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Roundtable on Population Health Improvement; Board on Population Health and Public Health Practice; Institute of Medicine. Business Engagement in Building Healthy Communities: Workshop Summary. Washington (DC): National Academies Press (US); 2015 May 8.

Business Engagement in Building Healthy Communities: Workshop Summary.

• Hardcopy Version at National Academies Press

2 Lessons from the Blue Zones ®

The Danish Twin Study established that only about 20 percent of how long the average person lives is dictated by genes, while about 80 percent is influenced by lifestyle and environment, said keynote speaker, Dan Buettner, founder of the concept of Blue Zones ® . 1 To better understand the role of lifestyle and environment, Buettner set out to “reverse engineer longevity.” In association with National Geographic and with funding from the National Institute on Aging, Buettner and a team of demographers studied census data and identified five pockets where people are living verifiably longer lives by a number of measurements (Ikaria, Greece; Loma Linda, California; Nicoya, Costa Rica; Okinawa, Japan; Sardinia, Italy; see Box 2-1 ). A team of experts then used established methodologies to try to determine why people had such remarkable longevity in these areas, which were dubbed “blue zones.” The intent, Buettner explained, was to identify lessons or principles that could be applied to build healthier communities and to help people live longer and better lives. In describing the five blue zones, Buettner shared the stories of several individuals, each close to or more than 100 years of age. He showed photos of them swimming, surfboarding, lifting weights, working, and volunteering in their community. Health information is boring, he said, even in the cases of the best research and data. Using a human story to present health information increases audience engagement.

The Blue Zones. Ikaria, Greece The Greek Island of Ikaria has the greatest adherence to the Mediterranean diet in the world. The people live about 7 years longer than Americans do. A survey by the University of Athens of all 674 people over age 70 on (more...)

POWER 9 ® PRINCIPLES

In meeting numerous centenarians, Buettner realized that in no case did they reach middle age and then decide to pursue longevity through a change in diet, taking up exercise, or finding some nutritional supplement. The longevity occurred because they were in the right environment—an environment that fostered a lifestyle of longevity. Regardless of location, the same nine lifestyle characteristics were identified across all five blue zone environments, which Buettner termed the “Power 9 ® ” principles. Activity, outlook, and diet are key factors, and the foundation underlying behaviors is how people in blue zones connect with others (see Figure 2-1 ).

Power 9 ® principles. Shared traits of the longest-lived people from the five blue zones around the world. SOURCE: Buettner presentation, July 30, 2104. Used with permission.

• Move Naturally The world's longest-lived people do not “exercise.” In blue zones, Buettner's team observed that people were nudged into moving about every 20 minutes. For example, they were gardening, they kneaded their own bread, and they used hand-operated tools; their houses were not full of conveniences. When they did go out (e.g., to school, work, a friend's house, a restaurant, or to socialize), it was almost always on foot. Movement is engineered into their daily lives.
• Down Shift Stress is part of the human condition, Buettner said, and people in blue zones suffer the same stresses that others do. However, the people living in blue zones have daily rituals that reduce stress and reverse the inflammation associated with stress. Rituals varied and included activities such as prayer, ancestor veneration, napping, and happy hour.
• Purpose In the blue zones, people have vocabulary for purpose. Buettner described a recent study from Canada that followed 6,000 people for 14 years and found that those people who could articulate their sense of purpose had a 15 percent lower risk of dying. Another study, this one from the National Institute on Aging, found that people who could articulate their sense of purpose were living up to 7 years longer.
• Wine at 5 Except for the Adventists, people in blue zones consumed moderate amounts of alcohol (most commonly two glasses per day, but as much as four glasses per day).
• Plant Slant A meta-analysis by Buettner of 154 dietary surveys in all five blue zones found that 95 percent of 100-year-olds ate plant-based diets, including plenty of beans. Beans are inexpensive, full of fiber and protein, and nutritionally rich, Buettner said. The 100-year-olds also eat a lot of carbohydrates, but in the form of whole grains and sourdough breads rather than in breads leavened with yeast.
• 80 Percent Rule The longest-lived people have strategies to keep themselves from overeating, Buettner said (such as the Confucian mantra some Okinawans use to stop eating when they feel 80 percent full). There is clinical evidence that strategies such as stopping to say a prayer before meals, eating slowly so that the full feeling can reach the brain, not having televisions in kitchens, or eating with family lead to a decrease in food intake. In all five blue zones, people eat a large breakfast and a smaller lunch, and dinner is the smallest meal of the day.

Connections

• Loved Ones First Centenarians spend a lot of time and effort working on their relationships with their spouses and children. Children are likely to keep their aging parents nearby and to consider them to be fonts of wisdom that will favor their own survival.
• Belong People in blue zones tend to belong to a faith-based community. Individuals of faith who regularly attend a faith-based service live 4 to 14 years longer than their counterparts who do not, Buettner said.
• Right Tribe Health behaviors are contagious, Buettner said. Deleterious behaviors (e.g., obesity, smoking, excessive drinking, loneliness, unhappiness) are also contagious. They world's longest-lived people “curate” social circles around themselves that support healthy behaviors.
• PRINCIPLES INTO ACTION: LIFE RADIUS

Americans spend more than $100 billion annually on diets, exercise programs and health club memberships, and nutritional supplements, Buettner said. And while proper nutrition and exercise are good, this approach leads to short-term successes and long-term failures. Interventions need to last decades or a lifetime to affect life expectancy and lower rates of chronic disease, he said. Within 3 months of starting a diet, about 10 percent of people will quit. Within 7 months only about 10 percent will remain on the diet, and by 2 years less than 5 percent will still be adhering to the diet. Exercise programs show a similar pattern, Buettner said. Many people start exercise programs after the end-of-year holidays and have quit by autumn. Adherence to daily medication regimens also drops off over time.

With additional funding from National Geographic , Buettner set out to identify populations that were unhealthy but were able to improve their health and to determine what led to lasting improvement. In general, public health initiatives for non-infectious diseases have not been successful, he said. Tens of millions of dollars have been spent on major initiatives (e.g., for heart disease prevention), and while there is sometimes initial success in changing health behaviors, once the spotlight is off and the health researchers and media are gone, people revert to their baseline behaviors. One successful example Buettner did identify took place in North Karelia in Eastern Finland. In 1972 this region had the highest rate of cardiovascular disease in the world. A team led by Pekka Puska reduced the incidence of cardiovascular disease by 80 percent over 30 years and reduced the incidence of cancer by more than 60 percent. Puska's approach, Buettner explained, focused not on the individual but on the environment and the systems around the individual.

The Life Radius Approach to Optimizing the Living Environment

With funding from AARP, Buettner assembled a team of experts to consider how to optimize what he dubbed the life radius —the environment where people spend about 80 percent of their lives (see Figure 2-2 ). The best investment for optimizing the environment is policy, he said. For example, are fruits and vegetables affordable and accessible, or are fast food and snacks cheapest and most accessible? Do ordinances promote sprawl, or are there incentives for creating livable spaces? Is smoking widely permitted, or more difficult to do? (For instance, consider the difference between West Virginia, where smoking rates are as high as 35 percent, and San Luis Obispo, California, where smoking rates are less than 10 percent.)

Life radius. Optimizing the environment where people spend 80 percent of their time. SOURCE: Buettner presentation, July 30, 2104. Used with permission.

Another key factor is the built environment. By making the active option the easy and safe option, the activity level of an entire population can be raised by 30 percent, Buettner said. People increase activity without gym memberships or exercise classes by, for example, walking or biking to school, work, or shopping. Social networks are also important in the life radius, strategically bringing together people who are ready to change their habits and setting up a network to spread the lifestyle. There is also a huge opportunity to affect health through building design, Buettner said. The team identified 120 evidence-based ways that schools, restaurants, grocery stores, workplaces, and other buildings can be set up to nudge people to move more, eat less, eat better, socialize more, smoke less, and reduce stress. Finally, one factor that is unique to the life radius approach is a focus on purpose. Buettner described workshops on purpose and initiatives to connect people to volunteering, noting that volunteers have lower rates of cardiovascular disease and lower health care costs.

Taking the life radius approach forward, Buettner and his team focus on 12 “pillars.” The first three pillars are areas in which city governments can make a difference: the built environment, food policy, and tobacco policy. The approach is to start with a conversation, gradually introduce best practices, and ultimately get local leaders to choose 10 priorities and coach them to fruition. This is the best investment and has the biggest impact for the population, Buettner said.

The next six pillars are the places where people spend their day: employers, schools, restaurants, grocery stores, faith organizations, and home. The team developed checklists of revenue-neutral ways that these environments can be optimized for health, and it offers blue zone certification for those that implement a certain number of changes. The last three pillars are programs for creating new social networks, getting people involved in volunteering, and helping them define a sense of purpose.

Case Example: Albert Lea, Minnesota

Albert Lea, Minnesota, was selected from a handful of potential sites for the pilot Blue Zones project. Buettner stressed the importance of having community and leadership buy-in and commitment as well as the need to “listen, not pontificate.” Albert Lea was a beautiful city, but no one could walk anywhere. By connecting sidewalks, people could walk downtown for dinner or to church or schools. Older people did not have to walk through fields or cut across dangerous traffic. Albert Lea originally wanted to widen its main street and raise the speed limit, which, Buettner said, creates stress, danger, noise pollution, and air pollution. Over a series of long conversations, the city agreed to instead put a trail around the lake at the end of the main street. That trail is now busy all of the time with people being active because it is easy, accessible, and pretty, Buettner said. A vast section of the parkland was simply open lawn. The team convinced the city to put in six community gardens, which Buettner said filled up instantly; a seventh garden was added the second year. The gardens are not only a good place for regular, low-intensity physical activity, he said, but a place for people to connect.

Grocery store and restaurant pledges were developed to help change the way people eat. For example, at a blue zone restaurant patrons have to ask for bread, rather than having it brought to the table automatically. Sandwiches come with fruit, but diners can ask for fries instead. Buettner also described the impact of changing the adjectives on menus. For example, no one wants to order the “healthy choice salad,” but call it the “Italian primavera salad” and sales increase. Restaurants also let diners know that they can order split plates or take leftovers home. The big grocery chain agreed to tag longevity foods and created a blue zone checkout aisle with healthy snacks in the racks. Schools agreed to implement a policy of no eating in hallways or classrooms. A blue zone club was also established, and about 25 percent of the population signed a personal pledge to take action toward achieving a set of personal health and lifestyle goals.

In association with the University of Minnesota, Buettner developed the “vitality compass,” a free tool that lets people calculate their overall life expectancy and three other broad metrics. 2 A total of 33 metrics are captured (e.g., what people eat, how often they attend a house of worship, and their body mass index [BMI]). Completing the assessment at baseline and again sometime later after implementing changes can provide a fairly good measurement of impact. Some residents agreed to let blue zone team members come into their homes and optimize their kitchens—for example, with smaller plates, planting gardens, etc. About 1,100 people joined community walking groups (“walking Moai” 3 ), 60 percent of which are still together 5 years later. Residents also attended a purpose-defining class and were quickly matched with volunteer organizations to provide them with an outlet for their newly articulated purpose.

After the first year of the pilot project in Albert Lea, with 3,400 participants (24 percent of the population), entering the participants' information in the vitality compass program suggested an average life expectancy gain of 3.2 years due to changes in their life habits. Participants also self-reported a collective weight loss of 7,280 pounds. The city of Albert Lea independently reported a 40 percent drop in health care costs for city workers. Buettner noted that some of these figures briefly caught national media attention, but the underlying question is what were the permanent or semi-permanent ways in which the environment or ecosystem was changed.

Creating More Blue Zones

After the Albert Lea pilot project, the Blue Zones project teamed up with Healthways and issued nationwide request for proposals for the next blue zone city. From the 55 cities that applied, the Los Angeles Beach Cities (Hermosa, Redondo, and Manhattan Beach) were selected. After 3 years, the measurement of 80 different facets of well-being (physical and psychological) by Gallup–Healthways showed a 14 percent drop in obesity (compared to a 3 percent drop in obesity across California), a 30 percent drop in smoking, and better self-reported eating habits and increased physical activity.

Buettner said that these results caught the attention of Blue Cross/Blue Shield of Iowa and of the governor of Iowa, Terry Branstad, who invited the Blue Zones project to conduct a publicly supported, privately funded state-wide blue zones initiative. Iowa is a state with a huge pork industry, Buettner pointed out. Instead of trying to address the entire state of 3.2 million people and 995 cities at once, the Blue Zones project set up demonstration cities. Ninety-three cities “auditioned,” and the 10 cities that were most ready for change were selected. Impressive drops in obesity rates and increased health care costs savings are already being observed, and Blue Cross/Blue Shield of Iowa actuaries are calculating a health care savings over a 10-year period of $5 billion due to the establishment of blue zones. New blue zone projects are now starting up in Fort Worth, Texas, and Kauai, Hawaii.

• GOING TO SCALE

Buettner closed his presentation by sharing some lessons learned from working with 20 cities through six iterations of the project. Scale is the hardest aspect of the project, Buettner said. The first lesson in achieving scale is to start with “ready” communities. Unlike public health, where interventions are targeted at the most at-risk populations, prevention targets the people who are most ready for it. It takes some time to find that readiness, he said, and you have to say no to some communities. Invest in rigorous measurement. “If you can't measure it, you can't manage it,” he said, and data are needed to back up the approach. Orchestrate “the perfect storm,” he recommended, engaging the schools, restaurants, grocery stores, city council, and the media, so that everyone is hearing about blue zones everywhere they go. Finally, the process takes time. A workplace may be able to institute effective interventions in 1 year, but communities really need 3 to 5 years, often longer, in part because policy change can be a slow process.

There is no downside to any of the interventions, Buettner concluded. He suggested thinking about programs as an operating system, and striving to make permanent or semi-permanent changes to the system.

The open discussion that followed expanded on the concepts of readiness and scale. Buettner emphasized the value of a few successful demonstration projects in creating broad interest. Engaging everyone at once is generally not successful, he said. When working with communities, one should try to identify those employers who are most committed, and who are willing to commit some of the budget from human resources, marketing, their foundation, or other departments and orchestrate that perfect storm. He added that data on workplaces suggest that the main determinant of whether or not an employee likes his or her job is whether he or she has a best friend at work. Businesses have an enormous opportunity to connect people strategically so that their relationships transcend the commercial or business relationships. Set up those networks internally, make small changes to the policies and the built environment, and measure rigorously. Once you have shown what works, distill that into a scalable model for other companies, starting with the companies that are most ready and most committed, he said.

A participant expressed concern that some of the most at-risk communities may never be as “ready” as Albert Lea and that not including them might exacerbate some of the disparities further. Buettner clarified that blue zones tries to intervene at the whole city level, adding that 15 percent of the population of Albert Lea is Hispanic migrant workers who are very poor. Although the Blue Zones project may not necessarily be working in the poorest neighborhoods, the policy changes made (e.g., de-normalizing tobacco, making healthy foods more accessible and affordable) should benefit all of the communities in a city. Another participant suggested that some of the concepts about readiness are related to equity. How do we create more readiness in communities so that they are more prepared to change? Buettner clarified further that the Blue Zones project does not necessarily assess individual readiness as much as leadership readiness and whether the private and public sectors are open to innovation. Sign-on from the leadership components usually reflects the support of a larger population, he said.

A participant observed that for the original blue zones there was the sense of population homogeneity and a common culture and wondered whether more diversity within a city affects the outcomes. Buettner responded that it is easier if the population is more homogeneous, has a strong sense of civic unity and pride, and speaks a common language. However, the Los Angeles Beach Cities are very diverse and the initiatives have been very successful.

See http://www ​.bluezones.com (accessed December 12, 2014).

See http://apps ​.bluezones.com/vitality (accessed December 12, 2014).

Moai, pronounced “Mo Eye,” is an Okinawan term that roughly means “meeting for a common purpose.” For more information about walking Moais, see https://www ​.bluezonesproject ​.com/moai_events (accessed December 12, 2014).

• Cite this Page Roundtable on Population Health Improvement; Board on Population Health and Public Health Practice; Institute of Medicine. Business Engagement in Building Healthy Communities: Workshop Summary. Washington (DC): National Academies Press (US); 2015 May 8. 2, Lessons from the Blue Zones®.
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This 4-week challenge could help add a decade or more to your life

There are places in the world, called Blue Zones , where people naturally live long, happy, healthy lives. And you don’t have to pack up and move to Okinawa, Japan, or Ikaria, Greece, to increase your lifespan. You can bring the lessons of the Blue Zones to your own life, home, family and neighborhood.

Researchers found out about the Blue Zones after they discovered that genetics is only responsible for about 20% of how long you live. That means other factors are behind 80% of your longevity. By studying the habits and lifestyles of the people who live the longest, we can tease out the common threads and weave them into our own lives.

Dan Buettner wrote the original National Geographic cover story on the Blue Zones, “The Secrets of Long Life,” and a series of books centered around the Blue Zones. His latest book, " The Blue Zones Challenge: A 4-Week Plan for a Longer, Better Life ," shows how to optimize your life for better health and longevity. “I am simply distilling what the world longest-living people have done and showing you a way to put it to work in your life,” he told TODAY.

In the Blue Zones, people don’t have to think about making healthy choices. They live in cultures where the healthy choices are the default choices. They mainly eat a plant-based diet. They walk and garden. They spend time with the people they love.

“People in the Blue Zones don’t have better discipline or better adherence to habits or better self-control than we do in America. They simply live in places where the healthy choice is the easy choice. Their unconscious decisions are better throughout the day, and over years and over decades, that’s what works when it comes to longevity,” Buettner said. “It’s not about trying to change your habits, because trying to change your habits usually fails. What we’re asking you to do is make some long-term changes to your surroundings, and then just live in it. And you should live longer and happier.”

The Blue Zones Challenge uses evidence-based nudges to guide you through four weeks that can help you design your environment so you, too, can make healthy choices by default. The challenge starts with self-tests of your vitality, happiness and purpose. After four weeks, you can retake these tests to see how the changes are making a difference in your life.

Over the four weeks of the challenge, you’ll take advantage of opportunities to eat healthy foods, move more, connect with others, and practice other healthy habits from the Blue Zones. “Four weeks is enough time to reshape the environments that are going to make a difference in your life,” Buettner said.

Here are a few key messages from the book.

Connect with people who support your goals

Building your social network is crucial for living a healthy lifestyle. “When you think of longevity, you have to think about things that are going to last for years or decades. And friends, especially our best friends, tend to be in our lives for a long time, and they exert a measurable influence on how we behave,” Buettner said.

You need at least one Blue Zones buddy, and ideally two or three real-life friends who:

• You can count on to care about you on a bad day.
• ·Like being active — that could mean walking, tennis, gardening or biking.
• Eat a primarily plant-based diet.

You might find like-minded people in faith-based groups, plant-based cooking classes, volunteer organizations, Meetup groups, the Blue Zones Life Facebook page , or your neighborhood. You can plan to get together with these people a couple of times a week for a walk or a meal, or connect with short video chats if you don’t live close to each other.

Design your home for better health

Make it easy to default to healthier choices. Start in your kitchen. “If you’re eating a whole-food, plant-based diet , it’s probably worth six years of life expectancy over eating the standard American diet,” Buettner said. He recommends you get an Instant Pot , pressure cooker or Crock-Pot and a good whole-food, plant-based cookbook. Along with your family, find a half-dozen recipes that sound good and cook them together.

“The most important ingredient in any longevity diet is taste,” he said. “What we care about is what tastes good at our next meal.”

 He pointed out that you can still have treats, just save them for when you go out. At home, stock up on healthy foods and eliminate foods that aren’t so good for you, or store them out of view.

Here are a few more healthy home-design tips:

• Put your walking or running shoes out where they will remind you to use them.
• Set up a corner with pillows where you can sit and read or work on the floor — getting up and down from the floor builds strength.

Find your purpose

People in the Blue Zones have a sense of purpose that shapes their lives. “We know from good research that comes from the National Institutes on Aging that people who can articulate their sense of purpose live about eight years longer than people who are rudderless,” Buettner said.

Your purpose might come from your work, volunteering, a hobby or your family. 

Thinking about your purpose might take some time, but it’s worth it when you start every day filled with joy and intention. Buettner recommends writing a purpose statement that captures your essence, one where you envision how your life has an impact on the world.

Try these six simple steps

Not ready to commit to the Blue Zones Challenge? Buettner offers a few easy-to-implement tips that can help you live longer:

• Eat a handful of nuts every day. Nut-eaters live about two years longer than non-nut-eaters.
• Learn to like beans. Beans are a common food in all the Blue Zones , and eating about a cup a day could add four years to your life expectancy.
• Keep a bowl of fresh fruit on the counter. Seeing it will nudge you toward a healthy snack.
• If you drink alcohol, make it wine. Specifically, cannonau wine. That’s a wine made from the grenache grape that the people of Sardinia, Italy, drink — it has three times the healthy polyphenols you’ll find in other wines, he said.
• Get the toaster off your kitchen counter. Most of what we put in toasters is unhealthy, Buettner explained.
• Plan your meals. It makes grocery shopping — and healthy eating— easier.

Stephanie Thurrott is a writer who covers mental health, personal growth, wellness, family, food and personal finance, and dabbles in just about any other topic that grabs her attention. When she's not writing, look for her out walking her dog or riding her bike in Pennsylvania's Lehigh Valley. 

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The world’s 5 Blue Zones: Lessons on longevity and wellness

Blue Zone regions captivate with their exceptional health and longevity statistics, standing as beacons for wellness in a world rife with lifestyle diseases. 

These five distinct areas across the globe host communities where people not only reach 100 years more frequently but do so with vitality. 

This blog offers a glimpse into the lives of those who inhabit these zones and distills their habits into practical lessons. 

You’ll discover how simple changes can significantly impact your health and lifespan. Let’s explore together what makes these regions extraordinary and how their practices can be applied universally for a healthier, happier life.

1. Ikaria, Greece: The island of long life

This beautiful island boasts of its impressive health and long lifespan, and it also has a fascinating past. Historically, it has faced invasions from Persians, Romans, and Turks, leading its residents to seek refuge away from the coastlines [ 1 ]. 

This retreat created a unique culture, one steeped in tradition, strong family values, and notably, extended lifespans. 

Today, most Ikarians sidestep common ailments like dementia and chronic diseases. Astoundingly, one out of three Ikarians sees their 90s.

The question then arises: What do they do differently? A range of factors contribute:

a. Embrace active living

The mountainous terrains of Ikaria encourage natural activities. Simple tasks like gardening or strolling have become staples. Tip: Incorporate regular, effortless physical activities into your day.

b. Adopt a Mediterranean diet

Their diet emphasizes fruits, vegetables, whole grains, legumes, and olive oil . Try integrating more olive oil for its benefits to heart health.

c. Sip on herbal teas

Ikarians often gather for herbal teas, such as wild rosemary, sage, and oregano. These teas not only offer antioxidants but also help maintain blood pressure.

d. Prioritize naps

Taking regular afternoon naps is an Ikarian tradition. Such breaks potentially reduce heart disease risks.

e. Fast when possible

Rooted in their Greek Orthodox Christian faith, Ikarians frequently fast, which might be linked to extended lifespans.

f. Cultivate social bonds

Relationships are central to Ikarian life. Strengthening social ties could elevate overall well-being.

g. Choose goat’s milk

Many Ikarians prefer goat’s milk over cow’s milk. It offers benefits like potassium and the calming hormone tryptophan.

Ikarians have beautifully integrated the keys to longevity into their daily lives . Adopting even a few of these habits could significantly elevate our own wellness journey.

2. Okinawa, Japan: The land of immortals

Located at the southern tip of Japan, Okinawa has an enviable reputation. Dubbed as the “Land of Immortals,” this region boasts individuals with impressive longevity. 

Notably, Okinawans experience fewer cases of cancer, heart disease, and dementia compared to Western populations [ 2 ]. Impressively, the women here outlive their counterparts across the globe.

So, what’s their secret? Here’s a glimpse:

a. Strong social bonds

At the heart of Okinawan culture is the “moai,” a lifelong circle of friends offering emotional and financial support. This powerful network assures individuals that they’re never alone, especially in their golden years.

b. Sense of purpose

The concept of “ikigai,” or a reason for being, is deeply ingrained. Older Okinawans possess a clear sense of purpose, fueling their zest for life and feeling valued.

c. Plant-based diet

A significant portion of the Okinawan diet revolves around vegetables, seaweeds, sweet potatoes , and tofu, which are nutrient-rich yet low in calories. 

An interesting inclusion is Goya, celebrated for its antioxidants and properties that regulate blood sugar. Although pork is consumed, it’s reserved for special occasions and in moderation.

d. Gardening is key

Gardening is not just a hobby; it’s a way of life. It provides physical activity, reduces stress, and ensures a constant supply of fresh produce.

e. Embrace soy

Consuming soy-based foods , such as tofu and miso soup, can provide Okinawans with flavonoids that promote heart health and potentially reduce the risk of breast cancer.

f. Sunshine for health

Regular exposure to sunlight ensures optimal vitamin D levels, promoting stronger bones and overall health.

g. Physical activity

Daily activities like walking, combined with a furniture-minimal lifestyle, ensure that older Okinawans maintain lower body strength and balance.

h. Medicinal plants

Traditional gardens in Okinawa often feature mugwort, ginger, and turmeric. Consumed daily, these plants offer protective health benefits.

i. Positive outlook

Okinawans exude a positive attitude, having overcome hardships. They relish the present, ensuring they remain affable and attract younger company as they age.

3. Sardinia, Italy: Mountainous fountain of youth

Located on the picturesque island of Sardinia, a cluster of villages forms what is known as the first Blue Zone. 

This unique area came under the spotlight in 2004 when researchers discovered the M26 marker in its inhabitants—a genetic trait associated with remarkable longevity [ 3 ]. 

Due to the geographical isolation of this region, the genes of its residents have predominantly remained pure. 

This has resulted in a striking statistic: there are nearly ten times more centenarians per capita in this region than in the U.S.

Beyond genetics, the cultural isolation of this region plays a pivotal role in the longevity of its residents. The people of Sardinia lead a traditional, health-conscious lifestyle . 

This includes sourcing their own food through hunting, fishing, and farming. Moreover, they prioritize close-knit bonds with family and friends, frequently indulging in laughter and wine, which play an integral role in their well-being. Key takeaways from the Sardinian lifestyle:

a. Diet matters

Focus on a plant-centric diet supplemented occasionally with meat. The conventional Sardinian diet emphasizes whole-grain bread, beans, fresh vegetables, fruits, and in specific areas, mastic oil. 

Pecorino cheese, rich in omega-3 fatty acids and sourced from grass-fed sheep, is a staple. However, meat is primarily reserved for festive occasions.

b. Prioritize family

Strong familial ties are characteristic of Sardinian culture. A support system formed by close family members reduces instances of depression, suicide, and stress.

c. Elders are precious

Elders in the family are highly respected and celebrated. Their roles are multifaceted—they offer affection, childcare, financial assistance, and wisdom. Their presence has a profound impact on the younger generation, pushing them towards success.

d. Stay active

Emulate the Sardinian shepherds by walking at least five miles daily. This not only benefits your cardiovascular health but also positively impacts muscle and bone metabolism without the strain associated with rigorous sports.

e. Moderate wine consumption

Incorporate a glass or two of red wine, preferably Cannonau, into your daily routine. Rich in flavonoids, this wine helps in reducing arterial blockages. Moreover, it’s believed to reduce stress levels among its consumers.

f. Laughter is therapeutic

Sardinians are renowned for their distinct sense of humor. Regular interactions filled with laughter are a staple, acting as a stress reducer and potentially decreasing the risk of heart disease .

g. Beneficial goat’s milk

Introducing goat’s milk to your diet might offer protection against age-related inflammatory diseases, such as heart disease and Alzheimer’s.

4. Loma Linda, California: America’s Blue Zone

Situated in the sunny Southern California, Loma Linda is not an ordinary town. It’s a place where the Seventh-day Adventist church has thrived since the 1840s, and its principles have been deeply rooted in the community. 

The church’s core tenet revolves around health being central to their faith, and this perspective has had profound implications on the longevity of its members.

Today, nearly 9,000 Adventists in Loma Linda have distinguished the region as America’s blue zone [ 4 ]. 

Remarkably, they enjoy an average of a decade longer lifespan than most Americans. Their secret? A combination of vegetarianism, regular exercise, and abstaining from smoking and alcohol.

So, if you’re intrigued and wish to harness some of this American longevity magic, here’s a breakdown of tactics commonly practiced in Loma Linda:

a. Time for reflection and relaxation

Taking a weekly 24-hour break, known as the Sabbath, allows Adventists to focus on family, God, camaraderie, and nature. This break not only provides relief from daily stress but also enhances social ties and encourages consistent physical activity.

b. Stay active and maintain a healthy BMI

A healthy BMI indicates appropriate weight relative to height. Active Adventists, especially those who minimize meat consumption, often have better cardiovascular health indicators than others.

c. Engage in regular, moderate exercise

The Adventist Health Survey highlights that intensive workouts aren’t necessary. Simple daily activities like walking can reduce risks of heart diseases and certain cancers.

d. Surround yourself with supportive friends

Adventists often form close-knit communities, deriving well-being from shared values and mutual habit reinforcement.

e. Incorporate nuts into your diet

Eating nuts five times a week can halve the risk of heart disease and even extend life expectancy by approximately two years.

f. Give back to the community

Volunteering isn’t just about helping others. It provides a sense of purpose, keeps one active, and can help in warding off feelings of depression.

g. Moderate meat consumption

While many Adventists are vegetarians, those who consume meat are advised to do so sparingly, emphasizing more on fruits, vegetables, and whole grains .

h. Eat early and light in the evening

A lighter meal in the early evening can aid in better sleep and maintaining a healthier BMI.

i. Boost plant intake in your diet

Rooted in biblical teachings, Adventists promote a diet rich in grains, fruits, nuts, and vegetables. Such a diet not only aligns with their faith but also has shown significant health benefits, like reduced risks of cancers.

j. Stay hydrated

Drinking 5 to 6 glasses of water daily can drastically reduce the risk of fatal heart attacks.

5. Nicoya Peninsula, Costa Rica: The Central American Paradise

Costa Rica, a Caribbean nation located in Central America, might be geographically close to the U.S., but when it comes to longevity, they’re miles ahead. 

The secret? Nicoya, a peninsula extending 80 miles just south of Nicaragua. Let’s explore why Nicoyans live longer and how their practices can influence our lives.

a. Plan de Vida

More than just a lifestyle, the ‘plan de vida’ is a sense of purpose that keeps Nicoyan elders positive and active [ 5 ]. It’s about having a clear vision of what gives life meaning.

b. Community and family ties

Nicoyan elders have a robust social network. They often visit neighbors and usually reside with their families, gaining support and purpose from living with children or grandchildren.

c. Practical diet tips

For the majority of their existence, Nicoyans have consumed a traditional Mesoamerican diet. Central to this are the “three sisters” of agriculture – beans , squash, and corn. 

It’s suggested that this combination may be one of the most nutritious for longevity. Furthermore, they believe in having a light dinner early in the evening, emphasizing calorie moderation.

d. Importance of hard work

Life isn’t just about relaxation for these centenarians. They find genuine joy in daily physical tasks, emphasizing the importance of staying active.

e. Sunlight benefits

Nicoyans understand the importance of sunlight for health . Regular exposure aids in vitamin D production, crucial for bone health and overall body functionality.

f. Valuing tradition

The traditions of the indigenous Chorotega play a significant role in modern Nicoyan life. The sense of shared history and the stress-reducing benefits of their traditional fortified maize and bean diet stand out as key elements of their lifestyle.

Closing thoughts

From the vibrant shores of Okinawa to the serene landscapes of Nicoya, each Blue Zone teaches us invaluable lessons on health, community, and purpose. 

Prioritizing family, embracing daily physical activity, and maintaining a balanced diet are just a few universally shared practices among these zones . 

It’s evident that longevity isn’t just about genes; it’s significantly influenced by lifestyle choices. Encouragingly, we don’t need to reside within these zones to reap the benefits. 

By integrating their wisdom into our routines, we can forge a path toward improved well-being. Remember, a wholesome approach to life can dramatically shape our health outcomes.

Is Singapore the world’s 6th Blue Zone?

Yes, Singapore is the world’s 6th Blue Zone recognized by Dan Buettner for its unique approach to promoting longevity, achieved through engineered changes over time.

What do all 5 blue zones have in common?

Blue Zones are regions where people live longer, healthier lives due to healthy diets, physical activity, strong community ties, and a sense of purpose.

What is a Blue Zone country?

Blue Zone countries are regions where people live longer and healthier lives due to specific factors like diet, physical activity, social connections, and a sense of purpose.

[1] https://www.bluezones.com/explorations/ikaria-greece/   [2] https://www.bluezones.com/explorations/okinawa-japan/   [3] https://www.bluezones.com/explorations/sardinia-italy/   [4] https://www.bluezones.com/explorations/loma-linda-california/   [5] https://www.bluezones.com/explorations/nicoya-costa-rica/

Photograph: Sunny_studio/Envato

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What are the world's blue zones which may hold the key to living to 100 and beyond?

Key to longevity highlighted by research in five communities with greatest proportion of centenarians.

Sardinia, Italy. Photo: Unsplash/ Fadi al Shami

Areas around the world with the highest ration of people aged over 100 could hold the key to enable longer life among the wider population.

Research across 20 years in five communities in Italy, Japan, Costa Rica, Greece and California, known as blue zones, unearthed secrets to long life that could increase the numbers living healthier into old age elsewhere.

Blue zones are demographically confirmed, geographically defined areas with the highest percentage of centenarians, those who are at least 100 years old, compared with the rest of the world.

Dan Buettner, an explorer and author, has studied five blue-zone communities around the world to understand more about why some people live considerably longer than others.

“The key factor across all the blue zones is that the centenarians living there did not wake up one morning and decide they wanted to live to 100,” Mr Buettner told The National.

“They simply lived in environments that nudged them into daily movement, encouraged social connectedness and plant-based eating – making the healthy choice not only easy, but unavoidable. We found that all the blue zones shared nine common characteristics that we feel create this environment of health.”

Demographers, anthropologists and epidemiologists found five blue zones around the globe: Ikaria, Greece; Sardinia, Italy; Okinawa, Japan; Nicoya, Costa Rica, and Loma Linda in California.

The so-called power-nine universal factors are natural movement, a sense of purpose, reduced stress, eating in moderation, plant-based diets, moderate but sociable alcohol intake, a sense of belonging or faith, strong family connections and social circles that encourage healthy behaviour.

“The world’s longest-lived people don’t pump iron or run marathons,” said Mr Buettner.

“Instead, their environments nudge them into moving without thinking about it. Knowing your sense of purpose is worth up to seven years of extra life expectancy and the world’s longest-lived people have routines to shed stress.

“In Okinawa, Japan, the people have a mantra 'Hara hachi bu', said before meals as a reminder to stop eating when their stomachs are 80 per cent full. And while centenarians typically eat meat, it is only five times per month.

“Moderate drinkers outlive non-drinkers, especially if they share those drinks with friends, and attending faith-based services four times per month – no matter the denomination – adds up to 14 years of life expectancy.

“Centenarians put their families first. They keep ageing parents and grandparents nearby, commit to a life partner and invest in their children. We know the world’s longest-lived people chose or were born into social circles that support healthy behaviour.”

Obesity influence

Health-conscious friends can also add a positive influence, Mr Buettner said, while those with three close friends who are obese are said to be 150 times more likely to be obese themselves.

The findings show the environment around us plays a major role in sustaining good health into old age.

Experts said only 20 per cent of what determines how long we live is dictated by our genes, with the other 80 per cent driven by lifestyle and environmental factors.

“In these blue zones where people actually age or live for longer, you can see they have a lot of things in common,” said Dr Zemer Wang, medical director at DP World’s Aviv Clinics in Dubai, where reverse ageing research is being conducted.

“The first one is that they're all very physically active. So it can be in Sardinia, in a place where they herd their goats in the mountains, and people in their sixties and seventies are still walking up those mountains.

“And it has to do with calorie-deficient diets, where people do not eat until they're completely satiated on a regular basis. Another factor is low stress, good social connections and family values.”

According to a PricewaterhouseCoopers report on longevity and ageing in Gulf populations, regional age distribution is relatively young compared to most developed nations.

In 2023, the median age in Japan, Denmark, Switzerland, the UK and US was 42, whereas that of Gulf countries was only 30.

The oldest person in the world is Spanish woman Marla Branyas Morera, who is 117.

In the top 10, three are from Japan, three from the US, with a Briton, Venezuelan and Brazilian making up the list.

“A very important aspect to healthy ageing is having a sense of purpose and a reason to wake up in the morning,” said Dr Wang.

“Whenever people retire, some all of a sudden become sick and then they die. This is not a myth. When you have less sense of purpose, you start to deteriorate.”

Rapidly ageing region

A recent PwC report covering the GCC showed those living in the Middle East were ageing at a significantly faster rate than populations in developed nations have done previously.

The trend has been driven by changes in fertility rates and lifespan.

A gleaming silver lining for healthy ageing is a longer working life that could invigorate economies with a later retirement age.

With more people working into later life, changes are being drafted in to increase the statutory retirement age across the world and curb stopping work early.

Life expectancy has increased from about 45 in 1850 to nearly 80 today and it is expected to keep rising.

Between 1840 and 2002, life expectancy increased by 2.5 years every decade due to significant advances in health care, sanitation, nutrition and education.

However, while the number of supercentenarians (those older than 110) has increased dramatically, their average age has not, indicating lifespan has not been greatly extended.

“Being healthy involves more than merely consuming appropriate nutritious foods, exercising and getting enough sleep,” said Dr Frank Lipman, a longevity researcher and proponent of biohacking to determine facets of healthy living at the Wellth Clinic in Dubai.

“Longevity is the accomplishment of a long life. We may hope for a long life so that we can spend many years with our loved ones or travel the world.

“However, living to a ripe old age does not always imply healthy or joyful longevity, particularly if it is accompanied by weakness or disease. If we are not thinking about how to live as long as possible in good health, we are missing the bigger picture.”

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Coming August 30

Live to 100: Secrets of the Blue Zones

We’re excited to announce that Blue Zones is coming to Netflix! Travel around the world with author Dan Buettner to discover five unique communities where people live extraordinarily long and vibrant lives.

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In the early 2000s, Dan Buettner collaborated with National Geographic to reverse-engineer a formula for longevity. He scoured the globe for years in pursuit of places where people live much longer than average, and the concept of blue zones came to fruition. To date, the expeditions unveiled Okinawa, Japan; Sardinia, Italy; Ikaria, Greece; Nicoya, Costa Rica; and Loma Linda, California, as blue zones with the highest rates of living centenarians. These five spots share some similar elements — a plant-based diet, natural movement, and putting family first — that have been proven to promote longevity and health in residents.

Live to 100: Secrets of the Blue Zones takes members around the world to investigate the diet and lifestyles of those living the longest lives. Explore the original blue zones, be immersed in their culture and lifestyles, and see how Blue Zones is applying the research in communities across the United States. Buettner offers insight on how to benefit from following at least some of their leads, because the only thing better than looking good as you age, is feeling good as you age.

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