Introduction

The desire to live and long and fruitful lives is a universal goal. With advances in science and a growing understanding of lifestyle’s impact on longevity, achieving that goal is more attainable than ever. However, the secret lies not just in medicine, but in embracing holistic approaches to health that encompass diet, exercise, social connections, and mental well-being.

The concept of Blue Zones, characterized by regions where inhabitants exhibit significantly greater longevity compared to global averages, originated from the seminal work of Gianni Pes and Michel Poulain, as documented in the Journal of Experimental Gerontology, which identified Sardinia, Italy as a notable epicentre of male centenarians (Pes & Poulain, 2003)1. Subsequently, Dan Buettner, a National Geographic Explorer and Fellow, popularized the term “blue zones” and embarked on an investigative journey to delineate the correlates of longevity. In his docu-series “Live to 100: Secrets of the Blue Zones”, Buettner traverses various longevity hotspots, aiming to discern commonalities among them. Employing a multidisciplinary approach, Buettner employs qualitative methods such as one-on- one interviews and observational studies of daily life, alongside quantitative analyses comparing Blue Zones to the United States.

Looking at this study into longevity from a health psychology perspective helps understand the importance of the biopsychosocial model of health; one that accounts for the complex interplay between biological, psychological and social factors affecting health and well-being.

This article comprises of two main sections:

Factors Contributing to Longevity: This section examines the elements that contribute to longevity in each Blue Zone, using the terminology and insights from Buettner’s docu-series.

Practical Applications for Community Health: This section discusses how the longevity factors can be applied to improve community health, the benefits of adopting these health habits, and potential limitations.

 

SECTION 1

The contributing factors to longevity are outlined for each blue zone shown in the docu-series.

Okinawa, Japan

 

Contributing Factor to Longevity	Description
Laughter	Umeto Yamashiro, a 101 resident of Okinawa is interviewed and exhibits maintained cognitive ability. She claims laughter and a positive outlook to life is the key.
Medicinal food	70% of Okinawan diet is sweet potatoes (a source of complex carbohydrates, fibres, active anti-oxidants) and the rest is an array of foods with medicinal properties.
Caloric density	The meal portion sizes are smaller but they are nutritionally dense.
Garden	Toyo Ota, a centenarian (exhibiting good motor and cognitive abilities while threading a needle) states how the Okinawan elderly spends a large amount of time gardening. This promotes range of motion, regular physical activity and is a near constant source of fresh produce.
Hara Hachi Bu	A term that means 8 out of 10, it is a principle that Okinawans follow to stop eating when you’re 80% full.
Maoi	These are life-long committed social circles that fulfil the need for human connection and belonging.
Ikigai	A constant sense of purpose that drives Okinawans to keep their minds and bodies engaged, ensuring spiritual health.

 

Sardinia, Italy

 

Contributing Factor to Longevity	Description
Steepness	The steepness of the village meant constant exercise for the residents without them even realizing it.
Good Carbs	The Sardinian diet composed of complex carbohydrates such as the sourdough breads that showed lower glycaemic absorption due to fermentation and Minestrone soup packed with fibre from the multiple vegetables.
Good Stress	Since the primary occupation of Sardinians was herding sheep, they were not subject to chronic stress. However, earning to actively cope with the small stressors that can arise in the life of a shepherd contributes towards longevity.
Care for Elders	They showed reverence for family and a core value towards community, keeping their aging members close by.

 

Loma Linda, U.S.

 

Contributing Factors to Longevity	Description
Faith	The doctrines of “Adventism”, the faith followed by residents in Loma Linda hold their community together and include regular exercise and rest. An example of staying physically active was ‘pickleball’, a sport activity built around community and the Adventist sabbath looks at the statement ‘On the seventh day, God rest’ as a reason to include leisure as an imperative part of life.
Volunteering	Adventists look for a sense of connection with others by using their time to volunteer in community drives.
Plant-Based Diet	35% of the residents are vegan/vegetarian with their diet regularly consisting of whole wheat grains, legumes, nuts, fruits, framing a positive approach to food that looks at addition instead of restriction.
Right Tribe	Since health habits are contagious2, being surrounded by like-minded people in Loma Linda ensured their population adopted healthy behaviours into their lives.

 

Ikaria, Greece

 

Contributing Factors to Longevity	Description
Herbal Teas	Vaso Parikos, an Ikarian centenarian and her daily consumption of herbal teas in can be linked to the low rates of dementia in this area, due to the highly anti-oxidant and anti-inflammatory properties of tea.
Raw Honey	Ikarian honey is un-pasteurized and un- processed, preserving the beneficial pollen and active bio-components.
Partnership	Panagiotis Kouloulias and Aleka Mazari, a       centenarian     couple       show               how partnership is linked to longevity.
Ikarian wine	Drinking Ikarian wine which is manufactured in the traditional manner, along with a Mediterranean diet increases the absorption of anti-oxidant compounds present.
Dancing and Laughing	‘Panegyris’ are social gatherings where people come together to dance for hours, making physical activity and caloric burn joyful.

 

Nicoya, Costa Rica

 

Contributing Factors to Longevity	Description
Plan de vida	Similar to the ‘ikigai’ of the Okinawans, people of Nicoya have a sense of purpose and a reason to work every day.
Do things by hand	Manual labour while during daily chores contributes to caloric burn.
Slow Down	Time is taken out of the daily routine by the people of Nicoya to be with family and friends.
Public health policy	The Costa Rican government has health policies in place that bring healthcare to the community.
Three sisters	A Mesoamerican food trifecta of corns, black beans and squash which provides all the nine essential amino acids without the cholesterol and saturated fat.

Dan Buettner looked at the common denominator among all these blue zones and found the following common threads.

 

Move Naturally	By Hand, Garden, Walk
Outlook	Unwind, Faith, Purpose
Eat Wisely	Plant-Based, Wine, Moderation
Connect	Family first, Partnership, Right Tribe

 

SECTION 2

In an endeavour to establish a Blue Zone within the United States, Dan Buettner initiated the Blue Zones Project, with Albert Lea, Minnesota as its pioneering city. Through environmental modifications such as fostering walking communities, promoting healthier dining options in restaurants, and enhancing walkability infrastructure, a significant portion of the population demonstrated the adoption and maintenance of healthier habits.

Contrastingly, Singapore serves as an exemplar of engineered Blue Zones, distinct from those rooted in historical influences, traditions, and practices. Ambassador Chan Heng Chee elucidates Singapore’s approach, which relies on a system of ‘nudges,’ including subsidies for nutritious crops to ensure affordability, extensive public transport networks coupled with governmental policies discouraging private car ownership, and initiatives like the Proximity Housing Grant, encouraging familial co-residence among the elderly. Singapore’s commitment to fostering a public- private partnership prioritizing public health underscores the active implementation of policies aimed at enhancing community well-being.

These instances illustrate how lessons gleaned from Blue Zones and their determinants of longevity can be universally applied. The overarching theme emphasizes integrating physical activity into daily routines through gardening, outdoor walks, and manual tasks to promote caloric expenditure and cardiovascular health. Furthermore, cultivating a positive outlook, engaging in faith-based communities, and prioritizing relaxation enhance overall physical, mental, and spiritual well-being. Additionally, adherence to unprocessed, plant-based diets, as observed in Nicoya, Costa Rica, underscores a clear correlation with longevity, accessible across various socio-economic strata due to the affordability of plant- based ingredients.

Maintaining robust social connections within family and community settings yields evident health benefits, with commitments to exercise partners increasing adherence rates.3 Governmental initiatives promoting infrastructure conducive to physical activity, as evidenced in Singapore, or active engagement in health policy, as seen in Nicoya, further contribute to longevity.

The common denominators across the blue zones, their health benefits and possible limitations are highlighted in the following table:

 

Health Habit	Benefits	Limitations
Daily physical activity	1.    Improved cardiovascular health 2.    Weight management     and control 3.    Enhanced mood and mental well- being 4.    Reduced   risk    of chronic  diseases like   type 2 diabetes, stroke, and certain cancers 5.    Stronger bones and muscles 6.    Higher sleep quality	·       Risk    of  injury   or overexertion, especially       without proper         guidance (mitigated by following the Blue            Zone priniciples   of   “move naturally”      wherein everyday chores and simple  range   ofmotion physical activities such as gardening                             and community sports are practiced.) ·       Time constraints and competing priorities may hinder consistency ·       Access to safe and suitable exercise spaces may be limited (areas to be targeted by government policies such as the ones implemented in Singapore, Costa Rica) ·       Weather conditions may affect outdoor activities

 

Plant-based diet

1.    Lower risk of heart disease             and hypertension as research shows meat being a contributing factor to these diseases 2.    Improved cholesterol levels 3.    Better weight management and reduced risk of obesity 4.    Lower incidence of certain cancers, such as colon and breast cancer 5.    Reduced risk of type 2 diabetes 6.    Improved digestion and gut health 7.    Increased intake of essential vitamins, minerals,           and antioxidants

·       Potential nutrient deficiencies if not properly planned (mitigated by adopting a balanced diet such as the “Three Sisters” in Nicoya) ·       Social and cultural barriers to adopting and maintaining a plant-based diet ·       Availability and affordability of fresh produce may vary ·       Need for education and resources to ensure balanced nutrition

 

Social community	1.    Decreased feelings of loneliness and isolation 2.    Improved mental health and reduced risk of depression 3.    Enhanced sense of belonging and support 4.    Increased self- esteem             and confidence 5.    Better            stress management and coping skills 6.    Opportunities for personal growth and development 7.    Improved overall quality of life	·       Potential for conflicts or negative social dynamics within communities (mitigated          by searching               for commonalities in faith or values such as the ‘maois’ of Okinawa and Adventists in Loma Linda) ·       Dependence           on social validation may impact individual autonomy ·       Inclusion/exclusion dynamics may lead to feelings of            isolation for some individuals ·       Time and energy commitments     to maintain social connections
Sense of purpose	1.    Greater resilience to stress and adversity 2.    Improved mental and emotional well- being 3.    Increased motivation 4.    Enhanced self- esteem and self- worth 5.    Better decision- making and goal- setting abilities Stronger        social connections      and community engagement 6.    Improved   physical health	·       Pressure to find or define one’s purpose may cause anxiety or existential distress ·       Not all individuals have equal opportunities                             to pursue their sense of purpose ·       Shifting societal values and norms may challenge or invalidate certain purposes ·       Overemphasis on productivity and achievement        may overshadow other aspects of well-being

 

Conclusion

By delving into the secrets of centenarians around the world, “Live to 100: Secrets of the Blue Zones” not only entertains but also educates, offering valuable lessons on how we can reconsider our approach to aging and inspires to make positive changes using science, lifestyle choices, and cultural factors that influence our ability to live longer, healthier lives.

The interconnectedness of health behaviours underscores the potential for motivation in one aspect to spill over into others.4 This serves as a testament to the importance of viewing health from the biopsychosocial standpoint. Thus, by effectuating semi-permanent and permanent environmental changes inspired by blue zones worldwide, endeavours toward a healthier tomorrow are realized.

References

1            Admin.       (2023).       History       of       blue        zones.        Retrieved   from https://www.bluezones.com/about/history/

2 Hu, F., Shi, X., Wang, H., Nan, N., Wang, K., Wei, S., … Zhao, S. (2021). Is Health Contagious? -based on empirical evidence from China Family Panel Studies’ data. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283520/

3 & 4 Taylor, S. (2017). Health psychology.  New York, NY:  McGraw Hill Higher Education.

(The above article is authored by Mr. Govind S. Kumar, a clinical psychology student at Pimpri Chinchwad University, Pune, India)