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What we can learn from the world's 'Blue Zones' - where people regularly live into their 90s and 100s

Lifestyle changes can cure some diseases and significantly extend our lives, writes Professor Ciaran O’Boyle.

IN 2005, THE American explorer Dan Buettner reported in National Geographic Magazine on his experiences in a number of areas of the world where people regularly lived beyond a hundred years.

Among the remarkable photos in his piece were those of an 89 year old woman collecting seaweed on a slippery embankment, another renewing her driver’s licence aged 100, a man water-skiing at 100 and a lovely photo of an 84 year old doing a perfect headstand.

Buettner went on to identify five ‘Blue Zones’, which he described as areas of the world where people’s lifestyles contributed to their living exceptionally long and healthy lives.

These were Okinawa in Japan, Loma Linda in California, the Barbagia region in Sardinia, the Nicoya Peninsula in Costa Rica and Ikaria in Greece.

It will come as no surprise that the research shows that longevity is determined by genes, environment and lifestyle, with lifestyle having a much greater impact than genes.

We know that we should take more exercise and eat more vegetables and fruit. That we shouldn’t smoke or eat lots of sugar, drink too much, or sit for long periods. Many people find these ‘shoulds’ and ‘should nots’ useful but somewhat negatively framed.

A more positive way of looking at it is the idea that lifestyle can be medicine. Lifestyle changes can significantly improve our health, cure some diseases and significantly extend our lives.

The need to act is urgent

Diseases of lifestyle are a major concern. According to the World Health Organisation (WHO), heart and lung diseases, cancers and diabetes are the world’s largest killers accounting for an estimated 38 million deaths annually, 16 million of which are premature.

According to the WHO, taken together, five conditions – diabetes, cardiovascular diseases, cancer, chronic respiratory diseases, and mental health disorders – account for an estimated 86% of the deaths and 77% of the disease burden in the European Region.

An estimated 80% of heart disease, stroke and type 2 diabetes and 40% of cancer could be prevented, primarily through improvements in diet and lifestyle.

According to the Sláintecare report, managing chronic disease in Ireland accounts for a growing share of finite health resources and demands new approaches. Lifestyle factors such as smoking, drinking, levels of physical activity and obesity – 66% of Irish people are overweight or obese – continue to be issues which have the potential to jeopardise many of the health gains achieved in recent years.

Changing the way we think about health and disease

The good news is that there is much that we can do at individual, community and national level to redress the increasing trend in lifestyle related diseases.

Traditionally, medicine and healthcare were more focused on treating disease rather than preventing it. The past decade has seen the development of a new specialty of lifestyle medicine and we are learning more about the complex ways in which our behaviours influence our bodies to produce disease.

In 1993, for example, researchers discovered a previously unknown, persistent type of low grade inflammation associated with obesity that they suggested could explain the chronic disease effects of excessive weight gain. This silent inflammation has subsequently been found to be induced not only by obesity but by a variety of lifestyle factors and to be important in the development of many chronic diseases.

We are also learning more about how we can improve our mental health and well-being by adopting a number of strategies associated with the new science of positive psychology.

Identifying and playing to our strengths, developing an optimistic mindset, identifying and being thankful for the good things in life and practicing mindfulness meditation have all been shown to increase significantly one’s happiness and well-being and, in turn, contribute to improved health.

Engaging the public

Public interest and appetite for positive health education is high and growing. This month RCSI University of Medicine and Health Sciences will launch a new Centre for Positive Psychology and Health, the first of its kind in the world.

In the last 24 months, RCSI has engaged with over two million people through a public health lecture series and the new Centre will build on this by providing resources to equip people to develop their resilience and optimise their health and wellbeing.

Last month the McKinsey Global Institute reported that, using interventions that already exist today, the global disease burden could be reduced by about 40% and active middle age extended by 10% over the next decades.

Over 70% of the gains could be achieved from prevention by creating cleaner and safer environments, encouraging healthier behaviours and addressing the social factors that lie behind these, as well as broadening access to vaccines and preventive medicine.

The Blue Zone strategy

So what do the people in the Blue Zones do that gives them such long happy lives?

Buettner identifies nine key attributes:

  1. They include regular low intensity activity as part of their normal everyday lives.
  2. They stop eating when they feel 80% full
  3. They eat primarily a plant based diet
  4. They take a small amount of alcohol daily
  5. They know what their “meaning in life” is
  6. They know how to “downshift” i.e. how to slow down and relax
  7. They practice a faith and attend services
  8. They put their loved ones first
  9. They maintain good social connections.

The Blue Zone projects also show that we must also design environments that make it easy for people to change their behaviours.

In 2008, Buettner and his team designed a plan to apply his Blue Zones principles to an
American town. He auditioned five cities and chose Albert Lea, Minnesota for a “Blue Zones Vitality” project. The key to success involved focusing on the ecology of health creating a healthy environment rather than relying on individual behaviours.

The results were remarkable. As a whole, the community showed an 80% increase in walking and biking and 49% decrease in city workers’ healthcare claims. The community shed 12,000 pounds, walked 75 million steps and added three years to their average life expectancy. City officials reported a 40% drop in healthcare costs.

One of the positive impacts of the dreadful Covid pandemic is that it has made us much more aware of the importance of health in our lives. It has increased our understanding of the impact of our individual decisions and actions in managing the risk to ourselves and others.

Proper hand hygiene and cough etiquette, wearing masks and maintaining social distance are all lifestyle changes, and we are learning that we have a tremendous capacity to adapt.

Now is the time for us to change the way we think about health so we’re concerned not just with the absence of disease but also our physical, mental and social well-being.

To quote Plato, “The part can never be well unless the whole is well”.

Professor Ciaran O’Boyle is Director of the RCSI Centre for Positive Psychology and Health

Professor Ciaran O’Boyle
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