.

[00:12:36] David Rehkopf: So there's actually more, um, naive CD8 T cells than memory T cells and these people that are living longer. And so this is something that's kind of giving us a few clues to, you know, some potential differences over the life course that are there in koya.

[00:12:50] Russ Altman: That is fascinating because as I think back on the areas of the world that you mentioned and like, it's basically my next set of vacations as far as I can tell. Um, [00:13:00] these do did seem to be relatively isolated places. You know, it was the tops of...

[00:13:04] David Rehkopf: Yeah.

[00:13:04] Russ Altman: ...hills, uh, uh, Sardinia, little, uh, locales in Sardinia.

[00:13:08] David Rehkopf: Yeah.

[00:13:08] Russ Altman: And so that it, that does suggest, you know, we always have to remember that humans and really all beings on earth. Uh, this infectious disease has been a huge contributor to evolution.

[00:13:21] David Rehkopf: Mm-hmm.

[00:13:21] Russ Altman: And we see it, we see marks in the genome all the time for things that have been, um, developed in order to fight infection. So it sounds like one of the [00:13:30] possibilities here is that they have had less of an assault because of a relatively privileged, not so, um, diseased infectious disease life. Uh, is that one of the competing hypotheses?

[00:13:41] David Rehkopf: Yeah, exactly. That's one of the hypotheses and this kind of like interesting, um, you know, perhaps sweet spot of just the right amount of exposures....

[00:13:52] Russ Altman: Right.

[00:13:52] David Rehkopf: ....In childhood as you're developing. And then obviously with like better sanitation and, you know, uh, and [00:14:00] uh, better medications, um, and older ages than also not having some of those exposures there. So, uh, absolutely one of the kind of primary things we're digging into.

[00:14:09] Russ Altman: And I'm sure the other thing that people just the regular person would think of is diet. So, uh, how do the diets, do those diets line up across all of those locations? Or is it all over the map?

[00:14:20] David Rehkopf: So, um, a little bit of both, you know, the dietary data that I've worked with, um, you know, the one main thing is, you know, there's not a lot [00:14:30] of like fast food in these places, right? Or the kind of, or sugar sweetened beverages and all the stuff we know to be or have pretty good evidence that are not good for our health. Like those are just not in those areas at all. Um, but of course there's a lot of places around the globe where people don't have access to that and in developing countries.

So it's not sort of the whole explanation. So it's this kind of combination of some aspects of more traditional diet. Without this transition to sort of the western diet, [00:15:00] I mean the interesting thing and, you know, dietary data is so difficult to collect. It's really difficult to get accurate dietary data. And when we were looking at what explained the differences in, in telomere length, you know, we didn't see dietary differences. You know, we were looking at kind of the consequences of that. We were looking at, uh, you know, blood pressure, we're looking at cholesterol levels, like we didn't see those being really different between Nikoya and the rest of Costa Rica. So we kind of didn't [00:15:30] find that evidence, but at the same time, it's really difficult to accurately measure, uh, diet. So it might have just been kind of measurement error.

[00:15:36] Russ Altman: So the other biological thing that you've mentioned a couple times is this methylation. So could you just first describe why it's of interest and what its biological role is, and then maybe a little bit about the differences that you see there.

[00:15:47] David Rehkopf: Yeah. Yeah. So this is kind of ongoing work. We've started with a pretty small pilot sample size. We've gotten that sample size bigger, and now we have kind of a replication sample to try to replicate that. So just kind of [00:16:00] caveat these as speculative. Um, but, um, you know what DNA methylation is, is, um, modifications to the genome. Um, that can, um, develop over the lifetime that are like fairly stable but also can change over time. They can be determined by genotype, they can also be, uh, determined by environmental exposures and they affect, um, gene expression that eventually becomes protein proteins, which then can contribute to physiological differences, including [00:16:30] disease.

And so it's this kind of interesting sweet spot where, the environment can affect humans, um, in a relatively stable way, in ways that may affect their health. So this is where we got some of these. Uh, the other thing about it is, um, part of what makes all our cells really different in the body is the methylation that surrounds them.

So there's these really canonical differences in DNA methylation by cell type. So that's why actually we could get into some of those details about the CD8 naive cells.

[00:16:59] Russ Altman: Oh.

[00:16:59] David Rehkopf: Or the CD8 [00:17:00] memory cells. Um, because we have these DNA methylation signature and we could see that, uh, differ. One of the things we found in Costa Rica with this, the other thing is, there's some canonical changes with age in DNA methylation, and we saw that a lot of these folks, like the centenarians, looked like 13 years biologically younger based on some of these, um, aging metrics.

Um, so we're getting again this sense of there's, um, general things going on. There's also less of [00:17:30] variability in DNA methylation, which is a good thing. And then now we're gonna have the sample size to start diving into kind of like specific genes, specific pathways, um, to see if that gives us any more clues to the specifics.

[00:17:41] Russ Altman: Yeah. But that, uh, I can see it, it really goes back to what you were saying about how this is incredibly important corroborative evidence because you know, a lot of the data sources about health and about diet, uh, you know, you get worried that you might be missing something and you don't want to be the next set of National Geographic articles that are wrong. But when you're seeing, uh, [00:18:00] very persistent and reproducible changes, um, whatever it is that's causing these differences, you're seeing fingerprints in the DNA that are pretty much, pretty convincing that it's a real thing and I can see the real value there.

This is The Future of Everything with Russ Altman. More with David Rehkopf next.[00:18:30]

Welcome back to The Future of Everything. I'm Russ Altman and I'm speaking with David Rehkopf from Stanford University.

In the last segment, we explored our current understanding of the differences between folks who live longer than average and the rest of us.

In this segment, we will discuss the impact of government policies and corporate practices on health. Do the conditions of the place you work actually affect your lifespan? Yes, they do.

David, I wanna ask you about these more macroscopic things that [00:19:00] you've looked at, like the impact of corporate decisions or the impact of the government. Is there evidence that these kinds of decisions affect longevity?

[00:19:09] David Rehkopf: Yeah, that's one of the big, uh, questions I had. And, you know, so what can we learn from other places, but what, what do we have evidence for here? And I think one of the things I've confronted is like lots of people think, you know, economic factors matter. Um, they believe they're important.

Um, but then there's kind of these two barriers. One is like, well, that's never gonna [00:19:30] change. We are as how we are as a society. And then secondly like, well, how do you even study that? You can't do a randomized trial, right.? So I've been kind of trying to confront those two objections.

[00:19:39] Russ Altman: Yeah.

[00:19:39] David Rehkopf: So on, on the first, we are actually doing things. I mean, you pick up the paper, you pick up the New York Times. I can find like five ways we're really changing social determinants of health like every day. Um, and so one of them that I've studied a lot, um, is the earned income tax credit. So this was a policy that started back in the eighties. Um, it was, uh, actually in the seventies. It was [00:20:00] expanded over time. Um, and it's now one of our largest anti-poverty policies. So what I look at is, Uh, temporal changes in that, uh, changes in benefit structure. Sometimes one state will implement it and another state won't, and we do some kind of statistical matching of those states. And so we try to triangulate a around a lot of different kind of evidence.

So a lot of the strongest evidence, uh, that, um, me and other colleagues have found is for actually, uh, reducing the [00:20:30] number of low birth weight kids. Uh, we found it reduced maternal smoking. And so that's one of these things, um, that, um, you know, getting people smoking.

[00:20:39] Russ Altman: When you say it.

[00:20:40] David Rehkopf: Yeah.

[00:20:40] Russ Altman: When you say it, you mean the earned, you found evidence that the earned income, uh, credit.

[00:20:45] David Rehkopf: Yeah.

[00:20:45] Russ Altman: Um, and was it a correlation or did you actually take enough, get enough information that you could actually start to draw causal connections?

[00:20:54] David Rehkopf: Yeah, that's what we've tried to do. Um, so as you know, uh, drawing [00:21:00] those causal, you know, you're never a hundred percent certain. I think about, like I actually really wish papers would say on a scale of zero to 100, this is how causal we think it is. And like, other people could vote on it, you know? So I, on that scale, I'd say it's, you know, on scale of, uh, zero to 100, it's like 70. Uh, you know.

[00:21:17] Russ Altman: Okay. So pretty good. Pretty good.

[00:21:19] David Rehkopf: Yeah. So I think it's pretty good. Um, and, you know exactly, and we did that by looking, you know, matching states controlling for a like a big vector of covariates about how we think those [00:21:30] states were different in other ways. And then looked at after that the credit was implemented. And so households will get up to 2 or $3,000, um, back. You know, households that are making like 15, 18, $20,000 a year. So it's like a really big difference. And we found that there were, you know, improvements in those perinatal outcomes for women who were pregnant during that time. And part of that was through reduced smoking.

[00:21:53] Russ Altman: Wow. Okay. So there is an example of a governmental decision.

[00:21:57] David Rehkopf: Yeah.

[00:21:57] Russ Altman: That you can pretty much draw a straight line to [00:22:00] the outcomes. Mm-hmm. Just out of curiosity, did are I, are you able to actually find out what they did with the money or is that, I mean, that sounds like it would be super hard to do. Um, but it's 2 or 3000 extra dollars.

[00:22:11] David Rehkopf: Yeah.

[00:22:11] Russ Altman: And maybe it almost doesn't matter, like maybe. They, whatever set of decisions they made, they were healthier decisions.

[00:22:17] David Rehkopf: Yeah. So that, you know, and it's really interesting 'because that was something that was debated in the field. You know, there were a number of studies looking at what was called this, like check effects. And like sometimes when people got check effect, there were more admissions [00:22:30] to the ER for sort of like accidents and things. And so I think it's really important to think about specific policies like the EITC and who they benefit and they benefit more, uh, single female headed households. And so those allocation decisions are gonna be different. So we actually did a study on that, there's sort of consumption data.

And a lot of people, what we found was really interesting is it's kind of forced savings. When you're right at the edge of poverty, there's no way you can save money, but you get this as a bundle of like [00:23:00] $2,000, right? And so a lot of people used it for like car repairs, to buy a car, for transportation, to pay off debt, um, to pay bills.

And so a lot of that is, you could imagine really stress reducing and that. You have all these burdens, you couldn't save up enough money for these things, but the EITC like helped you do that.

[00:23:18] Russ Altman: So that's amazing, so I'm glad I asked that question 'cause you actually do know to some extent how that money was spent, and it kind of makes sense.

[00:23:24] David Rehkopf: Mm-hmm.

[00:23:25] Russ Altman: I'm, I'm very interested in this. You made a quick comment that, uh, women head of [00:23:30] households, uh, benefited more from the credit. So, uh, I don't know anything more to say about that it seems fraught.

[00:23:39] David Rehkopf: So yeah. No, no. Thanks for giving me a chance to explore that yet. I think like the main comparison I was making is like a lot of these sort of, you know, negative, more damaging effects of income were actually studies that were done. Um, you know, looking at like single men, they get their paycheck. There were more sort of admissions to [00:24:00] the um, uh, like ER, so I'm thinking of these sort of Alaska credit studies. Um, so for the EITC, most of those credits, so most of the credits are going to, uh, single parent headed household with kids. So you have to have kids to get the biggest credit.

[00:24:17] Russ Altman: Right.

[00:24:17] David Rehkopf: Um, and we saw really beneficial effects, um, on health like across the board. And that's where we said, okay, so how does this, like why do these other studies showing some of these negative effects or showing [00:24:30] that even, you know? And so that was one of the potential explanations there. And we did, you know, we do have a small sample of men, um, getting, uh, the EITC, um, who are uh, who have a dependent children. So much smaller sample, but we just didn't see as big of effects, um, you know, in those households. So, you know, remains to be figured out. But it was interesting.

[00:24:51] Russ Altman: Really interesting. Okay, so what about corporations? Uh, the other thing you could look at by opening up the newspaper every day is...

[00:24:57] David Rehkopf: Yeah.

[00:24:58] Russ Altman: ....all the ways that the corporations are either [00:25:00] changing the world around them or their work, uh, expectations and work conditions. And I know, I think you've looked at both. So tell me about corporations and their impact on health and how we can even measure that?

[00:25:12] David Rehkopf: Yeah, I think, you know, there's so much literature on, you know, uh, government policy, public policy, social policy that I don't really wanna leave out corporations and the places people work, they have a huge impact on our lives. We spend a lot of our time, uh, working. Um, a lot of stress [00:25:30] when you're not working and you're laid off and so, um, you know, wanna dive into that.

So, I will say it's much harder to get, um, data, um, like, uh, on corporations and corporate environments. So we've had a few different studies. One where we could look, had data on both physical hazards and sort of stress in the workplace. So there's this demand control model. So how much autonomy do you have over your work versus how much is someone telling you what to do? There seems to be this kind of sweet spot there where [00:26:00] people can be, uh, are healthier and all these things that we're look, we look at, you know, have a much bigger impact than sort of. Um, some of the wellness programs that companies have introduced. So I'm not saying the wellness programs aren't a good idea, but just the structure of work, the latitude people have, the amount of stress seems to really matter for health longer term.

[00:26:21] Russ Altman: Oh, that's interesting. So the investment in the work and the general work environment is actually more cost effective, or could be

[00:26:29] David Rehkopf: mm-hmm.

[00:26:29] Russ Altman: More cost [00:26:30] effective for health. Then the special purpose programs for the employees to like, you know, do more exercise or whatever.

[00:26:36] David Rehkopf: Yeah. Um, yeah, I.

[00:26:37] Russ Altman: It's very interesting.

[00:26:38] David Rehkopf: A lot of these are like, you know, both ands, but like ignoring the structures, ignoring the stresses is really, um, you know, not getting the most out of your employees. So done things on sickness absence for sure. So, Uh, some of my work, like almost two decades ago now was showing, um, this demand control really being related to how often people are [00:27:00] sick, both sort of short-term illness, but also longer term illnesses as well.

[00:27:04] Russ Altman: So, I don't know if this is within your academic interest, but do corporations listen to this and do you see, is there a business to be made helping them, like rethink how they set up the, uh, work environments for their employees? Or is that, uh, kind of not your job?

[00:27:20] David Rehkopf: I. Uh, no, it is, you know, I think I've increasingly been trying to look at outcomes that would be of interest [00:27:30] to the corporations. Like, so that sickness absence is an example.

[00:27:32] Russ Altman: Right.

[00:27:33] David Rehkopf: Not just like, okay dude, um, you know, do you die at age 95 or 96? Like maybe a company, uh, isn't selfishly gonna care about that, but like, do you have more, uh, you know, cold and flu and, uh.

[00:27:45] Russ Altman: Right.

[00:27:45] David Rehkopf: You know, on the short term, which is definitely gonna, uh, affect productivity. And so, um, you know, I'd say there's other folks here at Stanford, um, you know, uh, Nick Bloom, other people who are doing a lot more in this area and really trying to frame it in [00:28:00] ways that would be of interest to companies. But from my perspective, like, you know, at least telling that story about health, I think is, you know, adds to those arguments.

[00:28:08] Russ Altman: And this is unfair, but that doesn't mean I can't ask it. Uh, we just came out of a period where the work at home and the work at work world is turned upside down and it's not clear where we're gonna land. But is there any early work or any hypotheses you have about how. The, um, the new way of working, I'll just call it that.

[00:28:27] David Rehkopf: Yeah.

[00:28:27] Russ Altman: With, uh, a mixture of work at home. [00:28:30] Hybrid. Hybrid is the word. Uh, is that gonna be a good thing, bad thing and uh, or do you think it, we're not even gonna be able to study it because it was just not long enough in the lives of the people who were affected?

[00:28:40] David Rehkopf: I think that we will, we will be able to study it. Again, getting to the causal question, it's gonna be really different causally. Um, you know, because companies that, you know, gave employees more flexibility, there's just really different people working there.

[00:28:55] Russ Altman: Right.

[00:28:56] David Rehkopf: But I do think there may be some wedges that we can [00:29:00] get where there were things that were a little more idiosyncratic about, uh, corporate decisions on who could work at home, who couldn't. Those sort of, the hybrids. Um, and, you know, with, with some statistical matching, looking at for some kind of, um, you know, natural experiments. Uh, I think absolutely that's something that we should be investigating. I mean, it's such a huge part of our lives, like whether we have that independence to be at home, whether how well we're connected with other people, um, that, uh, it's gonna be worth our efforts to try to dive into that.

[00:29:29] Russ Altman: [00:29:30] Well, we'll have to have you back on the show in 60 years to see what was the death outcomes of the workforce from the pandemic.

Thanks to David Rehkopf, that was the future of longevity.

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