One Health was the theme around which the Milan Longevity Summit 2026 (Milan, May 20–23) focused: the health of the person, the animal and plant worlds, and the planet, in the traditional sense but expanded to an integrated vision.
Science and society, research and real life, global ambition and local reality, namely humans within a complex ecosystem. These dimensions and aims share a common thread, as the Summit’s core suggests, a throughline: longevity. Longevity is addressed and broken down into three pillars that fully embody it: Longevity, Humanities, and Prosperity. All of this comes in a blend of theory, outreach, practice, and results, because preparation for longevity starts long before, in youth, and within a healthful context. Its achievement is a responsible act, one that must be built day by day.
From Demography to Genetics
Starting from demography, there is a clear flattening of the lifespan curve in industrialized societies, with a dip especially in the United States. The evidence points to a ceiling in life expectancy growth: from the 1990s, when Italian men gained about three and a half months of life each year and women about two months, we moved to observing, in the early 2000s, a general slowdown in lifespan curves for both sexes, although looking at disaggregated data reveals trends toward slowdown with very “personalized” patterns.
For example, there is evidence that certain European regions continue to lead longevity growth, such as Northern Italy, Switzerland, and central-northern Spain, progressing at a sustained pace, in contrast to parts of Europe where life expectancy declines due to unhealthy lifestyle choices and widening inequalities. This phenomenon could help explain both the stall in U.S. longevity and the regional Italian differences—about four years of healthy life expectancy between a woman in the Northeast and one in the South. The science message is clear: if we do not find strategies to break the biological ceiling of human life, there are only a few “solutions” to elongate lifespan.
Therefore, the focus must shift to healthspan, the window where one can act to ensure we live longer not just longer, but healthier. This challenge to healthspan must be won against the risk, no longer potential, that health systems already under strain will collapse. It is essentially a push toward the welfare of areas that, although inhabited by true centenarians, are fragmenting due to migration and lifestyle changes. Regions, thus, at risk of disappearing, with one exception: Sardinia, Ogliastra.
This also calls for a new input from genetics in longevity: a recent Science study has radically changed the aging perspective in terms of lifespan and healthspan. By disentangling extrinsic causes of death from intrinsic mortality in large cohorts of Danish twins, the study finds that genetics account for 55% of lifespan, versus the 15–20% previously estimated, suggesting that it is very hard to alter healthspan’s trajectory without genetic information. In this new light, genetics and lifestyle, how physiological reserves are expended and invested, are balanced. An aid in determining this balance today comes from Artificial Intelligence systems that, at relatively modest cost, enable analysis of vast amounts of data for an individual.
In other words, today’s computing systems and multigenic relative risk algorithms (PRS) empower the physician to assess, relative to the general population curve, whether a person is in a stronger or weaker position regarding exposure to diseases such as cardiovascular or neurodegenerative conditions.
Preparing for Longevity
Longevity is not improvised; it is a constant effort, a work in which one prepares and trains through simple strategies and tools. Science matters, but it is not enough: first you must clarify the real goals: highly personalized medicine for a few, or lifestyle changes for many.
The latter should be the focus, by “programming” plans and strategies that are simple—general, non-personalized norms that are accessible and adoptable by all—and do not require heavy investment: eating well and exercising remain the winning weapons, widely known but still practiced and implemented by only a few, with ongoing attention to the person’s psyche, where the lever to reach a goal is gratification, not motivation or willpower. The latter is far from sufficient or reliable in successful strategies.
From Artificial Intelligence to Predictive Genetics
The management of longevity is evolving at a rapid pace, especially with the advent of Artificial Intelligence, which is making technologies affordable that were previously costly. For example, Finnish researchers have developed a blood-screeing system, already validated in thousands of people, that tracks specific metabolites and, when integrated with AI and expert systems, can predict the relative risk of developing a range of conditions, including certain cancers.
An AI algorithm capable of interpreting 30 hematochemical parameters, from a full blood count to LDL cholesterol, can then yield a score of organ age—an important datum for clinician and patient, instrumental in shaping personalized preventive programs. Added to this is predictive genetics—a full DNA sequencing technology that, while still costly, produces meaningful outputs that offer a new reading of longevity.
Through complete DNA sequencing and the interpretation by AI systems, it is possible to obtain a profile of the individual, enabling knowledge of potential risk for the development of specific diseases during life and launching targeted prevention programs. These technologies, however, have not yet been fully adopted in the national health system, pending validation study data, but are expected to enter clinical practice soon.
The synergy between technologies, precision medicine, and predictive medicine, integrated with lifestyle medicine, can—and will—impact health in extraordinary ways.
Menopause News
A study from the Weizmann Institute of Science, based on data from two large cohorts—European and American, differing by ethnicity, socioeconomic background, education, and more—analyzed all organ physiological parameters in women. It found that all female bodily systems experience a sudden functional downturn in the year of menopause, a downturn that is either undetectable or less pronounced in women undergoing HRT (Hormone Replacement Therapy). This therapy is now more accepted after the FDA (Food and Drug Administration) removed the packaging warning about potential breast cancer risk, which had been based on studies using equine estrogens and medroxyprogesterone acetate—hormones not identical to human ones.
Where HRT is not contraindicated or chosen not to be used, physical exercise remains the most effective modality to counter aging, even more potent than diet, though the latter should be tailored to exercise practice, in reverse. For example, providing a protective dietary intake on training days and higher activity, swapped with other foods of different nature, lighter on days of rest from intense practice. Furthermore, therapeutically, other interesting drugs are on the horizon, such as geroprotectors and senolytics, along with other next-generation agents that will likely be used for prophylaxis in the coming two decades, in the absence of safety data, benefiting especially women. Today, however, these drugs are already employed in specific clinical contexts.
Exercise and the Role of Muscle
Physical exercise is fundamental, especially in longevity terms, to support hormonal balance, sleep—which hinges especially on muscle—and aging, with muscle playing a pivotal central role. Maintaining muscle mass slows aging, because insulin receptors reside in the muscle; thus, losing muscle predisposes to insulin resistance even with a proper diet.
Muscle is also a regulator of hormonal function, and muscle contraction is among the most important stimuli for maintaining bone health. This means aging happens because we lose muscle, not the other way around. Remember that aerobic and resistance work on the legs is crucial: this muscle group is the most important for longevity, with robust literature showing a close link between leg strength and muscle mass, health, and mortality.
The message from experts is clear: we should start these healthy habits—exercise, physical activity, and proper diet—when we are healthy and do not feel an urgent need, with a higher dose of activity for women, since muscular training helps strengthen bone substantially, reducing osteoporosis risk. Not least, exercise is a neuroprotector; it stimulates the production of a range of growth factors that protect brain health.
Evidence on Inflammaging
New technologies today allow assessing immune resilience by measuring CD4 and CD8 in the blood, two types of white blood cells (T cells) that are central to the immune system. Immune resilience describes the phenomenon where, in the context of, say, influenza, the immune system activates to kill the virus and does so effectively under normal conditions, leaving a small inflammatory residue that later settles back within range.
In non-resilient individuals, unable to control inflammation effectively, this does not happen: inflammation remains latent until it flares with subsequent infections, reaching a chronic state in older age. Inflammation is further influenced by factors such as a hypercaloric diet and other unhealthy habits.
Additional important evidence comes from studies indicating that resilience and non-resilience are genetically determined, which helps explain, for instance, why younger people during a pandemic end up in intensive care while older individuals coped better with COVID. Knowing this is crucial because tools to counter non-resilience exist: foremost vaccination, from seasonal flu shots to the shingles vaccine. Both are highly effective and protective in other contexts as well.
For example, it has been shown that in the week following influenza, the risk of heart attack increases sevenfold in non-resilient individuals with atherosclerotic plaque, enough to trigger a level of inflammation that promotes plaque rupture and thrombosis, leading to a heart attack. Meanwhile, the shingles vaccine—not only does it protect against shingles and its recurrences, but it appears to reduce the risk of dementia by about 25%, through a mechanism not yet fully understood.
In essence, vaccination induces a less inflammatory immunity at our disposal, compared to innate immunity, which is highly inflammatory, and antibodies, non-inflammatory, which, when present, neutralize a virus without relying on innate immunity. Other effective strategies, especially for non-resilient individuals, include avoiding inflammatory triggers, such as moderate-to-intense exercise, and taking Omega-3s to reduce circulating inflammatory signaling molecules like C-reactive protein, interleukin-6, and tumor necrosis factor.
New Technologies
Other potentially interesting tools are emerging for managing specific conditions. For instance, neuromodulation techniques for treating obesity and diabetes, biomimetic nanomaterials to speed healing in severe pathological contexts, glycans as biomarkers for personalized health monitoring, and autonomic regulation through a neuromodulatory approach to improve overall resilience.
Abbonati a Karla Miller
