Beach Blue Zones miracle: Beach Cities show big health gains
Lisa Santora, the chief medical officer of the Beach Cities Health District, with her daughter, Maia. Photo by Tom Sanders
The Blue Zones Project arrived in the Beach Cities a little more than two years ago with an intention as audacious as it was well intentioned. Its goal was to give people longer, better lives.
The project grew out of National Geographic explorer Dan Buettner’s investigations into the longest-living, healthiest peoples on the planet. Partnering with the cutting-edge employee well-being company Healthways and the powerful data-gathering of Gallup Polls, Buettner sought to apply health and longevity lessons derived from these geographies – called Blue Zones by demographers – to a population within the United States.
The U.S. is in the midst of an epidemic of ill health. Two-thirds of Americans are overweight or obese. Obesity rates among children have nearly tripled since 1980. Twenty percent of kids aged 6 to 11 are now classified as obese, resulting in an uptick in childhood diabetes and cardiovascular disease. A 2010 study by the Center for Disease Prevention discovered that Americans had begun to reverse a more than century-long trend towards higher life expectancy – in a very rare occurrence in an industrialized nation, Americans are dying younger.
Our multi-billion dollar health care system is in emergency mode, focusing itself more in dealing with the outcomes of Americans’ quickly degenerating health rather than its causes.
Dr. Lisa Santora had worked on the front lines of health care and realized it was a losing battle. After working as a primary care physician, she joined the Beach Cities Health District as its chief medical officer in the hopes of finding ways to reverse such trends through preventative health measures. Through its Livewell Kids nutrition education programs in Redondo Beach Schools, BCHD in 2006 achieved a rare feat – actually moving elementary school childrens’ Body Mass Index down by .7 percent, a small but significant achievement in public health circles.
But BCHD CEO Susan Burden had greater ambitions. The health district, formed as a care provider when the South Bay was essentially rural area in the 1940s, had been transformed into an agency that largely focused on preventative health care. BCHD’s outreach to children, seniors, and the economically disadvantaged had proven effective, but Burden sought to reach people of all ages and socio-economic statuses.
In early 2010, Burden ran across literature about Healthways, a for-profit health care company that worked with some of the biggest corporations in America on improving employee health through preventative means. She asked Santora to look into it.
Santora, a self-described research geek, discovered what would become the Blue Zones Project. Buettner and Healthways were looking for community ripe for what amounted to a revolution in health. They had assembled some of the brightest minds in academia and public policy and were looking for a place to put into practice not only lessons from the Blue Zones, but emerging methods in achieving social change. The goal was to reach a significant percentage of a population and improve its health, creating a ripple effect that would impact the entire community positively.
“It’s like a healthy epidemic,” Buettner said. “It works the same way, actually. Except in this case, instead of SARS or encephalitis, it’s a Blue Zones mindset.”
Santora emailed Buettner. The Beach Cities, she suggested, would be a great candidate for the Blue Zones Project, in no small part because BCHD already existed to facilitate its implementation.
Buettner responded. He quickly understood that in Santora and the health district, he’d found a person and an organization that could embrace the Blue Zones Project.
“Lisa is a visionary,” Buettner said. “She gets it. She is really the one who said, ‘Let’s try something new.’ And we soon found that the entire community was receptive.”
Santora and Burden received the support of the BCHD Board of Directors to bring Blue Zones to the Beach Cities, but it also required the massively tricky feat of getting every elected body in the each of the three cities to sign off – which, remarkably, they were able to do within months. In September 2010, the Beach Cities were chosen from more the than 60 communities nationwide who had applied to become the Blue Zones Project.
The Beach Cities, given the community’s affluence and ocean-orientated lifestyle, seemed less in need of a health epidemic than most places. But the Gallup-Healthways Well Being Index (WBI), which monitors health indicators in 188 communities nationwide, quickly provided evidence contrary to this perception. A survey taken in late 2010 showed that 60 percent of local residents were overweight or obese – just below the national average. Emotional health indicators were more disturbing: the Beach Cities ranked 176 out of 188 cities in stress, 160th in anger, and 178th in worry. By way of national comparison, the beach cities were angrier than Detroit and as stressed out as New Orleans. Healthways vice president John Harris described these as “scary numbers” upon their release.
Hermosa Beach Mayor Jeff Duclos was shocked. “It was a big eye opener, in that we need to realize we are not as healthy as we think we are,” he said. “We are not as chill as we think we are. We are none of those things. We are stress monkeys.”
Buettner was not surprised. He’d explored countries around the world that were far less affluent and far healthier and happier.
“I don’t think prosperity equals health,” he said. “To a certain extent, it’s prosperity that has made us unhealthy. It’s the fact that every family has owned two cars, and now kids, instead of riding bikes, are in cars. And we can afford to buy more food than we need, and our electronic entertainment has replaced simpler, cheaper entertainment that connects human beings.”
The Blue Zones Project his reached virtually every aspect of the community since outreach efforts began in late 2010. It has been active in schools, workplaces, restaurants, city politics, and perhaps most crucially, in building a series of social networks that increase community connections and support healthier behavior. People who were previously strangers have formed small groups called “moais” – based on a practice among the longest-living people on Earth, in Okinawa, Japan – in order to walk together, cook together, and discuss their purpose in life.
“What has emerged for me, in a very loud voice in our community, is we do want to be connected, and we do want to live on purpose,” said Lauren Nakano, the Blue Zones Project director for BCHD. “And, of course, we do want to be healthier.”
The project has been successful to an almost shocking degree. A glimpse at some of the data emerging from latest Beach Cities Gallup-Healthways WBI survey, which will be more comprehensively unveiled later this month, shows statistically significant improvements across the board in the community’s health.
The first pilot program that Blue Zones embarked upon – for nine months in a small Midwestern town in 2009 – was called “the Miracle in Minnesota” for its increases in the projected longevity of townsfolk, their collective weight losses, and health care savings realized by employers.
Call this the Beach Cities Blue Zones miracle. What is occurring, Buettner believes, is that local residents are winning back years of their lives.
“On the aggregate, absolutely,” he said. “…These are astounding numbers. And because this is Gallup, and they have over two million surveys from around the country, you have a de facto control group – so you can see how the Beach Cities has done not only against U.S. averages, but also against California averages. And we just blew the numbers out of the park. We are outperforming the rest the rest of California by 700 percent by some measures of improvement, like how many fruits and vegetables people are eating in the Beach Cities, over the last few years.”
“It’s exciting,” said Burden. “I’ve been in health care management now for over 25 years, and pretty much everywhere I’ve been – with true dedication with my peers and the organizations I was a part of – it was always dealing with the issues too late. Always. Whether it was a hospital, a children’s clinic – 75 percent of what we are dealing with is preventable. This is one of the first times I feel like there is good evidence you can really go upstream in somebody’s life at different intervals and make great choices, and help before you run into chronic disease processes.
“To me, it’s been the most fun I’ve had professionally, and it is the most satisfying.”
School children in Redondo Beach exercise before classes start. Photo
Thriving
Dan Witters is a numbers guy. As the research director of Gallup’s Health and Well Being Index, he is professionally dispassionate about data. But even for Witters, some numbers that emerged from the WBI survey conducted among Beach Cities residents a few months ago jumped out.
While much of the data has not yet been divulged – such as emotional health comparisons to other cities – it’s clear that everything from healthy behaviors to how people view their lives and the cities within which they live have made statistically significant improvements.
The first measure that caught Witters attention was a life evaluation measure Gallup uses worldwide. Gallup classifies people as “thriving,” “struggling,” or “suffering,” according to how survey respondents rate their current and future lives on a ladder scale with steps from 0 to 10, based on a methodology established 50 years ago called the Cantril Self-Anchoring Striving Scale. People are considered thriving if they rate their current lives a 7 or higher and their lives in five years an 8 or higher.
Less than a quarter of people in the world are thriving. The Beach Cities, in this sense, were ahead of the curve going into the Blue Zones Project, with 64 percent of local residents classified as thriving in 2010, markedly above the U.S. average of 53 percent.
Today, 72 percent of Beach Cities residents are thriving, compared to 54 percent of Americans.
“This is pretty impressive stuff,” Witters said. “We aren’t doing a census, of course – we are talking to 1,200 randomly selected adults, but that is a plenty large enough sample, with a narrow range of error. We are fairly confident this represents authentic improvement.”
Healthy behaviors have improved locally at a similar rate. In 2010, 60 percent of local residents reported eating five servings of fruits and vegetables at least four days the previous week, above the national average hovering in the mid 50s and California at 59 percent. While this behavior has remained stable elsewhere, in the Beach Cities it has jumped to 66 percent.
“This is a big win in the Beach Cities,” Witters said. “There is a lot more people eating fruits and veggies.”
Improvements are remarkably consistent, mostly in this four to seven percent range, locally. The percentage of people who report exercising at least 30 minutes a day three days a week, for example, jumped from 60.5 percent in 2010 to 66 percent today, outpacing the national average, which remains hovering in the mid 50s and the California average in the high 50s. Similarly, the 11 percent of Beach Cities residents who reported themselves as smokers in 2010 has dropped to 7 percent while the national average has stayed at about 20 percent.
In a measure called the City Momentum Metric, people were asked if they believe the community in which they live is getting better, staying the same, or worsening. Beach Cities residents were a little bit more optimistic than most in 2010, with 61 percent believing the community was getting better, compared to national and California averages in the high 50s. Today, that number has remained stable elsewhere but has increased to 67.6 percent locally.
“People don’t just feel better about their own lives, but also better about the community,” Witters said. “Two-thirds think the city or area in which they live is getting better as a place to live. That is pretty impressive.”
Witters acknowledged that there was a question whether statistically significant change could be achieved in the Beach Cities given the fact that many of the WBI numbers locally were higher than average at the outset and thus could be near their ceiling.
“I think that was a fair question to have asked,” Witters said. “I think the answer has been answered pretty definitively. The answer is yes – there was indeed room for improvement that was meaningfully large, and there has been a lot of improvement realized.”
Dr. Noel Chun, a member of the BCHD Board of Directors, said a key part of what attracted the health district to the project was the ability to create an evidence-based approach that provides data on how preventative health can work, something that has proven elusive throughout the history of such public health measures.
Chun stressed that the work has just begun. He said that beyond the three-year span of the initial Blue Zones Project, he hopes a decades-long study will be undertaken that shows the effectiveness of the model over decades.
“We have to keep doing it, keep monitoring and improving what we do,” Chun said. “It’s a multi-year, multi-generational commitment. That is our mission at the health district. We want to be a model for other communities and people interested in doing similar things. I think we are in a unique situation and we are very lucky to have these resources. And I am very optimistic and enthusiastic about carrying this as far as we can carry it.”
City leaders in Redondo Beach practice some Blue Zones-inspired stretching before a public meeting. Photo
Slow mo
In public health realms, achieving minuscule percentage changes is difficult. And so the changes that appear to be occurring since the arrival of the Blue Zones Project in the Beach Cities have the potential to be a national model.
The Blue Zones Project has already expanded to the entire state of Iowa, and it appears Texas could be next.
“To be honest, you guys were the early adaptors,” Buettner said. “It kind of worked in a little town in Minnesota, but the question was, ‘Can it work in an area like Los Angeles?’ And the answer is yes.”
Buettner stressed that the Blue Zones Project is less a program than it is an operating system. Some of what the project will achieve – and this is something that has really just begun – are changes in the built environment that make healthier choices convenient.
“The overarching plan is really to structure the social environment and community in such a way that it’s easier to make the right choice for your health and well being,” Chun said.
Blue Zones partnered with the South Bay Bicycle Coalition in helping enact a master plan that will add 216 miles of bike paths locally. Each of the three Beach Cities has also adopted policy documents derived from the Blue Zones Project, the fruits of which will not be apparent for years – a shift in how city streets and public places are constructed to encourage cycling, walking, and social interactions.
“City planners now are looking at the streets and the way cities are designed not just through the lens of how do I optimize this to get as many cars down the runway as possible,” Buettner said. “They are looking through the lens of how do I optimize this for human beings. It’s a shift in the culture that doesn’t happen overnight.”
The Blue Zones approach has been three-pronged: policy, purpose, and social. All three are intermingled, in some sense – 11 local schools, for example, have adopted “Walking School Bus” programs in which parents and children walk together in groups to school rather than drive.
Lincoln Elementary School student Patrick Stolz, 6, waks to school during the first Vitality City Walking School Bus last October. He is followed by Redondo Beach Mayor Mike Gin and district 5 Councilman Matt Kilroy. Photo
“The Walking School Bus is a little concept, but it’s really a huge undertaking,” said Mike Gin, mayor of Redondo Beach. “Parents act as chaperones for kids, walking a few blocks to school. It’s an opportunity to get a little exercise, and it’s not a really huge change in behavior, because it’s so much fun. It’s bringing people together as a community.”
A series of purpose workshops – launched by nationally recognized expert Richard Leider – have engaged people in better aligning their values with how they live their lives. Walking Moai groups that engaged more than 1,600 people have now spread to activities beyond walking, such as “Purpose Moais” in which people from different walks of life join to discuss purpose.
More than 150 workplaces have also become involved in the Blue Zones Project, including all three cities, school districts, and businesses such Skechers, Body Glove, Crowne Plaza Hotel, and Zico Coconut Water.
As Buettner says, the overarching theme is instilling a “Blue Zones mindset.” Redondo Beach City manager Bill Workman says it is a mindset that has impacted city hall in ways large and small. His director of planning, Aaron Jones, recently brought him a loaf of healthy, homemade bread, and co-workers regularly go for walks together. But it has also permeated the decision-making process.
“Internally, people are talking about it, helping each other,” Workman said. “People are walking together and have really embraced it. Externally, all the planning issues – all the things we look at, especially in harbor revitalization, all the policy generated is about ‘How does this fit with walking and biking?’ I’d say 10 years ago that wasn’t even in the discussion.”
Duclos says a key part of the Blue Zones mindset is learning some very simple lessons about slowing down.
“I think it’s important, the eating habits, walking more, doing all of those things are important, but it really comes down to taking time to slow down and sort of be more purposeful and enjoy the time you have,” Duclos said. “That is the hardest thing to achieve and that is a big component of where we need to go. The actual Blue Zones areas – this was a big characteristic of them. They were very communal, and they enjoyed each other’s company and had a sense of community and enjoying each other. In this big metropolis we live in, everybody is sort of hard wired to be separate from each other. In Hermosa, we are the most densely populated city in the state, almost – 20,000 people crammed into 1.3 sq. miles. You’d think it’d be easier to have that sense of community, but it’s not. We have the same problems everyone else has, and that is a big lesson that is a part of all this.”
Nakano says this sense of slowing down applies both to the way streets are built and the way people construct their own lives. There is a connection, for example, between a person finding meaning and social connection in a Moai and making Aviation Boulevard more pedestrian and bike friendly.
“Slowing down means being more present,” she said. “It is safer. It allows other people to use that as a thoroughfare. It really has a direct impact and benefit to business, because people actually take time to stop and really notice. I think it’s helping people be more present to their communities, to themselves, and each other. And all of the things we are looking at, and the ways we are prioritizing these kinds of things in our community, give people the opportunity to do that more.”
Santora believes the progress being made by the Blue Zones Project is both real and sustainable.
“The anecdotal evidence we’ve heard from the community, the involvement of the community, all the way to the objective evidence we are seeing in the Gallup-Healthways WBI data, is demonstrating we are we are on target and we are having an impact on the health and well-being of the community,” Santora said. “It reinforces the importance of creating environments, be it a built environment or a social environment, that help nudge people towards engaging in healthy behaviors.”
“It has far exceeded my expectations. It’s great to see it, from the person who was being a geek on the computer and being a Google stalker…It really has taken on a life of its own, and we just really hope to keep advancing this community to that vision of a healthy beach community.”
See bluezonesproject.com for more information and to get involved.