Latest / CareTalk: Healthcare. Unfiltered. / How to Live a Long and Healthy Life with Dan Buettner
Transcript
- 0:00Dan Buettner has unlocked profound secrets of longevity and happiness.
- 0:04He journeyed to the unique places around the world, dubbed the Blue Zones, where people regularly live into healthy old age.
- 0:11Dan discovered what they have in common and is now applying Blue Zones insights to create healthy communities around the United States.
- 0:19Can Blue Zones slow or reverse the recent slide in U.
- 0:22S.
- 0:22longevity?
- 0:23Listen in to find out.
- 0:33Welcome to CareTalk, America's home for incisive debate about healthcare business and policy.
- 0:38I'm David Williams, president of Health Business Group.
- 0:41And I'm John Driscoll, the president of Walgreens Health.
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- 0:47Well, it's the source for trending healthcare industry news, links to the latest podcast episodes and highlights, and original blog posts that dive deeper into our podcast topics.
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- 1:02Well, David, we're going to have to promote Dan's new Netflix series.
- 1:05It's killer on blue zones.
- 1:07Uh, welcome, Dan.
- 1:08How are you, my friend?
- 1:10It's a delight to be here and delight to see you again, John.
- 1:13Always a, always a pleasure.
- 1:15So maybe we'd start with how did you get interested in longevity and, and, and I mean you actually invented that I think the term blue zones.
- 1:24Maybe talk a little bit about your origin story to give folks some context.
- 1:29I had a company in the, in the, Late 90s, early 2000s, at a full time staff of people and we, our, our business was, uh, solving great mysteries.
- 1:40Most of them were ancient anthropological mysteries, like why the Maya civilization collapsed.
- 1:46And we got approached by the country of Japan to, um, to see if, uh, to help them solve a mystery they were trying to solve around Bronze Age, um, disappearance of culture.
- 1:58And, um, We, one of my researchers came upon a report from the World Health Organization that found that Okinawa, Japan had the longest disability free life expectancy in the world.
- 2:10And I said, aha, now there's a good mystery.
- 2:13And we got Japan off of their Bronze Age culture yawner and, uh, let's go figure out why people are living a long time in Okinawa.
- 2:22And, and they went for it.
- 2:24And, um, my following tripled during that amount of time.
- 2:29This is when the internet was.
- 2:31Barely getting started.
- 2:32We have 1.
- 2:328 million followers.
- 2:35And, um, I reasoned if there were long lived areas in Asia, there must be long lived areas in, in Europe and Latin America, maybe even North America.
- 2:44And if you could find these places, confirm them and knowing that only about 20 percent of how long we live is dictated by our genes.
- 2:53That these places hold about 80 percent of the formula for a longer, better life.
- 2:58Now, my brand of longevity or my version of it is not this sort of hyperbolic lived 120, uh, with a genetic hack.
- 3:08Uh, my version is a reverse engineering of longevity of finding verified populations.
- 3:16that have achieved the outcomes we want, which is making it to a mid 90s.
- 3:21That's about how long you can promise the average person and then finding the common denominators.
- 3:27So no matter where you are in the world, what are people doing?
- 3:31Uh, as a, as a, as a population reaching.
- 3:34Mid nineties and hundreds occasionally and then packaging that up and that's what that's what Blue Zones has been and you know, Netflix and I've four New York Times bestsellers.
- 3:45If you Google Blue Zones and and and then John tangentially with you helping cities take these ideas, put them to work and lower health care costs and thereby raise life expectancy or vice versa, I guess.
- 4:00So you did find some of these blue zones, which I think is of interest to people, but you also did find these so called common denominators and articulated some key principles.
- 4:09What are some of the key ones?
- 4:12So the longest lived women in the world, Okinawa, longest lived men are the highlands of Sardinia, the island of Ikaria, Greece.
- 4:19You have a population of 10, 000 living about seven years longer than Americans with virtually no dementia.
- 4:26Uh, then the Nicoya peninsula of Costa Rica, about half the rate of middle age mortality, and they spend one 15th the amount we do on healthcare, which is a very clear indication that you don't have to be wealthy to be healthy.
- 4:40And, uh, I also think some really important policy lessons there.
- 4:44And then in the United States, among the seventh day Adventists in and around Loma Linda, California, you have a population of people, Americans living about seven years longer than their California counterparts.
- 4:56And it, you know, this has taken me 20 years, but.
- 4:59When you look at the common denominators, if you look at a meta analysis of dietary surveys done in all five blue zones over the past 80 years, you get a pretty clear picture of a diet of longevity.
- 5:11And instead of superfood hyperbole, uh, what they're eating is 95 percent whole plant based food.
- 5:20Their diets are very high in carbohydrates, but not simple carbohydrates, complex carbohydrates.
- 5:26So the five pillars of every longevity diet in the world are whole grains of various types, greens, and you know, whatever's coming out of the garden, tubers like sweet potatoes, interestingly, about 65 percent of all calories.
- 5:43in Okinawa until about 1975, where it came from sweet potatoes.
- 5:49Um, nuts as a snack, and then the cornerstone of every longevity diet in the world is beans.
- 5:55And if you're eating a cup of beans a day, that's worth about four extra years of life expectancy over getting your protein from, uh, less healthy sources.
- 6:05Um, but we also see people in blue zones, they have vocabulary for purpose.
- 6:10Our healthcare system doesn't.
- 6:12Embrace that because it's hard to make money off of purpose, but we know that people can articulate their sense of purpose, live about eight years longer than people who can't, uh, who are wake up rudderless, um, they have, uh, time honored.
- 6:28Uh, rituals that reduce the stress of the human condition really, uh, the prayer for the Adventist, the ancestor veneration for the Okinawans, taking naps for the Ikarians and the Nikoians, and in Sardinia's happy hour.
- 6:46But they have this punctuation in their day where they downshift.
- 6:50Um, focus on something other than their busyness or whatever they're worried about.
- 6:56And in many cases involves a little bit of alcohol, but those are some of them I could go on, but, um, I, I, I give, you know, I think David needs more naps and Dan, you and I need to focus on happy hour, but can you, one of the things that jumped out at me when I was reading your books and, and, and watching some of your, your, your shows is how important social connection was.
- 7:20Whether it's the, you know, the, those families making, making pasta and making bread in Sardinia or the, the, the multi generational, uh, relationships in Japan.
- 7:32Can you talk a little, you know, we, we live in America, people are talking about the epidemic of loneliness, you know, how many men really can't name, you know, one friend, um, and that what struck me is the, the men walking up the steps.
- 7:46Uh, I think it was in, it was in the Sardinia area, uh, how important social connection is because talk about something that no one's going to pay for, but how, but that's super important.
- 7:56Maybe what you learned and what you observed in, in around social connection.
- 8:01Yeah.
- 8:02If you could put the effect of three good friends in a, in a, in a capsule, it'd be a blockbuster drug.
- 8:09Having at least three friends you can count on on a bad day is worth about seven extra years of life expectancy over suffering loneliness, which about 30 percent of Americans suffer, by the way.
- 8:20And the, the thing, there's a few things we see in blue zones that are different than American.
- 8:26Blue zones, people tend to celebrate age.
- 8:30So the older you get, the more honored you are.
- 8:33You know, here in America, we celebrate youth.
- 8:36And you can pick up any magazine and page through and, you know, most of the ads are going to be young, beautiful people.
- 8:42In Sardinia or Okinawa or Ikaria, the biggest birthday of your life is your 96th birthday.
- 8:50And, um, you would never put your aging parent in a retirement home because that would shame the family.
- 8:56So instead, mom lives within the, in the mother in law apartment, uh, and she is, uh, helping with child care.
- 9:08She's helping cook the food and transmitting this diet of longevity to the next generation.
- 9:15Or dad lives.
- 9:16In the mother in law apartment and he's running the garden and and transmitting agricultural wisdom or resilience or seeing the economic up and downs over the last 70 or 80 years and it can help the family, whether the storm so they're harnessing that wisdom instead of warehousing that wisdom elsewhere.
- 9:36But the big point I want people to take away is that social connection.
- 9:42Yes.
- 9:43Uh, you can proactively do it.
- 9:45And I think one of the best strategies to longevity, especially for a guy and John, you're quite right.
- 9:49It's harder for guys than it is for women is to go through and proactively invite friends, healthy friends to lunch or.
- 9:58To happy hour, uh, to some common sport and put the time, effort and money you put into some new diet or some new, you know, exercise strategy and, and put it into making, uh, new friends or, or even old friends that you want to bring bracket into your social circle.
- 10:15I mean, you and I reconnected after seven years and, you know, we still like each other even though there's a few more wrinkles and at least on me that you're, you look like a.
- 10:24You know, we're both, it's the lighting, living in a walkable community is the best thing most of us can do, uh, to, to favor, uh, if you live in a soulless suburb where you get it in your attached garage.
- 10:42Drive to work, go into an underground garage and walk up to your office.
- 10:46Your opportunity for serendipitous social interaction, many of which eventually lead to friendship, are, are nil.
- 10:54As opposed to living in, you know, Santa Barbara or, or Boulder or, uh, downtown Naples, Florida, where just a walk to the store to buy a cup of coffee is going to occasion three or four bumping into people and, and human interactions.
- 11:11And that's how you overcome loneliness, I think.
- 11:14So Dan, I know there's been...
- 11:16Dan, I know there's been a great reaction, Dan, as you're mentioning, even at the dawn of the internet, many followers coming along.
- 11:22Obviously, you know, books are bestsellers.
- 11:25The Netflix series is popular.
- 11:27I'm interested in what is the reaction among some others in sort of the broader healthcare universe.
- 11:32Like I hear other people say, Hey, you know, your genes is only 20 percent your behaviors, the rest, and then, or healthcare is only a small part of it.
- 11:39And then they focus on healthcare, but what do people like in public health or the healthcare industry themselves?
- 11:44What's been the reaction there?
- 11:47Well, you know, all the incentives in the healthcare industry are lined up behind sickness.
- 11:54Uh, you know, most, whether it's hospitals or doctors or, you know, pharmaceutical companies, they sort of rely on people to get sick and come use their services.
- 12:04Um, so in America, it's tough to, to, um, To find revenue models, but our, uh, our business, the Blue Zone Projects, we've managed to work in 72 cities, usually funded by the not for profit Blue Cross Blue Shield plans or the hospital systems who are, um, committed to a population of people getting them healthier, well, we can be really successful in that, uh, and, and we bring to the table an ethos of not trying to change.
- 12:31Everybody's behavior or convince them of a certain diet, but our approach is optimizing their, their environment, their ecosystem, uh, from the time they wake up in the morning to the time they go to bed with hundreds of nudges and defaults that unconsciously.
- 12:50Have them making better choices in what they eat, how they move, how they socialize throughout the day.
- 12:56And, um, given, you know, the, the economic headwinds that we have, we've been enormously successful.
- 13:02It was purchased recently by a large healthcare system.
- 13:05Uh, so there is some, there's some, um, I'd say glimmers of hope that true prevention can start to, to prevail here in America.
- 13:15Well, it's an interesting, you know, what I think is fascinating about that model is you're almost building a muscle for social wellness that doesn't exist in some ways in many of the solar suburbs that, that, that probably are places like David and I grew up in, um, there, there, there, there, there were engineered by real estate folks for optimizing the space as a, as opposed to, you know, Optimizing connection.
- 13:41And one of the interesting things about your business is that they are a little nudges.
- 13:45It's like slightly smaller dinner plates and giving them away, creating walkways so that people as part of their natural community that that that that there are unlike a lot of ways to get to hack your way to to to health.
- 14:02You're actually making it a little simpler to have a better life today that builds on a longer life tomorrow.
- 14:09And I think that's One of the most interesting things about the Blue Zone model for change is it's not asking for abrupt change that people don't like, but really how do you make it more of an incentive, a positive incentive.
- 14:23To get healthier now and then, and then, because I think there are positive advantages short term and incredible long term events.
- 14:31Have you, are there, is there any one community you'd point to Dan that's kind of invested over long term and can you measure the outcomes?
- 14:38Over a longer term to show that all these nudges are driving results.
- 14:43You can't get funding if you can't measure it.
- 14:46So, uh, Gallup measures, uh, every one of our cities.
- 14:49Uh, we get a baseline, basically BMI at the, at the population level.
- 14:54And that's a great North star because BMI, uh, strongly correlated with the, uh, rate of diabetes, rate of, of course, rate of obesity, but a rate of heart disease, cancer, and even dementia.
- 15:06So you can lower BMI, you lower all those other related chronic diseases.
- 15:11And that's body mass index, which is just a clear and simple mathematical measure, or are you healthy or are you either obese or trending that way?
- 15:20Yeah, it's uh, it's sort of how much you weigh or how much fat you have on your body, uh, more or less.
- 15:27So, um, Fort Worth, Texas, we came in there, worked for five years.
- 15:32And, uh, our most effective tools are actually policy tools.
- 15:35It's convincing city government to make their city more walkable.
- 15:39Just by doing that, you can raise the physical activity level by as much as 20 percent, convincing city government to consider ordinances against, for example, billboards.
- 15:51Neighborhoods with billboards have about 10 percent lower rates of obesity than neighborhoods with billboards.
- 15:57We don't know why that is, but if you eliminate the billboards, you eliminate Some obesity.
- 16:02Um, it's not, um, we come in with menus.
- 16:05We don't come in saying you have to do anything, but evidence based policy menus.
- 16:10And we help them, uh, uh, select for feasibility and effectiveness.
- 16:16And you want to put these population wide strategies to work.
- 16:21Um, it's not that having dinner plates doesn't work.
- 16:24It's just hard to execute that at the population level.
- 16:27So policy is a big, uh, tool.
- 16:29But in five years...
- 16:31Uh, we managed to lower, uh, the BMI of, of Fort Worth by about 3%.
- 16:37Uh, which is, uh, it doesn't sound like a lot, but that probably occasioned 19, 000 fewer heart attacks at about a hundred grand a piece.
- 16:47Uh, they're economists figured that our, our program saved them a quarter of a billion dollars a year in healthcare costs.
- 16:54Those aren't our numbers.
- 16:55Those are their numbers reporting about our project.
- 16:59And um, Uh, we, uh, also raised, uh, there's, uh, something called WBI ranking on 170 MSAs or, you know, big cities.
- 17:12Um, Fort Worth was fifth in the bottom when we started and they were in the middle of the pack when we ended.
- 17:18And we achieved this not trying, by not trying to convince a million people in Fort Worth, Texas.
- 17:24cow town to eat more veggies or to get out and exercise more.
- 17:29But we went in and we optimized their policies.
- 17:32We had a certification program for.
- 17:35Restaurants, grocery stores, workplaces, schools, and churches, about 30 percent of those places, uh, optimize their designs and policies.
- 17:44So people move more, uh, eat better and socialize more.
- 17:48And then we got about seven or 8 percent of the adult population to become blue zone ambassadors, to optimize their own homes.
- 17:55And like you said, use smaller plates and that sort of thing.
- 17:58But when you triangulate people, places, and policies.
- 18:03Uh, with a professional team, uh, overseen by national experts.
- 18:08For five years, we have not failed yet at making cities healthier, but it's a counterintuitive approach and it requires a different kind of investment than the healthcare industry is used to making.
- 18:22So a lot of times interventions work, you know, while they're active phases in place, so usually they're shorter than five years.
- 18:28So it's impressive to have a, you know, a five year program and have the impact.
- 18:32Where do you see things going for the longer term?
- 18:34Because obviously you're talking about people living for, you know, decades and, uh, and, and it's not just a five year thing.
- 18:40Is it become more of a kind of a virtuous self reinforcing circle after five years, or are there new interventions that you do to take things to the next level or just to keep them, where do you see the vision beyond the five years is my question.
- 18:54Well, we're very focused on permanent or semi permanent changes to the environment, so in the case of Fort Worth and most of our other cities, when we increase the walkability by 50%, those bike lanes and those sidewalks and that, uh, those roads that are now on a diet are there for decades, so the effect continues to linger on.
- 19:14If I'm successful at getting billboards out of a city, that lasts for as long as the billboards are out of the cities.
- 19:20Um, so.
- 19:22That's the benefit of taking an environmental approach as opposed to a behavior modification approach.
- 19:27And to your very good question, uh, we've had several of these cities that once they get Blue Zone certification, and they start using that as an identity.
- 19:37We are a healthy city.
- 19:39That's not, it's a self reinforcing loop that it's easier to pass policies that favor health because, well, the rest of the country recognizes us as being healthy.
- 19:50We, you know, we can't let the, uh, lack smoking law come in or, you know, we, we, we, we can't, uh, we can't let them come build billboards here when they haven't been there before.
- 20:02So, um, yeah, but the important thing is, yeah.
- 20:05Uh, don't try to change people's behavior.
- 20:08You'll fail for almost all of them, almost all the time in the long run, change their environment and you're set up for permanent success.
- 20:17And in the context of falling life expectancy in the U.
- 20:21S.
- 20:22is there, are there one or two things that you, if you, okay, I'll give, we'll give you the magic wand.
- 20:27We all believe in blue zones.
- 20:28You're now the.
- 20:30Advisor to the president.
- 20:31Uh, you've got both houses of Congress aligned, which is never going to, never going to happen in our lifetime, but you could drive a couple of policy changes.
- 20:40That would directly address, uh, deaths of despair, you know, uh, actually for the first time decreasing life expectancy in America, which is the first time in, in, in certainly the last hundred years since it's been carefully measured.
- 20:52What would they be?
- 20:53What would be the two things at a national level we should be doing?
- 20:56I haven't.
- 20:57You're probably not going to like either one, but the first one is change the farm bill right now.
- 21:03You know, taxpayers subsidize cheap grain, um, Sugar.
- 21:09Um, yeah, cheap grains are used, uh, in feedlots to, to, uh, make, the average American eats 220 pounds of meat a year.
- 21:19I'm a big believer you should eat whatever you want, but 220 pounds is just too much.
- 21:23And the meat is very high in omega 6 fatty acids.
- 21:27It's fatty and it's too cheap.
- 21:29That's why we buy too much meat.
- 21:31And that's part of the reason we're obese.
- 21:33A lot of these cheap grains, wheat, rice, corn, uh, are going to high fructose corn syrup.
- 21:39They are the building blocks of our junk food, food environment.
- 21:4370 percent of all food in grocery stores is, is processed or added sugar.
- 21:48That's driving about 600, 000 unnecessary deaths every year.
- 21:53If we simply made manufacturers pay the real cost of their inputs, you'd see a lot more healthy food, uh, rising to the top in these.
- 22:05Um, you know, $3 Happy Meals would all of a sudden cost $20 and you wouldn't have as many people paying for 'em.
- 22:11So that's one thing.
- 22:12The second thing is I'd raise the price of gas to about $12 a gallon, and people are probably, are throwing eggs at their screen at me right now.
- 22:20But, um, Singapore, for example, they, Singapore, I, I, I profiled Singapore in this Netflix series.
- 22:29It's a city with the highest health adjusted life expectancy in the world.
- 22:33They live 12 more good years.
- 22:35Only 11 percent of people drive.
- 22:37Why is that?
- 22:38Because they put a 300 percent tax on cars, another 100, 000 fee to drive that car, and 10 a gallon gas, and only 11 percent of people can actually afford to drive.
- 22:49But they took that tax revenue, and they put it into a cheap, fast, clean, pleasant, ubiquitous, uh, subway system.
- 22:57Which most people take everybody's walking to the subway and, um, and then walking from the subway back to, to their home every day.
- 23:05They're getting 6 to 8, 000 steps in a day without even thinking about it.
- 23:09Uh, there, Singapore is a place where 4 percent of people are obese.
- 23:14Here in America, 42 percent of people are obese and that's because they're part of the big reasons because they're walking and we subsidize gasoline and we should pay the real price of gas and that would drive a lot more people out from behind the steering wheel onto their feet and and to their better health and greater happiness too, by the way.
- 23:35So, Dan, uh, when John asked you that question, I thought maybe he was referring to the job vacancy in the House of Representatives, which I understand does not need to be filled by someone who is a member of Congress.
- 23:43But after you put your first two things, I have a feeling that you could get even more trouble from the members than by compromising with the Biden administration.
- 23:50So let's say you can't actually have those two things happen in Washington.
- 23:55You know, the Washington Post had an article this week where they showed not blue zones, they showed purple and the deepening purple zones across the country where life expectancy is falling, sometimes by a lot.
- 24:04So with the current, you know, political constraints that are in place, what is possible?
- 24:11Is it a matter of having a few Blue Zones?
- 24:14No, well, right now, the Blue Zone project work is limited to areas where there's a real visionary CEO.
- 24:21Um, so block grants, for example, from the U.
- 24:24S.
- 24:24government that would, uh, uh, offer some seed money for cities who want to do this kind of work.
- 24:31And when I say this kind of work, it's designing for health.
- 24:36evidence based ways to design cities so the healthy choice is the easy choice and there's very deep literature on this.
- 24:43Uh, to my knowledge, there's no federal funding.
- 24:45If some of funding even got the ball rolling or made it easier for cities and other communities to create a healthier design, we could probably raise 10 or 20 percent.
- 25:04So Dan, do you, do you, do you, you're, you've been at this now for a long time.
- 25:08You're, you've got bestselling books, even cookbooks.
- 25:11Um, you've got the Netflix series.
- 25:15Are you hopeful?
- 25:16I mean, are you, are you, are you, are you, are you, are you wise and, and, and more conservative now?
- 25:21What, what do you project to be the impact?
- 25:24You're, you're, you're an evangelist, but now you've actually seen it in the field.
- 25:28What are your hopes for America kind of embracing?
- 25:31Blue zones as a, as a philosophy and as a strategy.
- 25:35Well, so we have 14 years in 72 cities and.
- 25:41We now have the both the economic argument and we have the data to show it actually works.
- 25:46So, you know, I lack the, um, the power in Washington, uh, and I also like writing better than I do sort of evangelizing this, this work.
- 26:01So it's there.
- 26:03Um, and I think more and more it is recognized as a, as a, uh, Another way to go or a way to enhance what we're doing already in the health care space.
- 26:15So I do think there'll be a slow growth to this kind of work But there's a lot of headwinds for America and trying to get healthier the you know, the the big food companies you know Cattlemen's Association and the Um, uh, the, the, uh, lobbyists that represent oil companies there, they, they have more power than they ever have.
- 26:40So, uh, the chances that our federal government are, is going to, are going to make the tough choices to make a healthier America, I don't see that coming, but I do see the mayors like Betsy Price of, of, um, Fort Worth, Texas and, uh, the mayor of Phoenix, Arizona, Jacksonville, Florida, who throw their, uh, their political equity and during their term buying health.
- 27:05Municipal governments can get way more done than the federal government.
- 27:09And where the opportunity lies is with the mayors and city councils in the medium sized cities around America.
- 27:16I think they're the ones that have the capacity to show the way to the rest of the country.
- 27:21Well, that's it for another episode of Care Talk.
- 27:24Our guest today has been Dan Buettner, bestselling author and explorer whose insights are reshaping how we think about health, community, and the pursuit of a meaningful life.
- 27:33I'm David Williams, president of Health Business Group.
- 27:37And I'm John Driscoll, president of Walgreens Health.
- 27:39If you like what you heard or you didn't, please subscribe on your favorite service.
- 27:43And Dan, thank you for giving us a hopeful, uh, actually cheaper path to health.
- 27:50Uh, happiness and a longer life.
- 27:52Keep up, keep doing what you're doing.
- 27:53My friend, we're, we're, we're really proud of you and we're happy to share the, share the wisdom with the rest of the world and we'll see you when you're a hundred and several times before.