Over three million Americans died in 2023. Heart disease, cancer, stroke, and Alzheimer’s disease together form the majority of the proximate causes of these deaths [1]. To combat these diseases, thousands of researchers and billions of government and philanthropic dollars have been mobilized.

However, one could view the cause of death from another perspective. In 2023, over 96% of total deaths occurred in Americans over 34 years of age, and over 75% in Americans 65 years and older [1]. Though the proximate cause of death may be cancer, cardiovascular disease, and Alzheimer’s disease, age is an undeniable correlate in the vast majority of these cases and the likely underlying driver of most mortality. Even for infectious diseases like COVID-19, the majority of deaths occur among Americans over 65 [2].

Some researchers have homed in on an idea known as the geroscience hypothesis: That by targeting the process of aging rather than the proximate causes of death, more deaths can be averted [3, 4]. Breakthroughs that slow the rate of aging to reduce mortality from multiple aging-related diseases could be transformative, especially in comparison to the alternative of tackling one disease at a time. Researchers estimate that completely curing cancer would only increase lifespan by about 3 years, as many individuals who die from cancer are often elderly, frail, and suffering from other comorbidities [5, 6]. Therefore, they would likely die from other causes even if their cancer were cured. Delaying aging and its associated frailty could thus have many times the benefit of completely curing just one of the late-onset diseases of aging.

Though the feasibility of slowing down aging is uncertain, previous breakthroughs and theoretical advances in geroscience and medicine provide a basis for evaluating the relative likelihood of success. In this article, we discuss the policies that implicitly support a framework of combating age-related diseases—here termed the disease-centric model— and what would need to change to support combating aging directly (the geroscience model) (see Figure 1). For each of these models, we will briefly discuss their scientific history, assess current U.S. institutional and political support, and discuss successes and challenges. Finally, we highlight future funding opportunities for U.S. policymakers wishing to target one or both of these approaches. By comparing these two frameworks, we aim to provide insight into the future of aging research and its implications for aging-related policies.

The disease-centric model

The current approach to most research on age-related diseases in the U.S. conforms to the disease-centric model. Under this model, researchers seek to develop both preventative and curative treatments for a range of age-related ailments such as heart disease, diabetes, Parkinson’s disease, and cancer. Although this model acknowledges correlations between age-related diseases (i.e., comorbidities), research goals are nevertheless focused on a specific disease or organ system rather than aging as a holistic concept. This is exemplified by the FDA evaluation process for New Drug Applications. When studying aging, it is impractical to use all-cause mortality as a measure of therapeutic efficacy because this necessitates tracking all subjects until the end of life. Instead, the FDA might use surrogate endpoints to evaluate therapeutic efficacy. Surrogate endpoints are clinical markers that, while not a direct measurement of clinical benefit, are reasonably likely to predict it (1). All surrogate endpoints that the FDA has previously considered are for specific diseases; none have been used for more general, holistic conditions such as aging [7]. Moreover, many proposed surrogate endpoints for aging are in fact statistical summaries of multiple physiological sub-endpoints [8]. Thus, for a drug intended to slow aging, the most straightforward path to approval would be to target a specific recognized disease or condition associated with aging for which there are established surrogate endpoints [9]. Beyond the drug approval process, this disease-centric framework is also embedded in the basic research landscape.

Current support: Most aging research funding is disease-centric. The organizational structure of the National Institutes of Health (NIH) reflects a disease-centric perspective. Through 27 different scientific Institutes and Centers, the NIH conducts and funds research into different areas of human health and disease. Although one of these is the National Institute on Aging (NIA), several prominent age-related diseases (heart disease, diabetes, Parkinson’s, and cancer) each fall under the purview of their own institutes [10]. Cancer, the second-leading cause of death in the United States in 2021, continues to receive the largest portion of NIH funding; the National Cancer Institute (including the Cancer Moonshot initiative) received the largest appropriation in the 2024 NIH budget, amounting to US$7.2 billion, 64% more than the NIA [11, 12]. These substantial investments reflect the prioritization of cancer research and the broader commitment to addressing major health burdens through targeted funding.

Even the NIA has, in recent years, focused specifically on Alzheimer’s disease and other dementias. When Congress authorized the creation of the NIA in 1974, the Research on Aging Act implicitly invoked a geroscience approach, promoting the “study of the aging process” rather than the diseases of aging, and the “[extension of] the healthy middle years of life” (2). The shift to a more disease-centric approach is exemplified by the landmark National Alzheimer’s Project Act (NAPA) of 2011 (3). In the wake of NAPA, Congress dramatically increased NIH appropriations for Alzheimer’s and related dementias, with annual federal Alzheimer’s research funding climbing from the hundreds of millions into the multiple billions of dollars, most of which are allocated to the NIA [13, 14]. Out of total NIA appropriations for 2024, over 50% was allocated for neuroscience research, with less than 10% directed towards “Aging Biology” [15]. This prioritization reflects a broader Congressional trend of increasingly backing a disease-centric model of aging research.

There is a similar trend within NIH study sections, the groups of researchers who review grant applications on specific topics through the centralized Center for Scientific Review (CSR). As of 2023, only two of over 200 CSR Standing and Special Study Sections focus on aging as a distinct phenomenon, indicating an emphasis on disease rather than a more comprehensive, geroscience-oriented approach [16].

Current NIH budget proposals for fiscal year 2026 suggest decreasing the budget to US$27.9 billion—a 39% reduction—and reflect plans to consolidate the 27 Institutes and Centers down to 8 [17]. Although the NIA would remain a distinct Institute under this plan, given the proposed budget cuts and rapidly evolving policy landscape, the NIH’s approach to aging research in the near future remains unclear.

Successes: Disease-centric research has dramatically improved disease outcomes. The disease-centric approach has driven tremendous advancements in the diagnostics and treatment of multiple conditions, yielding significant benefits for individual health outcomes. Cancer treatment has seen remarkable progress, with cutting edge advancements in mRNA cancer vaccine development (currently in clinical trials) [18], and even potential artificial intelligence applications [19] that digitally recreate patients’ tumors to personalize therapy holding significant promise. Among current therapeutic innovations is CAR T-cell immunotherapy, such as tisagenlecleucel, which has already been shown to eliminate cancer in 83% of patients with relapsed or treatment-resistant leukemia [20]. Immune checkpoint inhibitors have also had a great impact on cancer treatments, decreasing the risk of death by 26% across all cancers [21]. These breakthroughs are reflected in population-level cancer survival rates; for instance, myeloma survival rates have gone from 35.6% in 2001 to 61.1% in 2016 [22].

In the case of diabetes, the disease-centric model has led to the development of a wide range of pharmacological treatments that help manage blood sugar and delay disease progression. Recently, therapeutics such as tirzepatide (U.S. trade name Mounjaro) have proven quite effective for the treatment of obesity and prevention of diabetes [23]. Beyond pharmaceuticals, technological innovations such as automated insulin delivery systems—capable of adjusting insulin dosing based on continuous glucose monitoring—have revolutionized diabetes management [24]. Additionally, the first cellular therapy derived from deceased donor pancreatic cells represents a major breakthrough in potential long-term treatment [25]. From 2000 to 2019, the death rate from diabetes in the U.S. decreased from 28.1 to 19.1 per 100,000 people [26].

Modern treatment of cardiovascular diseases represents another major success for the disease-centric model [27]. A stellar example of successful drug development are statins. Statin therapy across clinical trials was shown to reduce the risk of myocardial infarction by 33%, strokes by 18%-25%, and overall mortality by 15% [28, 29]. With widespread use of statins, age-adjusted annual heart disease mortality fell by 56% between 1950 and 2000 [27]. It should be noted that statins are used in conjunction with preventive care and lifestyle management (smoking cessation, diet, exercise) and decoupling the two is not possible here.

Importantly, disease-centric therapeutics might be effective in extending healthspan even in the absence of a specific disease diagnosis. One compelling example is metformin; originally a diabetes drug, it has given rise to an aging-centered view of therapeutics. Metformin improves glycemic control, and has also been proposed to have effects that encourage healthy aging such as altering inflammatory responses and reducing the risk of DNA damage and mutation [30, 31]. It is important to note that diabetes is associated with comorbidities such as cardiovascular disease, obesity, kidney disease and even cancer [32]. Therefore, treatments targeting diabetes might also improve the overall well-being of an individual through their impact on comorbidities. Whether metformin can ameliorate the impact of aging on non-diabetic patients is an important open question, with the Targeting Aging with Metformin (TAME) trials having received preliminary approval by the FDA to address this, although it has not yet been launched [33, 34]. These findings suggest that, although the disease-centric model has traditionally focused on treating specific conditions, its successes may provide valuable insights into healthy longevity interventions.

Challenges: An increasing gap between healthspan and lifespan. Despite the impressive advances in disease-specific treatments, life expectancy gains in developed nations have stalled. Between the year 2000 and today, life expectancy in Senegal rose from 57 to 67 years, while life expectancy in the United States rose only from 76 to 77 years, despite the U.S. having the highest annual healthcare expenditures at US$4.9 trillion in 2023 [35]. Over the 20th century, pioneering efforts in public health and medicine have led to a doubling of the global life expectancy at birth (from 32 years in 1900 to 71 years today), driven largely by reductions in early-life mortality through public health measures—clean water, antibiotics, and vaccines [36]. Senegal’s dramatic gains in life expectancy were a result of lowering childhood mortality rates [37]. In the U.S., however, where childhood mortality was already minimized by 2000 [36], gains in life expectancy must be achieved at the other end of the equation: prolonging the healthy lifespan of the elderly or improving access to healthcare for those populations with lower life expectancy. Whether substantial investments in disease-specific therapies in developed nations have led to meaningful increases in the upper bounds of the human lifespan remains contested.

So far, the evidence suggests only modest gains. Despite cardiovascular disease and cancer receiving some of the largest shares of research funding in the U.S., their estimated impact on average lifespan remains limited. Advances in cardiovascular care have added just 2.26 years for men and 2.05 years for women in Europe, while improvements in cancer treatment have contributed only 1.07 and 0.84 years, respectively [38]. These numbers should not be seen as a failure of the disease-centric approach, rather, they highlight its limits. One leading argument against the disease-centric approach is that focusing on individual chronic illnesses encounters diminishing returns due to competing risks. In old age, the likelihood of all age-related diseases increases [6]. Even if one fatal disease is prevented or cured, another illness is likely to emerge.

The disease-centric approach, which focuses on reducing mortality from fatal illnesses, may keep elderly patients alive, but the improvements in healthspan have not kept pace with increases in lifespan [39]. Today, 45% of patients over 65 live with two or more chronic conditions [40]. To juggle their simultaneous treatment, 30% of these patients take five or more medications at once [40]. Adverse drug interactions associated with polypharmacy alone account for 12% of hospital visits in this age group [40]. In the U.S. and many other developed nations, demographic data suggests a discouraging trend: Efforts to prolong lifespan are not met with equal gains in prolonging our healthspan [41, 42]. Globally, the healthspan-lifespan gap has widened to 9.6 years. In the U.S., that gap is the largest in the world at 12.4 years [43].

Recognizing that current strategies often extend “sickspan” rather than healthy years, many researchers in the aging field now prioritize interventions aimed at increasing healthspan rather than lifespan alone [44]. Yet, if the goal of medicine is to prolong those years in which individuals remain healthy, it may be the case that the treatment and prevention of age-related diseases in isolation is not enough.

The geroscience model

In response to criticism of the disease-centric research model and its inability to continue delivering substantial improvements in overall healthspan, some researchers have proposed a different view of aging termed the geroscience model [3, 4]. This model suggests that one can target the fundamental upstream processes of aging to delay, prevent, or mitigate multiple age-related diseases simultaneously.

But what exactly are these upstream factors that contribute to biological aging? Although “wear and tear” theories of aging have been proposed since at least the 19th century, the specific biological processes implicated in aging have only been discovered in recent decades [45]. Researchers have made attempts to enumerate and categorize these upstream processes, otherwise known as the “hallmarks of aging” [46, 47]. Examples of proposed hallmarks include cellular senescence (cessation of cell division), chronic inflammation, and stem cell exhaustion (progressive decline in stem cell function) [46, 47]. The degree to which these hallmarks are independent and whether some hallmarks are further upstream of others remains debated within the geroscience field. A promising hallmark must have the following three traits: First, the process must correlate with the physical manifestation of aging. Second, experimentally enhancing the process causes an acceleration of aging. And third, interventions that restore the process to a more ‘youthful’ state result in a deceleration, or even reversal, of the aging process (see Figure 2). These criteria are not easy to demonstrate, and even the most promising candidates for the hallmarks of aging only partially satisfy these criteria.

Although aging can seem a hopelessly complex interplay of multiple biological processes, there is evidence that simple perturbations of key molecular pathways can have profound effects on lifespan in humans and model organisms. One of the earliest discoveries of a hallmark of aging stemmed from observations of a rare class of genetic disorders called progeroid syndromes: diseases that resemble an accelerated form of aging. Within a year of birth, patients with progeria display wrinkled and aged skin, and by the age of 10, suffer from arthritis, cardiovascular disease, and respiratory conditions that are rare in non-elderly populations [48]. The root cause of this disease was found to be mutations in a single gene, LMNA, critical to maintaining DNA integrity [48]. Interventions that extend lifespan and delay the onset of age-associated disease have also been demonstrated across several model systems. Modifying single genes in the insulin signaling pathway doubles the lifespan and delays the onset of a Huntington’s disease-like phenotype in the roundworm C. elegans (a well-characterized model organism in biological research)[49, 50]. Fruit flies and mice also exhibit extended lifespans in response to the perturbation of this pathway, with fruit flies displaying minimal or absent onset of oxidative stress-induced heart failure and mice experiencing reduced incidence of cancer [51]–[53].

If perturbations of single genes in key pathways can have such a dramatic effect on the pace of aging, it is possible to imagine how targeting the aging process itself in healthy human adults could be achievable. Evidence from epidemiological studies indicates that Laron dwarfism, which confers resistance to Growth Hormone (a primary regulator of the insulin signaling pathway), is associated with reduced incidence of cancer and diabetes—two major age-associated morbidities [54]. In light of this, a key goal of geroscience is to develop interventions termed “gerotherapeutics” (pharmaceutical and otherwise) that extend healthy human lifespan or prevent the onset of multiple age-related diseases simultaneously [55]. By focusing on the biological processes of aging, gerotherapeutics could offer a broader, more holistic approach to improving health outcomes in aging populations.

Current support: Geroscience at the NIH is rich in ideas but poor in funding. From an intellectual standpoint, the NIH has supported geroscience research, recognizing that aging itself is the common risk factor for many chronic diseases and making efforts to advance the geroscience field [3]. The Trans-NIH Geroscience Interest Group is a community of NIH researchers interested in how aging processes drive multiple diseases and in developing interventions that extend healthspan [56]. However, few initiatives explicitly aim to fund geroscience research or test new gerotherapeutics, and some of them have recently experienced funding cuts.

The NIA supports and coordinates several programs that test potential gerotherapeutics, although they make up a small fraction of the extramural research budget. The Intervention Testing Program (ITP) is an effort to test compounds for lifespan extension in mice in a standardized manner; each trial is independently replicated at three different universities [57, 58]. The ITP is funded through U-series grants, which include more substantial involvement from the NIA in planning and execution compared to extramural studies funded by more common R-series grants such as R01s [59]. Since its founding in 2002, the ITP has identified twelve compounds that significantly increase median lifespan in either male or female mice (but rarely both). These include disease-centric FDA-approved drugs such as the diabetes drug canagliflozin, a small molecule SGLT2 inhibitor. A very similar program called the CITP conducts testing in C. elegans [60]. In 2024, NIA funding for the ITP and CITP totaled US$5.2 million and US$2.12 million, respectively [14]. On the level of individual grants, these award amounts are generous; both are above the 75th percentile for other U01 grants from the NIA from 2022-2025 [14]. However, in a larger context, these two programs represent only about 0.18% of the total NIA request for extramural research grants in 2024 [15]. Notably, there are not any similar efforts to conduct human clinical trials of promising gerotherapeutics.

There have been recent shifts in the grant funding of the Dog Aging Project, another prominent animal geroscience study. The Project was a “long-term longitudinal study of healthy aging in the companion dog” that received US$29 million in grant support between 2018 and 2023 [14, 61]. The Project was supported by cooperative NIA U-series grants, similar to the ITP and CITP detailed above, but failed to obtain renewal in 2024. Some of the Project’s work now continues under a narrowed scope with the Testing Rapamycin In Aging Dogs (TRIAD) trial, supported by US$2 million of R-series grant funding in 2025 [14, 62]. The lack of U-series grant renewal is likely due to some combination of low scores from the independent study section members and a misalignment between the study’s goals and overall NIA funding priorities. The shift from a broad, cooperative grant to a more limited, traditional extramural grant is an example of a shift away from investment in geroscience research both at the NIA and perhaps the broader scientific community.

Current support: Congressional interest in geroscience research. Geroscience has been gaining recognition among various politicians as a key avenue for promoting longevity and healthy aging. In early 2023, a group of U.S. Representatives launched the bipartisan Congressional Caucus for Longevity Science to educate their colleagues and champion research aimed at extending the healthy lifespan [63]. The caucus signals a growing political will to treat longevity as a national priority, not just an academic topic. In the Senate, the Special Committee on Aging has also turned its attention to research. In February 2025, the Committee held a hearing titled “Optimizing Longevity: From Research to Action,” gathering experts to discuss how recent scientific advances in aging could be translated into policies that improve older Americans’ health and independence. Legislators on relevant House committees have generally expressed support for geroscience (4) and research into female reproductive aging, but that has not yet been reflected in more specific legislation or prioritization of geroscience in the federal budget.

Current support: Could the “Make America Healthy Again” initiative advance geroscience? The current U.S. Secretary of Health and Human Services (HHS), Robert F. Kennedy Jr., has pledged to “Make America Healthy Again.” Although this effort has few concrete goals so far, the Executive Order establishing the Make America Healthy Again Commission indicates some priorities consistent with a geroscience approach (5). The Order begins by noting that “American life expectancy significantly lags behind other developed countries” and advocates for focusing HHS priorities on chronic disease via “fresh thinking on nutrition, physical activity, [and] healthy lifestyles” [64]. However, the aforementioned 39% budget reduction proposed for NIH in 2026 includes a 39% cut to NIA specifically, making increased geroscience funding in the near future unlikely [11, 17].

Successes: Promising evidence for hallmarks of aging. There is evidence that some interventions can lead to what is called multifaceted rejuvenation—that is, the reduced onset of multiple age-related diseases alongside lifespan extension. Exercise is one example of a gerotherapeutic intervention [65]. A meta-analysis of 11 studies found that regular physical activity is associated with an increased life expectancy of 0.4–4.2 years, even when adjusted for confounding variables such as education, body mass index, or pre-existing chronic conditions [66]. This translates to an all-cause mortality reduction of 30-35% between physically active and inactive individuals, and significantly lower risk of cardiovascular disease, diabetes and cancer [66].

A healthy diet is similarly linked to longevity and lower incidence of multiple age-related diseases. The Mediterranean diet, consisting of lean proteins, vegetables, fruits, and healthy fats, was shown to be associated with a 23% decrease in all-cause mortality risk in a 25-year cohort of 25,000 adults [67]. Caloric restriction has also emerged as a potential gerotherapeutic intervention, with the landmark 1935 paper from McCay et al. demonstrating a remarkable 30-50% lifespan extension in rodents subject to a 20-40% reduction in calories [68]. The evidence for increases in longevity associated with caloric restriction has been validated across multiple species, including non-human primates, and is consistently associated with reduced aging hallmarks in multiple organ systems [69]–[72]. These results across model organisms strongly suggest that caloric restriction will similarly increase lifespan in humans. In 2007, the NIA sponsored the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) Phase 2 trial. CALERIE enrolled healthy, non-obese adults to assess the health effects of a 25% reduction in caloric intake over the course of two years [73]. While only achieving a 12% reduction in calories on average, follow up studies analyzing CALERIE trial data converge on statistically significant—albeit modest—slowing of aging trajectories across a variety of biological-aging metrics [74, 75]. These outcomes align with a potential healthspan extension effect, although direct evidence of healthy lifespan extension through caloric restriction would still require a decade-long clinical trial.

Outside of lifestyle interventions, several promising gerotherapeutics have captured the attention of the field. Of all drugs tested in mice by the NIA ITP, rapamycin has displayed the strongest lifespan-extending effects [76]. Rapamycin acts as an inhibitor of the conserved nutrient-sensing pathway, mTOR, which is believed to mediate the effects of caloric restriction. Based on age at 90% mortality, rapamycin increased the lifespan of mice by 14% in females and 9% in males. Whether its longevity benefits arise from delaying cancer-related mortality, slowing aging mechanisms, or both remains unclear. Ultimately, rapamycin-treated mice displayed similar causes of death as control mice, with delayed onset of age-associated disease [77].

Another class of gerotherapeutics currently in development are senolytics, drugs that selectively eliminate senescent cells, which accumulate in tissues over time and have long been suspected to drive aging by secreting inflammatory factors [78]. Strong evidence for the causal role of cell senescence in aging was established in 2016, when researchers found that continual clearance of senescent cells in a transgenic mouse model was sufficient to increase lifespan and delay the onset of multiple age-associated phenotypes [79]. Subsequent studies using this mouse model have expanded the range of rejuvenative effects linked to senescent cell clearance, including reduced neuro-inflammation, improved cognitive function, and enhanced bone formation; highlighting the systemic influence of senescent cells across multiple organ systems during aging [80]–[82]. The convergence of emerging gerotherapeutics underscores the growing feasibility of multifaceted rejuvenation. Together, these findings reinforce the notion that aging itself may be modifiable, and continued research into both behavioral and pharmaceutical strategies could lead to breakthroughs in developing effective, broadly applicable longevity interventions.

Challenges: Convincing validation of gerotherapeutics remains elusive. To date, no drug has been FDA-approved to treat aging in humans. In addition to the need for additional basic research, the lack of standardized biomarkers of aging is a major obstacle to the approval of such a drug [8, 83, 84]. As human biological aging is a slow and complex process, with disagreement as to what characterizes its true starting point, any practical research requires the use of biomarkers to track different dimensions of the aging process. Although many different biomarkers have been proposed and tested on a small scale, there is no consensus among geroscience researchers which ones should be widely used, or even which criteria to use to evaluate biomarkers. Some of the debates include whether biomarkers of aging should be used to predict all-cause mortality, frailty, chronic disease, or all three; whether they should have a confirmed causal role in aging, or simply be associated with it; and to what extent they can be used to evaluate potential gerotherapeutics [83].

It is also worth considering the challenges at the basic science level that contribute to this translational gap. One issue inherent to studying aging is the time it takes to observe results in interventional studies. For instance, cancer can be induced in a mouse and the impact of an intervention on tumor growth and metastasis can be gauged directly. An aging intervention, on the other hand, would need to be assessed via its effect on lifespan in lieu of promising biomarkers. As such, researchers are incentivized to focus on shorter-lived species such as invertebrates and mice that would allow for more rapid validation of study outcomes and minimize cost [3]. Studies performed in longer-lived vertebrates might reveal more directly translatable human interventions, but come at a greater cost of study maintenance. A lack of such studies in systems with greater promise of translatability, coupled with no clear pathway for FDA approval, has disincentivized public and private funding for gerotherapeutic drug discovery and clinical trials.

Future U.S. funding opportunities for disease-centric and geroscience research

Federal science funding has a profound impact on U.S. biomedical research and drug development: nearly one quarter of all U.S. medical and health R&D spending came from the federal government in 2020 [85]. Between 2010 and 2019, NIH funding has contributed to the R&D of over 99% of new approved drugs, and total NIH contributions to pharmaceutical R&D were on par with those of industry [86]. So far, we have discussed the current role of the geroscience and disease-centric approaches in modern aging research in the U.S., along with the potential benefits and limitations of each approach. Below we present specific examples of future directions for aging research funding under either approach to make such a decision more tractable.

It is important to note that a geroscience research approach can lead to disease-centric therapeutic improvements, and vice versa. As discussed previously, metformin is a disease-centric diabetes drug, yet it might have unintended, off-label use as a gerotherapeutic. Another example is semaglutide, initially a diabetes drug, with effects on cardiovascular disease and potentially other age-related diseases [87]. Exercise, dietary restriction, and high-quality sleep are generally thought of as gerotherapeutic behavioral changes, but may have positive disease-specific effects as well. For example, short sleep duration is associated with dementia and several other chronic diseases [88, 89]. In these ways, the potential outcomes of a geroscience or disease-centric research approach are not necessarily mutually exclusive.

Augmenting the disease centric-approach: A Heart Disease Moonshot and disease interactions. The disease-centric approach has undeniably led to significant breakthroughs in the diagnosis and treatment of various diseases, as discussed above. Efforts to combat cancer, diabetes, Alzheimer’s, and cardiovascular diseases are essential and ongoing; these initiatives will never be fully exhaustive and could continuously aim to decrease mortality rates. Given the impact of the Cancer Moonshot, one might ask whether similar large-scale efforts could be applied to other age-related diseases. For instance, in the U.S., ischemic heart disease is the leading cause of decreased healthspan in most states in the US [90], but funding for heart disease research lags far behind funding for cancer research. In 2023 the NIH disbursed about US$9 billion in extramural grants for cancer research, but only US$1.9 billion for heart disease out of a total research grant allocation of US$32.6 billion [11]. This funding gap highlights the potential impact of a heart disease “moonshot.”

While the comorbidity of many diseases is well-recognized, the mechanistic understanding of disease-disease and treatment-disease interactions remains limited. Epidemiological data show an unexpected inverse association between cancer and Alzheimer’s disease, yet it is unclear if this is due to the respective treatments for each disease or the diseases themselves [91]. Similarly, it is unknown why people who survive pediatric cancer have a higher risk of early mortality from seemingly unrelated cardiopulmonary diseases later in life [92]. Even within a disease-centric framework, more research can be done to understand how diseases interact rather than treating them in isolation.

Furthering the goals of geroscience: Increasing data, data sharing, and biomarker accessibility. As previously mentioned, one of the limitations of the geroscience model is the lack of agreement on which biomarkers of aging to use and how to use them. Such biomarkers may be especially important given evidence that the aging process can be measured in healthy adults as young as 26 years of age, with some proposing that aging begins at birth [93, 94]. Some researchers argue that funding efforts to centralize data and store samples, along with standardized, accessible protocols can help overcome these limitations [83]. Such a resource could enable more reliable meta-analyses of biomarker performance across larger datasets. Moreover, centralized storage of clinical samples and standardized analysis protocols could enable reproducible testing of different biomarkers on the same samples, thereby removing some common confounding variables.

The most prominent example of such a resource is the UK Biobank, which is a repository of the complete genome sequences of 500,000 individuals [95]. The Biobank also contains smaller amounts of medical imaging data, tissue samples, biomarker data, and electronic health records, along with standardized protocols for collection of these data. In the U.S., the NIH launched a similar effort in 2016 (“All of Us”), which recently expanded its whole genome sequencing dataset to include 414,000 individuals. However, All of Us is facing significant funding challenges, with funding in 2024 being 34% lower than the previous year, and funding in the latest 2025 Continuing Resolution cut again for a 71% total cut from 2023 [96].

In addition to increased data sharing, the advancement of geroscience would greatly benefit from large-scale, long-term human longitudinal studies [84]. These cohorts are essential for identifying biomarkers, evaluating interventions, and understanding how aging unfolds over time. For instance, the decades-long Dunedin Study has provided unique insights into how we view aging and has identified a functional measure of aging rate that is accessible using a single blood test [97]. Yet, studies like these are limited by insufficient investments and regulatory constraints.

Findings from basic geroscience research on aging biomarkers can be translated to tangible clinical benefit through increased funding opportunities for gerotherapeutic development and testing. For example, a program similar to the NIA ITP could be targeted towards human gerotherapeutic trials. In late 2024, the federal Advanced Research Project Agency for Health (ARPA-H) launched a program called PROSPR (PROactive Solutions for Prolonging Resilience). The initiative’s driving question is: “What if we had therapies to extend healthspan and prevent age-related diseases?” [98]. PROSPR builds on foundational work by the NIA and plans to work with industry partners and regulators to fast-track new healthspan therapies. Similar to All of Us, funding for PROSPR seems uncertain, as the inaugural event for soliciting proposals was recently canceled.

Finally, the cost of collecting aging biomarker data is currently prohibitive. The latest biomarkers of aging are based on (sometimes multiple) “-omics” (e.g. genomics) approaches that broadly survey a whole collection of molecules, such as DNA methylation throughout the genome [8]. Thus, collecting data for aging biomarkers is substantially more expensive than common disease-centric biomarkers, such as screening for genetic predisposition to breast cancer or detecting diabetes through blood glucose levels. Expensive data collection can hamper research and reduce clinical utility. If decreasing the cost of biomarker data is a desirable goal, research funding for biomarkers that rely on targeted measurements rather than broad “-omics” approaches could be a priority. In addition, providing funds to test clinical tractability of current biomarkers of aging would both inform ongoing biomarker research and help realize economics of scale to decrease assay costs [83].

Conclusion

The improvements in public health during the 20th century have been astounding, both for the U.S. and globally. Industrialization has allowed for the widespread availability of clean water, antibiotics, and access to modern hospitals which has led to a doubling of average lifespan [99]. In contrast, the 21st century in the U.S.—despite substantial gains in economic growth and technological development—has yielded only marginal increases in life expectancy. Healthcare spending in the U.S. has gone from 13.3% of GDP in 2000 to about 17.5% two decades later—during which real per capita GDP itself has risen over 30% [100, 101]. Yet, Americans only live a year longer on average today than they did in 2000 [102].

These diminishing returns highlight the limitations of a disease-specific approach; particularly for the elderly, where multiple pathologies and general frailty reduce the efficacy of treating individual diseases. Geroscience offers an upstream strategy: targeting the biological processes of aging to simultaneously improve multiple health outcomes. In short-lived model organisms, interventions like senolytics and calorie restriction mimetics have been shown to significantly extend lifespan [77, 80]. This suggests that aging is a modifiable process—even if translation to humans remains uncertain.

American public policy has a large bearing on the future of this nascent field. These efforts include directing research funding towards the discovery of tractable biomarkers of aging. Once these biomarkers are established, continued investment in human clinical trials will allow scientists to investigate therapies that alter these biomarkers and slow down the aging process. Ensuring that these biomarkers and their biological samples of origin are collected in a standardized, transparent manner will further aid the development of the field. At the same time, the disease-centric model remains a valuable framework. Investigating the end-stage manifestations of the aging process may be more tractable, and therapies developed for one condition may yet show synergy in alleviating other age-related diseases. Moreover, prioritizing efforts to ensure that individuals reach old age in good health—rather than focusing exclusively on extending maximum lifespan—may align more closely with public preferences. The assumption that lifespan extension is inherently desirable still warrants critical examination. Even in the absence of lifespan extension, an increased understanding of the aging process could lead to significant increases in healthspan. The decisions made in public policy today could play a large role in realizing those gains in the future.