Improving health through community policies gains momentum

Improving health through community policies gains momentum

By Paula Hartman-Stein, Ph.D.
August 4, 2021 - Last updated: August 2, 2021

Picture a city where walking and bike paths are abundant, most restaurants offer tasty plant-based options and grocery store displays of candy in the checkout aisle don’t exist.

Residents can join small walking groups, garden in community plots, lunch at potlucks, take cooking classes, meet neighbors at “Wine at 5” events and attend life-purpose discussion groups – all at no cost.

Workplaces provide standing desks, walking breaks, healthy snacks and wellness-supported benefits.

Schools incorporate physical activity before and after classes, have reusable-bottle-friendly water fountains and offer few processed, sugar-filled foods in cafeterias.

In that city, adolescent and adult obesity rates are dropping, smoking rates are less than 10 percent, cardiac mortality is low, economic development is up and people are living longer.

Is this a city of the future?

No, it’s a Blue Zone Project (BZP) community, one of 58 across the United States. Ranging in population from 6,300 in Corry, Pennsylvania, to 874,000 in Fort Worth Texas, these towns are trying to improve citizen health by focusing on systems rather than individuals.

Thirty-two communities have been certified as BZs and 26 are working on certification by Sharecare, an Atlanta- based health and wellness company.

Lex Green, president of the Pisgah Health Foundation, is the driver behind Brevard, North Carolina’s, effort to become the 50th BZ-certified city. He learned about the program from his youngest son, who read Dan Buettner’s book, “The Blue Zones: Lessons for Living Longer From the People Who’ve Lived the Longest,” at summer camp.

“My motivation is to extend life expectancy of individuals in our community, create a healthier city and help people reach out to the future and live their best lives now,” said Green. Altruistic ideals for improving health and longevity are not the only motivation, explained Dr. Allen Weiss, chief medical officer for the BZP.

“Insurance companies benefit. For example, in Iowa, Blue Cross/Blue Shield (BC/BS) had lower rates of sickness in their patients and profit margins increased.”

The 2015 summary of a roundtable on population health improvement found that BC/BS had a health care savings of $5 billion over a 10-year period. Currently, 15 cities in Iowa are BZ certified, more than any other state.

Terri Merritt-Worden, BZP’s vice president of operations, said the initiative does not diminish the role and responsibility of primary care providers or accountable care organizations.

“We lighten their load and provide great value that translates financially to those providing health care and health plan coverage. As we move to value-based reimbursement, we hope the BZ methods will become the way of the future,” she said.

Economic growth also can be a byproduct. According to Green, a developer of a boutique hotel chose Brevard over several other cities because being a BZ can attract more people to the area.

Mark Burrows, senior community program manager for the BZP in Brevard, said his focus is to improve public policies. Some contend a BZP reduces personal freedom, but Burrows said it “lifts people” to help them make healthier lifestyle choices and aligns them with like-minded people.

How the zones began

The Blue Zone concept originated from Buettner, who set out to “reverse engineer longevity,” he said in a 2015 summary of a roundtable discussion on population health improvement.

In association with National Geographic and with funding from the National Institute of Aging, Buettner and a team of demographers identified five areas of the world where people live verifiably longer and healthier lives: Ikaria, Greece; Loma Linda, California; Nicoya, Costa Rica; Okinawa, Japan; and Sardinia, Italy.

Research established that activity, diet and outlook were the underlying foundation for longevity in those cities.

Buettner’s team identified “Power 9” principles – move naturally, downshift from stress, identify purpose in living, eat a primarily plant-based diet, drink alcohol in moderation, stop eating when 80 percent full, focus on positive family relationships, belong to a faith-based community and create social circles of like-minded people who support healthful practices.

The focus of the BZP is to make healthy lifestyle choices easy, Buettner’s brother, Nick, said during a broadcast of Joe Casciani’s “Living to 100 Club” in 2019 on Voice America.

With funding from the American Association of Retired Persons (AARP), Dan Buettner and his team studied the life radius, or the environment where people spend 80 percent of their lives, and investigated how to strategically make that a healthier place. Buettner used Albert Lea, Minnesota, population 17,000, for his pilot site and enlisted 24 percent of the population to participate.

University of Minnesota researchers developed a tool for people to calculate their overall life expectancy as well as 33 additional metrics. The resulting data suggested an average life expectancy gain of 3.2 years, a collective weight loss of more than 7,000 pounds and a 40 percent drop in healthcare costs for city workers.

Following the pilot project, Buettner teamed up with Healthways to create more BZ communities. In 2016, Sharecare became the sole company with exclusive BZ licensing rights, including use of all toolkits, marketing and branding.

According to Chief Medical Officer Weiss, metrics used to assess health outcomes are based partially on statistics from the Boston University Department of Epidemiology and may include data from self-report surveys, the census and walkability scores as well as statistics such as the prevalence of bike lanes and smoking.

Sharecare’s Merritt-Worden said licensing a community typically takes three to five years.

How psychology plays a part

Although psychologists do not currently have a prominent role in the national BZP, psychological principles are behind several Power 9 principles. For example, people living in the five original Blue Zones used daily practices to reduce stress and reverse the cellular inflammation associated with it. To increase social cohesion, the BZP suggests residents create small group meetings called moai, an Okinawan term meaning “meeting for a common purpose.”

Included in the BZP are life-purpose workshops developed by Richard J. Leider, executive coach and author of several books, including his newest, “Who Do You Want To Be When You Grow Old,” written with David Shapiro.

Volunteers and staff lead the workshops, a potential role for retired psychologists looking for a new purpose. In his book, “The Power of Purpose,” Leider noted that studies suggest having a purpose in life protects against cognitive aging.

To learn more about BZP go to


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Paula Hartman-Stein, Ph.D., has a psychology consulting practice specializing in aging. After writing a chapter on what’s preventable in dementia in a forthcoming handbook on prevention of behavioral disorders, she produced a four-part webinar-on-demand series about enhancing brain and heart health. For more info, go to her website,