Can wealth buy good health?

American tech entrepreneur Bryan Johnson celebrates his birthday every 19 months. Johnson, who sold his payments processing company, Braintree Venmo, to PayPal for about $800mn in 2013 has, in recent years, become a diet and lifestyle influencer. And the reason he celebrates his birthday every 19 months is that he claims he ages only 7.6 months in a calendar year.

He puts this down to the numerous health and diet regimes that he follows — the most remarkable of which was using blood plasma taken from his son Talmage (although he has now abandoned this practice). He has said he spends $2mn a year on health and that his goal is to live forever.

But, while Johnson may be one of the more eccentric and high-profile proponents of the Silicon Valley cult of wellness, he raises an interesting question. Can you buy yourself healthy?

Certainly, in a basic way, you can. The connection between money and health is age-old. In the US, you can, more or less, plot a course of various health outcomes from a map of average income — and areas such as the Deep South fare notably poorly. A 2016 paper by researchers at Stanford and MIT found that, at age 40, life expectancy increases continuously with income percentile. 

However, the link isn’t quite as clear cut as it might at first seem. Cubans live, on average, ever-so-slightly longer than Americans, even though the latter are vastly richer. What’s more, average US lifespans are nearly five years lower than the average across a group of OECD countries.

One explanation for this is US income inequality — as those at the bottom have very poor health outcomes. By contrast, low-income Britons have appreciably better health than low-income Americans largely because of the UK’s universal health service. A poor Brit with health problems can go to the doctor or a hospital without worrying about money (although they may have a long wait).

Still, despite these variations, wealth still matters a lot. A 10-year study led by UCL researchers and published in the Journal of Gerontology in 2020 looked at how long people in England and the US can expect to live free from disabilities (which, for this research, included being unable to get out of bed or to cook for themselves) and what role socio-economic factors played in this.

The results were stark: the wealthiest third lived eight to nine more healthy years than the least wealthy third. The researchers said that “the biggest socio-economic advantage in both countries and across all age groups was wealth”.

This makes sense: in both England and the US, wealth is associated with better nutrition, greater fitness and lower stress. And, even in a country with free healthcare, rich people can afford to go private if they need to.

However, again, it is not straightforward. In the US, the wealth-health relationship is not linear. The 2016 Stanford and MIT study looked at deciles and percentiles, not thirds. It showed returns diminish the richer you are. Above a household income of $224,000, to get roughly, another 0.8 years of life expectancy, you need to earn approximately $1.7mn more a year. If you’re earning $14,000 a year, another $6,000 will get you 0.8 years.

Of course, there are plenty of other factors, too. There is a genetic component to longevity and health, and lifestyle choices can play a huge part. There are also places where long, healthy lives are the norm. The American explorer and longevity researcher Dan Buettner identified a number of these which he called “Blue Zones” — in locations ranging from California to Sardinia to Japan. Among the factors contributing to these geographical groupings were genetic and cultural isolation, quality of diet, level of exercise, religion and strength of family and community ties.

One of the most interesting findings was that, in the Sardinian Blue Zone, the number of men over the age of 100 was roughly the same as the number of women (almost everywhere else, women typically outlive men). It suggests that health is not only better in rich places, it can also be good where people lead “rich” lives.

And there is not much money can do when your time is up. Even the rich can die relatively young. A cursory glance down Forbes’ annual “In Memoriam” list of billionaires who died in 2023, reveals a number of people in their eighties and quite a few in their nineties. But there are also some in their seventies and even their sixties.

So while the link between wealth and health certainly exists, at a group level, other factors may be more important for individuals.

As Benjamin Franklin, one of the US founding fathers, wrote: “In this world nothing can be said to be certain, except death and taxes”. The rich put a lot of effort into avoiding both with varying degrees of success. Tech entrepreneur Johnson is now nearly 47 so we’ll have to wait another 45 years to see if, come August 2069, he’s 92 or only 75.

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This article is part of FT Wealth, a section providing in-depth coverage of philanthropy, entrepreneurs, family offices, as well as alternative and impact investment