Longevity medicine has one tenet at its core: don’t just react, prevent. Whereas standard medical care waits until blood work demonstrates high cholesterol and then offers treatment, longevity medicine takes a more proactive path. It may involve, for example, analyzing one’s genetic code in search of inherited predisposition to hypercholesterolemia and then developing a plan to help the patient maintain a healthy lipid profile for life, using tools that range from standard nutrition and exercise advice to AI-driven models that recommend hyperpersonalized interventions.

This in-depth medical care is often offered through concierge clinics accepting out-of-pocket payments. Many of these approaches are still emerging and unstandardized, but their popularity reflects the growing commercialization of aging science.

When Jordan Weiss, PhD, gives talks about the health inequities surrounding aging, he often asks the audience to raise their hands if they’d like to live to be 150 years old. When he goes on to ask if they’d like to be 150 years old, but in poor health and without the financial resources to cover basic bills, most hands drop, echoing the response to the aforementioned survey.

As Assistant Professor at the Optimal Aging Institute of NYU Grossman School of Medicine and Scientific Writer at Assisted Living Magazine, Weiss focuses on health equity from the lens of how long we live and how many of those years are spent in good health. In his view, living longer isn’t the whole answer: “The question is, what’s the upside of living or extending how long you live if you still can’t afford to pay your rent or feed yourself?”

Longevity medicine is largely inaccessible to lower-income populations, due to both cost and socioeconomic barriers. Income is a major driver of mortality; Weiss cites a 2016 paper demonstrating a staggering 14.6-year life expectancy gap between the top and bottom 1% of male earners, and a 10-year difference between the top and bottom 1% of female earners.

Weiss illuminates another, more subtle accessibility challenge facing longevity medicine: “Even if you made every [longevity medicine] intervention free, you still need to…interpret all that information.” That requires the consumer to possess a high degree of health literacy, which is typically higher in well-educated, high-income individuals.

“Wealthy patients walking into longevity clinics aren’t just buying the intervention, they’re buying someone to do that cognitive work and navigation for them, to be the quarterback of their health, or the CEO of their health, which is a service that’s almost completely absent from primary care for most other people.” Without someone to provide context and guidance, the large amount of data that longevity medicine testing reveals may simply be disregarded, or worse, widen disparities.

When discussing the ethical implications of longevity medicine access, questions abound: might longevity increasingly become a form of privilege, and is it acceptable for life-extending technologies to be unequally distributed?

Weiss asks, “Who benefits, who gets left behind, and does the innovation unintentionally widen healthspan inequality? Many longevity interventions are preventive, and they accumulate over time, so unequal adoption can create widening divergence over decades.” These questions must be weighed and addressed by policymakers, clinicians, and even laypeople as health innovation continues to progress.

Furthermore, the level of precision health relied upon by longevity medicine assumes a level of health engagement and empowerment that is not equally distributed. Chronic disease burden is already higher in socioeconomically disadvantaged populations.

Weiss points out that “feeling fine may mean something different to someone who’s grown up in a world where chronic disease is more prevalent.” They’re then less likely to seek medical care early, potentially altering the course of their health span for decades to come. Focusing on the highly individualized interventions offered by longevity medicine risks shifting focus away from population-level interventions that improve the health of millions, rather than only a few.

There are tangible steps toward more ethical integration of longevity medicine interventions that companies, clinicians, and policymakers must consider.

Study design on new innovations must center equity by including diverse sample groups and planning interventions that work within the context of lower socioeconomic communities. Companies must price products with equity in mind and market honest claims regarding the safety and efficacy of their products. Policymakers must create legal mechanisms that ensure pricing and access for all, as well as transparent marketing practices. Finally, leaders, medical professionals, and community members must focus on integrating longevity medicine principles into the greater public health system.

The clinician’s role is that of the interpreter: with more and more data on their hands, consumers are unsure which to act on and which they can safely ignore. Weiss points out that more data isn’t necessarily better: “If you take a test and it turns out you have a genetic predisposition to Alzheimer’s disease, which doesn’t really have a cure, what do you do with that information? How does that leave people feeling? How do we package and present these results in a way that’s actually helpful?”

Longevity medicine offers fantastic potential for increasing health span—a hope that many of us dream of—but the future of longevity medicine will be defined by not just how long we can live, but by who gets the opportunity to do so.

By integrating these advancements into the broader public health system and carefully balancing access so that not only the wealthy benefit, we can harness the power of medicine’s next big frontier: our futures.