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I’m going to take a few minutes here to talk about the best practices in health and longevity from around the world. This is the Rosetta Stone: How do you actually apply them to populations?
For about six years, I worked with National Geographic to find the parts of the world that lived measurably longer, and tried to distill some of their secrets down. They’re distilled both in a magazine article and the book, Blue Zones.
The idea was to work with demographers to find areas where there are populations – not just a few individuals, not just a few villages – but tens of thousands of people living in an area where people are living measurably longer than the rest of us. Either higher life expectancy, more centenarians per thousand, or something called the lowest rate of middle age mortality.
Then, once we found those places, I worked with a team of experts to distill down what they do. We found that no matter where we went – whether it was Okinawa, Japan, Sardinia, Italy, Costa Rica (the Nicoya Peninsula), or among the Seventh Day Adventists here in the United States – we saw the same nine things happening over and over again.
Some of those nine things were very intuitive. Eating a plant-based diet, not a lot of meat, lots of beans. Nuts seem to be very highly correlated with longevity. The ever-popular directive to drink. We know that people who drink a couple glasses of wine a day live longer than people who don’t. And, no you can’t save up all week long and have 14 on the weekend. People actually ask me that.
Most of the truly interesting finds were counterintuitive. Isolation knocks about eight years off your life expectancy. It’s as bad as a smoking habit. And one out of seven Americans are isolated and alone in this world. Belonging to a faith-based community – and actually showing up – is worth four to 14 years of life expectancy.
Having a strong sense of purpose. You know the two most dangerous years of your life? One is the year that you’re born. Because of infant mortality, you can’t do much about that. The other is the year you retire – three-fold spike in mortality that year. Is that because of the wild retirement party? No, I think you lose that impetus to get out of bed in the morning and that engagement with the world we call work, get out of the easy chair, take your medicine, stay fit, keep your mind mentally engaged.
The best science tells us the capacity of the human machine, my body, your bodies, is somewhere between 90 and 92. But life expectancy in this country is 79. Somewhere along the way we’re leaving about a dozen years on the table.
At least with the experience of Blue Zones, they’d probably be good years. The average American has three years of something called morbidity. We’ll spend about 95% of our lifelong health care dollars. Blue Zones have less than a year. So people who live a long time also have tended to live better throughout their lives. They die quickly – occasionally, in their sleep, and they tend to leave more left over for their descendants.
As you know – you guys work in the health care industry – you can tell people all day long what they ought to do to be healthier, to avoid heart disease, to avoid cancer, etc. But how do actually get people to do it?
Right now, we spend a lot of money on health care in this country. Between heart disease, cancer, and diabetes – these are mostly preventable diseases – we spend almost a trillion dollars. We spend that trillion dollars, I argue, pointing at the wrong target.
When you look at what really determines, what influences how long and how well we live free of diseases, about 80% of it is lifestyle and environment, 10% of it is genes, and 10% of it is how good our health care is after we got sick.
But how do we spend that trillion dollars? We only spend 4% of it on prevention, on making sure we don’t get those diseases. We spend some on research. A giant 88% is spent on trying to fix the problem after it’s already happened. Of the hundred billion or so we spend every year to try to prevent diseases, I argue, once again, we aim at the wrong target. We spend about $60 billion a year on diets, $28 billion a year on supplements, and $20 billion a year on health clubs.
They’re good ideas. Don’t get me wrong. The problem is, they don’t work. If you look at the recidivism curves of each of these strategies to prevent disease, you see that although you can get a lot of people to sign up (you can get 100 people to sign up for a diet today), within seven to nine months, you’ll lose 90% of them, and within two years, you’ll lose at least 95% of them.
I defy anybody in this audience to tell me about one diet that works for more than 5% of the people who get on it for more than two years. No matter how good the diet is, it’s going to work for just a tiny fraction. The same is true of most exercise programs and gym memberships. If you look at gym membership data, it’s the same thing. You start with a 100 today, in three years, you have about 10% left. Trying to spend a lot of money on gym memberships probably doesn’t make sense.
The average American burns fewer – and this is going to shock you – than 100 calories a day engaged in exercise. Against the 4,000 or so calories we eat every day, it’s nothing. It’s a candle against a Super Nova of a problem. Exercise as a public health initiative just doesn’t work.
The same thing with medicines and neutraceuticals. Even if we could come up with a longevity pill, you can’t get people to take it for long enough. Within six months, 70 or so percent of people who start taking a medicine are no longer on it.
Think about supplements in your own medicine cabinet. What pill, what vitamin, what supplement are you taking today that you were taking five years ago? There’s all kinds of good arguments for Omega 3 fatty acids and fish oils, but the problem is, we can’t get people to take them.
If this doesn’t work, what does work? About four years ago, I went back to National Geographic Council. I proposed a research program that would go out into the world and find community programs that started with unhealthy people and actually made them healthier and maintained it over time.
God bless that yellow rectangular little heart of theirs. They funded me. I did a worldwide search. I found two remarkable things. Number 1: It has never worked in America. We have spent tens of millions of dollars with heart-healthy programs, walking programs, and eat-your-veggies programs. But uniformly – and this is sort of the health equipment of the Hawthorne effect – as long as they’re under the gaze of the researchers, people will do what is asked of them. Uniformly, when the researchers pull out, people revert back to the exact same thing they were doing before.
I found two places in the world that have started with really unhealthy people. One focused on childhood obesity, and the other one focused on heart disease. The place that focused on heart disease brought down the rate of heart disease by 90% and maintained it for more than a decade. The place that focused on childhood obesity was in northern France, brought down the rate of childhood obesity and maintained it for eight years.
I got to spend time with each of these programs. I looked for what are they doing differently. What is working with them? I boiled it down to a central tenet, and that tenet was: They do not count on individual responsibility. They don’t tell you: It’s up to you to eat healthy and get your exercise. They essentially recognize that we’re all part of a system, and if you don’t change the entire system, you’re not going to have any long-term, measurable impact on health.
To put in very simple terms, I’ll ask you to think about that old experiment from high school, where if you throw a frog in really hot water, what did it do? That’s right! It leaps up. If you throw a frog in just lukewarm water, it’ll get comfy. And you can raise the temperature one degree at a time. It’ll get complacent and eventually, you can boil it to death. It won’t jump out.
When it comes to health in this country, the problem is not the frog. The frog does what its biology tells it to do. We are evolutionarily hard-wired to crave fat, to crave sugar, and to seek rest whenever we can. In fact, we are successful as a species because of that feast and famine gene. 99.9% of our history we had to forage and rest when we can.
The opportunity is not the frog; it’s the water. We now live in an environment of ease and abundance, and that’s the wrong kind of water for the frog today. How do you change the water? How do you change the system?
With that grant money, I hired the best people in the country, and in one case, the world, who could help me think about how you optimize people’s environment. Our first step was to define what is environment? Is it trees? How do you define environment?
It turns out that we spend about 80% of our lives within about 20 miles of our homes and workplaces. I call this the life radius. It turns out there are a number of things that influence that life radius. The first one is policy. Do I live in a place where it’s easy to smoke? Or is smoking de-normalized? Do we freely market junk food to children or do we have to subdue junk food marketing? Are fast food and sweetened sugared drinks inexpensive or are they a little bit more expensive? Do child-care facilities let children watch TV? On our licenses, is there an opt-in or an opt-out policy on organ donations? When it comes to food labeling, can I clearly see how many calories and how much fat I’m getting when I order food? All of that makes a measurable and long-term difference.
Built environment: None of the world’s longest-lived people ever ran marathons or triathlons, but what they did is live in an environment that nudged them into physical activity.
Robert Wood Johnson Foundation found that if you live in a city or a community where the active option is the easy option, you raise the activity level by 30 to 40%. No expensive gym memberships, no yoga classes, no ab master. You just make it so it’s easy for people to walk to the store, walk to the grocery store, walk to the place of worship. Parks are cleaned up, so you actually want to let your kids go there.
Do you know the biggest deterrent to people over 60 to go out and get physical activity? Perceived safety – not even real safety. All you have to do is do things like clean up graffiti or put security cams in the right place, and you’ll get more people going out and getting physical activity. So, optimizing that built environment.
Third is the social environment. If your three best friends are obese, there’s a 150% chance you’ll be overweight. If your friends are unhappy, lonely, smoke, and do drugs, you’re more likely to have those same characteristics. Thinking about how you can first help people identify who their social network is, and then expand it in the right direction.
Another huge opportunity? The designs of churches, schools, workplaces, even your home. There’s over 50 design tweaks you can do to the structure in which we spend our daily lives that nudges into more physical activity, fewer calories, better calories, and more social interaction – all of which are predictive of better health outcomes.
And finally, purpose. I’m sure this audience is self-actualized and we’re all have a job that is speaking to our talents. But you’d be surprised how many middle Americans – I have the advantage now that I’m working with in LA and the whole state of Iowa – how many people wake up in the morning, go home, make dinner for their kids, and then they’re exhausted and they turn on the TV. So few people have that clearly defined sense of purpose like you see in Okinawa or in Costa Rica.
How do you help imbue a community with a sense of purpose? And, really, the end result or outcome you want? You want to get people to volunteer, lower BMI, lower rates of heart disease, and lower health care costs. Purpose, and move that to volunteering.
