The pernicious effects of America's sedentary culture in many ways mirror the country's expensive, convoluted healthcare system. Powerful healthcare institutions, though, can help change the course on the local level, advocates argue.
The world's oldest, healthiest people "never participated in the workplace health program," Dan Buettner, founder and CEO of the Blue Zones population health project, told attendees at America's Health Insurance Plans Institute. "Longevity is not something that's pursued, but ensues."
An international bicyclist and demography researcher, Buettner visited some of the world's healthiest places based on their disability-free life spans--Mediterranean islands, Costa Rica, Loma Linda, Okinawa, Japan. Now, he's trying to spread some of their features in the U.S. via the Blue Zones, a collaboration with Healthways to partner with states, cities and large companies to help make American towns more livable.
Among these is Sardinia, Italy, home to 20 times more centenarians than in the U.S. Shepherds in their 60s, 70s and 80s don't "work extraordinarily hard but have regular, low-intensity exercise," around five miles a day, Buettner said. They have a portable diet with fresh vegetables, whole wheat, grass-fed cheese, occasional meat and wine fermented with both the seeds and skin. (To be fair, many Sardinians also are thought to carry the M26 gene marker associated with such longevity.)
Another island Buettner found is Ikaria, Greece, where the average life expectancy is 8 years longer than in the U.S. and where one native son returned from the U.S. in his mid-sixties expecting to die of late-stage lung cancer in the 1970s. Instead, he lived another three decades, tending gardens, walking everywhere and playing dominoes with friends--not all to different from golden years in the best American retirement communities. In Ikaria, though, this is how most of the population lives. "They don't have cars," Buettner noted, and they have one of the purest forms of the Mediterranean diet.
Then there is Okinawa, Japan, home to the world's longest disability-free life expectancy, with one-fifth the rate of breast and colon cancer and one-sixth the rate of heart disease as in the U.S. A plant-based diet prevails in Okinawa, along with a high consumption of tofu and "Confucian attitude towards eating"--to stop when you think you're 80 percent full.
In Loma Linda,California, a vibrant Seventh-day Adventist community also has a plant-based diet, active lifestyle and strong social network and an average 10 additional years in longevity. Here, a 95-year-old doctor builds his own fences and does heart surgery 20 times a month, and a 105-year-old woman starts her day with slow-cook oatmeal, dates and a "prune juice shooter," and then pedals a stationary bicycle for 30 minutes before going to the local senior center.
Lifestyle and environmental factors seem to account for 75 percent of a person's long-term health, Buettner said, citing the long-term Danish twins study. Though the study was published in 1996, before the human genome was fully sequenced, the idea of lifestyle and environment drivers very much comports with the prevailing idea of "non-healthcare determinants of health"--where people live, their housing, financial means and social networks, their access to fresh food and transportation.
A $3 trillion opportunity
In America's health and financial problems--chronic diseases, high costs, deteriorating infrastructure, social isolation and aging citizens--Buettner sees a chance to address population health for the current and next generations and to do it on the local level.
Buettner and the Blue Zones project are trying to apply the principles they've found in the Sardinias and Loma Lindas, in such varied American localities as Southern California beach cities, Minnesota, Iowa, Fort Worth, Texas, and Oregon.
In a project in 10 Iowa cities that was convened with Wellmark Blue Cross and Blue Shield, Buettner boasted of some promising early results. Smoking is down in all the cities. In Cedar Falls, a new pedestrian bridge is connecting residential areas with retail, school and work areas, schools are offering "brain breaks" to let kids exercise more and 20 employers are participating to encourage more activity and curb junk food availability. In Waterloo, there are more 65 "Walking Moais," or walking clubs.
It's north of Iowa where the Blue Zones has its oldest and perhaps most promising project to date, Albert Lea, Minnesota, population 18,000. Since 2009, Albert Lea has seen a 40 percent decrease in per capita healthcare costs, thanks in part to a number of relatively simple but significant community interventions and infrastructure changes, Buettner said.
The Blue Zones and Healthways worked with city leaders to build more than six miles of sidewalks and a five-mile trail around Fountain Lake to connect residential neighborhoods with the downtown, schools, senior centers, and businesses. The bike-pedestrian trail has "made the lake a destination for neighbors with a walking path where once there was only a roadway," Buettner said.
The project also included somewhat radical food interventions, like convincing the local Hy-Vee grocery store to create junk food free check out lanes and getting restaurants to rebrand their healthiest options.
Walking has increased in Albert Lea by 70 percent and bicycling by 74 percent in the past five years, according to the National Vitality Project, and Buettner said that residents who participated in the program have lost a collective 8,000 pounds.
In many ways, small towns and less populated regions can reinvent themselves faster than big urban areas, Buettner argues. On the local level, institutions like hospital systems and health insurers can have an impact in supporting these changes under the mantel of population health, especially considering concerns about healthcare spending crowding out investments in education and transportation.
And as Albert Lea shows, there is already demand for more walkable communities. "We're an ag-based rural city promoting healthy living because it's the right thing to do and it's how we want to live and want our children to live," former Albert Lea city councilwoman Ellen Kehr told the Christian Science Monitor.
"When I started four years ago, I had high cholesterol and high blood pressure," added Albert Lea city councilmen Al Brooks, telling the CSM that today he walks more than two miles every day. "Now my cholesterol is lower, my blood pressure is 116/70, and I lost 15 pounds."