Govts Are Often Influenced By Private Interests, And Don’t Focus On Health, Says Dan Buettner

Only about 20 per cent of how long we live is dictated by our genes; 80 per cent is something else. So, while working with National Geographic, a team of demographers and I identified five parts of the world (Ikaria in Greece, Loma Linda in California, Nicoya in Costa Rica, Sardinia in Italy and Okinawa in Japan) where people live statistically the longest. Then, we spent three years validating their ages, (through) their birth and death records. We discovered that these places are home to people who live about 10 years longer than the rest of us. Much of my work has been about trying to understand the factors and the characteristics that seem to be accompanying longevity in all five of these places.

I was an explorer, and my speciality was unraveling scientific mysteries. In 2000, I read a World Health Organization (WHO) study that showed that Okinawa was producing the longest disease-free population in the world. And I thought: “Now that’s a good mystery.”

We started with Okinawa. And I reasoned, if there were long-lived people in Asia, there must be long-lived people in Europe and South America and North America, and maybe even Africa. So there began this 25-year-long journey.

You would understand economics, specifically behavioural economics. We are deluded largely by marketers to think that there is some pill or supplement or longevity hack or superfood or exercise program that’s going to make us live longer. Trying to change your behaviour or your habits fails for almost all people, almost all the time. They’re good business plans because every year we can get people signing up for diets and supplements and exercise programs. And every year they fail in about a month.

What works in blue zones is an environment that sets up nudges and defaults that govern people’s unconscious decisions. We all know that eating mostly a whole-food, plant-based diet is going to help us live longer.

Kerala in India is very good at that. We all know that moving our body is going to help us live longer. Staying socially connected, having a sense of purpose, avoiding toxins—these are all environmental factors.

So, we should not be spending too many resources and too much time on behaviour modification; we should be spending it on environment modification that produces longevity.

Counterintuitively, most of the blue zones are the poorest regions of the countries they inhabit. They do benefit from very good public health, and in most cases it is better than what we have in the US. They do have very small pensions, but we’ve lost what they have—it’s the support from families as they almost always live in extended families. They mostly supplement what they need to buy by having a garden. They live in communities that don’t require a car, eliminating the enormous expense of owning and maintaining a car.

Most of us are deluded in thinking that the answer to live longer lies wholly in some rich social security system. It lies in paying attention to the rhythms and the traditional mechanisms that got the human race where it was two generations ago. Also, paying attention to the people who are going to care about you when you live in walkable communities. And the cheapest, the most accessible and healthiest foods are peasant foods. It’s not tomahawk, steak, or seafood, or some fancy superfood. It’s beans, rice, tubers, sweet potatoes, and so on. India does a particularly good job by making use of these wonderful spices, which are healthy and cheap.

It’s just shifting the focus away from (the idea that) we got to make more money to how do we shape our surroundings. Beginning at age 20, both social and physical. Then, we’ll unconsciously make the right decisions and will hit our 80s and 90s surrounded by supportive friends and family. That’s the secret.

Most of the world till about 80 years ago died because of infectious disease, malaria, cholera, pneumonia, dysentery, diarrhea. The blue zones have the benefit of public health. They’re not dying from those infectious diseases because of steps their governments have taken, and they don’t quite yet die of chronic diseases which is killing most of America. The reasons in America are standard American diet, physical inactivity and loneliness.

India has the foundation for a blue zone. You’re very social, you have a phenomenal diet as you know how to make very cheap food taste delicious and better than most countries.

But you have a big infectious disease problem, much bigger than the other blue zones. In other words, people are dying from diseases due to lack of sanitation, and perhaps overcrowding in some cases. So anyway, it’s a blue zone in the making. Let’s put it that way.

Yes, policy is usually the most cost-effective tool for public health. I don’t know intimately but (it would matter) if the government prioritises making people healthy. There’s a project called The Global Burden of Disease, which looks at what is shortening the lives of people in India. Once you know that, you can attack specific ailments. I’m guessing, for the most part, it is heart attacks and probably diseases due to lack of sanitation on the infectious side.

So, the policy workers can focus and work at mitigating those problems. However, it’s going to be largely an environmental issue, limiting access to cigarettes and junk food, spending more money for clean water sources, and ensuring vaccinations and antibiotics for infectious diseases.

No gyms are not. It’s walkability, it’s taxing gasoline, having congestion control schemes where people have to pay tolls. The most effective thing you can do is get people out from behind their steering wheel on to their feet.

The best model of that in the world is Singapore. Believe it or not, Singapore has much higher population density than India has. So, if the Indian government really cared about people’s health, it would pay particular attention to Singapore. Singapore currently has the highest health-adjusted life expectancy in the world, and they do it with a heterogeneous population. It’s a melting pot—people of several religions live there just like in India. It started out as a very poor place like parts of India, and they have systematically adopted policy that favours human health.

They, of course, pay attention to financial and economic prosperity. But it’s a great fallacy that increasing GDP (gross domestic product) is going to fix everything. In fact, I would argue that, for a government, the best investment would be addressing health. That’s because if you are healthy, you have healthy children who grow up to be more educated. There’s much less of an economic toll on the family. And you get a healthier, more productive workforce.

Governments are often influenced by private interests that take away the focus, which should be getting the population optimally healthy.

It’s more than an experiment. We’ve been doing it for 15 years and in 70 cities. In every city we’ve worked in, we’ve seen measurable improvement. We measure BMI (body mass index) and life satisfaction.

They’re called blue zone or transformation projects, and are funded by insurance companies and hospital systems and supported by local governments. What we do is change the policy to favour the non-smoker over the smoker, the pedestrian over the motorist, healthy foods over junk food and junk food marketing. Then we go for businesses, schools, restaurants and workplaces. We offer blue zone certification if they change their designs and their policies to make people unconsciously move more, eat better and socialise more.

Most of the healthy city projects try to get people doing fun runs and eating their veggies, but they always fail. But when you reshape a city’s policies and its streets, and reshape the places that people live in so that they’re unconsciously making a better decision, we see BMI go down, life expectancy go up and healthcare (costs go down). That’s how we make our money.

Yes, but people misunderstand. The only way you can do this is by having a five-year commitment in a city of a million people. I need 20-25 full-time employees and five years. When people hear about blue zones, they want to be one, but they don’t really want to do the work. They just want the label.

You can do the math. How much that would cost. 25 employees. They need an office. They need retirement plans. They need vacation. They need training. It’s a big-ticket (expense), but when you compare the cost of keeping people healthy, the cost of caring for them after they’re sick, it’s a bargain.

We spend $4.4 trillion a year on trying to clean up the mess here in America, but you get about a 20-time return. It’s about 20 times cheaper to keep people healthy than it is to pay for them when they’re sick.

That’s not the way the American healthcare system is set up. So, we’re kind of swimming upstream on these things. But we’ve shown it’s successful, and it’s infinitely scalable.

If we took one-hundredth of what we spend on pharmaceuticals in this country, I could work in every city in America, and you’d see the obesity rate go down, and trillions of savings in healthcare and related productivity and absenteeism costs.

It’s possible. I would have to bring a team there, and I would have to meet all the local leaders there—the religious leaders, the people who are in charge. I’d have to say, we’re coming in with this unique approach; we’re changing the environment, not trying to change people’s behaviour; (ask them) is this something that interests you. I will need a yes and I’d say Mr Politician, you need to help me. I’m going to show you the ordinance and local laws that are going to make a difference. Are you willing to expend your political capital?

The answer to that is, yes, with the head of schools and the big businesses. Then I need to hire probably 30 people, a manager, and a budget for that. I need a lot of money to hire these people for five years, but yes, I could bend the curve, reduce obesity, heart attacks, type 2 diabetes and other diseases. The process is expensive and long, and it requires a different way of thinking.

I think all the blue zones are disappearing, and I’ve seen it just in the 20 years since I’ve been visiting them. The (number 1) reason is, they start importing cars, which are big killers as they pollute the air, cause accidents and take physical activity out of people’s lives.

Number 2, the standard American food culture with McDonald’s, Burger King and others (that serve) ultra processed junk food, that destroys health, and I don’t know how to stop that. Then, people are spending more time on their handheld devices; they’re not socialising and building relationships.

So, I’m more interested in places in the world that were unhealthy but are starting to change the trend. I’m writing another book right now for National Geographic on these places. There are several places where people live about 12 years longer than people in the US. That’s the future—not trying to save the old blue zones but focusing on the new blue zones.

nidhi@outlookindia.com