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Health

Does Japan’s Okinawa hold the secret to a longer life?

Years after uncovering the world’s longest-living communities via Okinawa, known as “blue zones”, an entrepreneur is trying to replicate them around the world

Okinawa is an elongated volcanic island in the Pacific Ocean, roughly 400 miles south of mainland Japan. Of the five main islands of the archipelago, it’s the smallest and least populated – it accounts for just 0.79 per cent of national GDP. And yet, by another measure, it’s one of the most successful places in the world: life expectancies on the island are extraordinarily high. Japanese citizens famously live for a long time, but Okinawans live even longer, on average seven years more than Britons, supposedly thanks to the combination of a subtropical climate, a nutritionally dense diet and a defined sense of ikigai, a Japanese concept that loosely translates as “a reason for being”. Older inhabitants have the highest life expectancy on earth, with 68 centenarians for every 100,000 people – three times the rate of America.

People have been searching for the secret to a long life for thousands of years, whether that’s Cleopatra bathing in donkeys’ milk or Google’s founders investing in biotech. For Dan Buettner, the solution lay on Okinawa. In 1999, Buettner was an explorer and National Geographic journalist who led expeditions trying to solve anthropological and historical mysteries, such as what caused the Mayan civilisation to collapse and whether Marco Polo ever reached China. An NG assignment to report on long-living communities led him to the Pacific island, where he recognised a perfect storm of conditions that combined to produce a population in which everyone over the age of 50 is “biologically ten years younger”.

Buettner knew he was on to something big. He approached the US National Institute On Aging and received funding to identify other global hotspots where people regularly lived to a healthy hundred. He found four more: Ikaria, Greece; Loma Linda, California; Sardinia; and the Nicoya Peninsula in Costa Rica. He dubbed these tiny communities “blue zones” and in 2005 published one of National Geographic’s best-known stories, under the headline “The Secrets Of A Long Life”.

Fourteen years on, Buettner, 59, heads up a for-profit healthcare company, also called Blue Zones, that runs public health initiatives in 49 cities across America, from Fort Worth, Texas to Spencer, Iowa. A regular on the wellness conference circuit, Buettner’s public speeches include the TED Talk “How To Live To Be 100+”. Alongside his brothers, Tony and Nick, and 150 full-time employees, Buettner tries to re-create something of the environment of a blue zone in the conurbations of the US. “Statistically speaking,” he tells me, “only about 15 per cent of how long you live is dictated by your genes. About ten per cent is how good your insurance and your surrounding hospitals are. The remaining 75 per cent is your lifestyle and your environment. What Blue Zones sets out to do is reverse-engineer longevity.”

Once a partnership with a city has been agreed in principle, Blue Zones offers a “menu” of targets for the administration to adopt. These could be anything from 30 per cent of restaurants including healthier options on their menu to 50 per cent of elementary schools adding more exercise to the curriculum. A city might select 20 criteria to meet and progress is then assessed by independent analysts Gallup. This “silver buckshot” approach, in Buettner’s words, means that populations often have no idea that these behavioural “nudges” are taking place around them.

‘What Blue Zones sets out to do is reverse-engineer longevity’

The concept of the “nudge” first became popular among American sociologists in 2008, around the time Buettner was formulating the Blue Zones company, via the publication of the wildly successful Nudge: Improving Decisions About Health, Wealth And Happiness by Cass Sunstein and Richard Thaler; within months, the UK and US governments were implementing its ideas in policy decisions. The theory goes that, rather than dictating how people should live, you instead design systems from the top down that cumulatively encourage desirable behaviour and discourage the undesirable. Case in point: Buettner isn’t so naive as to think he can get Americans eating the same diet as elderly Greeks and Okinawans – try planting an olive grove in Minnesota and see how that goes – but he can try to replicate, conceptually, the environments that lead to unparalleled longevity “where the healthy choice is unavoidable”. A city with 50 per cent fewer fast-food outlets or 100 extra miles of bike lanes is naturally going to offer a healthier environment, even if residents barely realise they’re being encouraged to adopt life-enhancing behaviours.

And it looks like it works. The city manager of Iowa City, Geoff Fruin, told GQ that his city’s Blue Zones partnership was unequivocally “a success”. The project lost funding after five years (most Blue Zones projects last roughly a decade), but Fruin says it inspired a sea change in the way the city conceived of the wellbeing of its residents. Similarly, Deb Logan, the executive director of a Blue Zones project in Naples, southwest Florida, says that the city and its surrounding area has had the highest life satisfaction in America for four years running. Eight years ago it ranked 73rd. Life expectancy rose by 2.4 months from 2015 to 2017, while the average across America fell by over a month.

Buettner is now in talks about exporting his concept to Moscow and ‘would love’ to run a Blue Zones project in a British city

Buettner is now in talks about exporting his concept to Moscow and “would love” to run a Blue Zones project in a British city, though it’s unclear how well it would work in a country with universal healthcare and a generally robust welfare state. Currently, Blue Zones projects are largely funded by local healthcare providers and insurers who want to reduce healthcare spending further down the line. Tellingly, in Naples, a local provider called NCH Healthcare System, the project’s sponsor, claims to have saved $27 million in healthcare costs over the first three years the Blue Zones initiative has been running there. Remote octogenarian communities may have inadvertently made American insurers tens of millions of dollars.

Over its decade-long existence, Blue Zones has faced some resistance, including from a local newspaper in South Carolina that took issue with the company’s process of choosing where to set up, suggesting that it zeroes in on communities that are already healthy. Buettner rebuts this by pointing out, “That’s like saying you’re the smartest kid in detention. America is not a very healthy country. About 70 per cent of us are obese or overweight.” Critics also allege that by giving cities a choice of success criteria, they only have to commit to the targets they will find easiest to hit. Buettner acknowledges that if Blue Zones were to face opposition from, say, the “Big Cola” lobby over a city’s proposed sugar tax, the company would simply drop it and find a less contentious issue. This, he says, is a reflection of the fact that all stakeholders need to be onside for Blue Zones’ philosophy of citywide nudges to work. “I’m very happy to go to the next city. We only work in cities that really have an appetite for innovation.”

One thing’s for certain: a healthcare scheme that manages to appeal to both Floridians and Muscovites can hardly be doing any harm. The allure of reaching triple digits remains strong and if there’s a way to reach a century without donkey-milk baths then it’s one that many will be willing to try.

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