From Optimization to Agency: Reframing the Future of Personal Health

While medical advances have afforded us the luxury of longer lives, we now spend many of our later years coping with the ravages of chronic illnesses of aging — cardiovascular disease, type 2 diabetes, neurodegenerative conditions like Alzheimer’s, and cancer.  Many of these conditions seem linked to long-term exposure to low grade systemic inflammation, a pathological process known as “inflammaging.” 

Because these diseases often take decades to emerge, there’s a conspicuous opportunity to prevent them (to various degrees) by addressing the inciting chronic inflammation early on, ideally before it even develops. 

Today’s Consumer Health Model: Optimize Metrics

Because the U.S. medical system concentrates most of its efforts on (and draw most of its revenue from) caring for the sick, rather than on keeping us healthy, many consumers are looking outside the traditional medical system for resources to support their health – particularly as evidence mounts for the utility of so-called “lifestyle” approaches such as exercise, diet, and sleep. 

Interest in more aggressive monitoring of aging, as well as the development of more and often better measurement tools has also led to a proliferation of testing companies like Functional Health and Lifeforce, even as the clinical utility of such testing has not yet been well-established.

Consequently, a remarkable number of consumer-focused companies, ranging from wearable manufacturers like WHOOP and Oura to fitness platforms like Peloton and Tonal, have positioned themselves in the personal health space.  Many focus explicitly on enabling consumers to optimize meticulously a range of parameters thought to be associated with health.  Even physician-prescribed medicines like GLP-1s are often embedded in programs that offer customized behavioral support and designed to maximize long-term results.

The dominant model – illustrated in the figure below – treats health as a quantitative function of measurable metrics and encourages users to optimize relentlessly. 

The canonical example here may well be longevity guru Brian Johnson’s “Rejuvenation Olympics,” where participants are scored every three months based on their DunedinPACE score, an experimental measure of the rate of biological aging, and then ranked publicly on a leaderboard (with Johnson proudly in first place).

There’s much to admire in this approach, which borrows from familiar methods for continuous improvement.  And many companies in this space are genuinely impressive.  Peloton, for example, motivates users to move. WHOOP encourages attention to not just activity but also to recovery.   

Where Today’s Consumer Health Vision Falls Short

Still, this vision of health tends to fall short in two critical ways.

First, it often overlooks critical human experiences – like connection – that are difficult to quantify but vital for flourishing.  A more expansive conception of health is needed.

Second, and even more fundamentally, it tends to ignore the foundational, catalytic role of agency in improving health.

Agency, as described by Martin Seligman, the father of positive psychology, is the belief that you can shape the world for the better.   I’ve described agency as the “motivational currency of health, the ATP of successful behavior change.” 

Critically, enhanced agency developed in one domain – which I’ve called the “agentic dividend” – can energize progress in other areas, creating a virtuous cycle of health.  See figure below.

Seligman and colleagues have found strong correlations between agency (or optimism – he often uses the terms interchangeably) and improved health.  As he explained to Yale Professor Laurie Santos on her “Happiness Lab” podcast, “Pessimism is probably between smoking two and three packs of cigarettes a day as a risk factor. And optimism seems to give between six and eight years of extra life, probably about twice as important as exercise.”

Encouragingly, Seligman also argues that optimism is teachable, through techniques known as positive psychology interventions (PPIs), such as cognitive reframing.

Yet despite compelling associations, we’ve seen limited evidence that these interventions meaningfully move the health needle at scale.  That’s the gap we now have an opportunity to address.

Our Opportunity: Improve Health By Cultivating Agency

Our current moment offers important opportunities to deliver at last on this promise. 

1. Orient existing platforms around agency

Companies that already operate at scale and support meaningful achievements – like strength gain or improved recovery – can do more to highlight the agentic component of these wins.  The opportunity is to infuse these achievements with a sense of agency – helping users recognize success as self-driven progress, not just score attainment.  GLP-1 programs offer a compelling case study here: the success they unlock often catalyzes broader life changes, not because of weight the weight loss alone, but because they restore belief in what’s possible.

2. Reach the overlooked customer

A focus on agency also creates on-ramps for those alienated by a hyper-quantified wellness culture.  For many, the relentless emphasis on metrics and dashboard feels off-putting or exclusionary.  By recognize the health impact of connection, intellectual engagement, and time in nature, for example, we can reach people where they are – and help build reservoirs of agency that power other, health-promoting behaviors.

3. Delivering PPIs at scale – a potential role for AI

Advances in generative AI may offer a scalable way to deliver effective PPIs, such as cognitive reframing, in short, supportive, bursts.  Startups like Lore Health and Slingshot_AI already seem to be exploring this space.  The goal isn’t ethereal new insights – it’s palpable, pragmatic real-world behavior change. 

Bottom Line

Consumers – motivated to live well, empowered by better information about aging, and supported by improving measurement technologies and compelling platforms — are increasingly looking beyond the traditional healthcare system for ways to support their health. To meet this moment, consumer health platforms must embrace a vision of health that goes beyond metric optimization.  By cultivating agency, the motivational engine of behavior change, these platforms can help improve not only the length of our lives but also the quality of our days.  

 

Note:

To continue this discussion, I’ve set up a workspace (kindwellhealth.com) and a dedicated account on X (@KindWellHealth) that focus on the opportunities and challenges of centering health around agency, and the role emerging technologies might play in enabling these efforts at scale.  Links to key readings can be found here as well.