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This is a nice graphic, and it seems cogent, but can you actually get a community to do it? I took this idea around a few organizations and eventually, the University of Minnesota School of Public Health and AARP decided to partner with me. This was in 2008.
We took this blueprint and we showed it to five cities in Minnesota – cities of about 20,000 people. [Aside: It’s not a silver bullet. I call it a silver buckshot, an evidence-based device.] We offered them to send us a proposal, an RFP. We went back to our offices and hoped that somebody would respond. All five of them sent proposals, thick as a phone book.
Essentially, we wanted cities that were ready, cities that would embrace this idea of changing environment. Believe it or not, Americans know they’re unhealthy, they know they’re overweight. If you bring them something that is doable and you can show them the way, you’ll be shocked how people come aboard.
The city that was most ready – the mayor, the city manager, the head of public health, the superintendent of schools, the head of chamber of commerce, the big CEOs – all signed this huge pledge. Dan, we get it. We want the Blue Zones community project. We’ll stand behind you. I wasn’t asking for money, but I was asking for action to orchestrate a perfect storm.
Albert Lea, Minnesota. Ninety miles south of Minneapolis, about 20,000 people (19,100 actually). We first came in and I brought my team – I call them my Blue Zones SWAT team – and we didn’t pontificate. We came in and we listened. We had a quiver of about 60 evidence-based ways we could change people’s environment.
We knew they wouldn’t all work. We knew some were too expensive. We knew some were already in place but we listened and then we went to work. We brought in Dan Burden. I call him the Mozart meets Albert Einstein of city planning. This guy’s a master.
They wanted to widen their main street. We said, “You don’t want to do that.” They thought they’d get more lifeblood from Minneapolis. Raise the speed limit to 50 mph, widen those streets. Right now the main street of Albert Lea looks like Mayberry – outdoor cafes, parents let kids walk downtown. If you raise the speed limit to 50 mph, parents don’t want their kids walking down there. This great meeting area gets ripped in half.
We said, “Let’s shelve that project for a while, and let’s think of some other ways to spend that money.” We worked with the city managers to make sure that there was one vector from each of the four neighborhoods to get downtown without having to cut through traffic or through a field. This occasion just building about 2 1/2 miles of sidewalks. There was a beautiful lake right on the edge of town – a lot like Lake of the Isles – but you couldn’t get around it. We took some of that street-widening money, and we built a trail around the lake.
Now, go to Albert Lea any given morning, as long as it’s above 20 below, you’ll see people rollerblading, biking, and pushing their kids in a stroller. That’s free! And you don’t have to pester people to do it – the active option, the easy option.
Taking a page from Blue Zones, we put in four public gardens. There’s nothing like gardens. You plant them in the spring, and for four months you’re nudged into weeding, watering, and harvesting. Plus, you meet your neighbor.
We brought Dr. Brian Wansink in from the Cornell Food Lab, who’s a master at creating food environments. We had him work with about 50% of Albert Lea’s restaurants to set up nudges and defaults. It makes a huge difference when you go into a restaurant, if they automatically serve you bread or if you have to ask for it. Do they automatically give you water, or do you have to ask for it? When you order your sandwich, do you automatically get fries or do you get a salad? We eat out 110 times a year. Those little defaults add up hugely.
Do you know the one adjective that assures most people won’t order an entrée? Label it the “healthy choice.” Nobody wants the damn healthy choice? They want something good! So, Italian, spring, or crispy or some nice adjective will get people to order it more.
We got most of the grocery stores to tag longevity foods. We even got them to create a checkout aisle so all the impulse buys were healthy buys. We instituted nine policies in schools, so our kids would grow up healthy. We wouldn’t even touch the 900-pound gorilla, which is school lunches.
One policy makes the biggest difference. Can your kids eat in hallways and classrooms? If you forbid that, that is associated with about 11% drop in BMI. And do you know how much that costs? Zero. You just cut out 8 hours of junk food eating from the kid’s daily life.
We went into most workplaces and had them sign a simple pledge. Once we had most of the rest of the environment optimized, we invited the whole community to optimize their individual environments. We had them take the Blue Zones pledge, which gave them 25 ways to optimize their home, their social network, their yards. We took it very seriously. We brought the top experts from the country in. If you want to do this, take it seriously. If it’s not right for you, we invite you to slip out. There’s no pressure.
We had them use our vitality compass. It’s a risk-assessment tool that also tells people their life expectancy and their biological age. That also gave us a baseline on 33 health behaviors, and we had them do semi-permanent things like dig a garden in their back yard. Let our experts come in and do 10 tweaks to your kitchen, so you consume 50 to 100 fewer calories a day.
And then we also went to people’s yards and de-convenienced their homes so they’d burn up to 100 extra calories a day. We got about a quarter of the population to agree to be clustered into groups of 5 We took people who are ready to change their health behaviors Although it looked like a walking club, it wasn’t a walking club The idea was to get people off their bar stools and fast food places and connect with other people who wanted to change their health behaviors and create long-term friendships. Three years later most of these “moais” as we call them are still together.
We worked with Richard Leider, a local purpose expert, to give everybody who wanted to in the town this internal inventory, which helped you identify your values, your strengths, your talents, what you like to do. Then quickly connected them with volunteer organizations. We generated tens of thousands of volunteer hours in that town. Again, it’s free! It’s just unleashing internal will.
USA Today followed us. Good Morning America, ABC Nightly News. Harvard School of Public Health Dean, Walter Willett, sent a team into Albert Lea and found our results stunning. At the end of the day, a year later, the things that we instituted were still in place, reported in US News & World Report.
All told, we were able to lower the average person’s weight by about 3 pounds, raise their life expectancy by over 3 pounds [sic], get reported higher levels of well-being. There’s about an 80% overlap between this talk and my last one, “Happiness and Longevity.”
And then the most important one. We had a 40% drop in city workers’ health care costs in over about an 18-month period. Based on that success, we’ve now been hired by Los Angeles, one of the beach cities down there. And the entire state of Iowa, announced by the governor. It’s going to be the next Blue Zone. So the idea is taking on fantastically.
I think the reason why is because other things have not worked so well. I don’t have to tell this audience that we have a huge health care problem in this country. 68% of us are overweight or obese and that number is expected to climb to the lower 80s within the next decade.
Diabetes is on the rise, the age-adjusted rates of cancer haven’t done much in the last 10 years. For the first time in living history, our children are supposed to live shorter lives than us. Is that because we’re stupid? Or, we’ve undergone some degeneration in our moral character? Or we’re less disciplined or love our children less than our grandparents did or our parents did? No!
Since 1970, our environment has changed to an environment of abundance and ease. Raise your hand if you walked to school when you were a kid. Almost every hand is up. Now, raise your hand if your children walk to school. Four hands.
In 1970, 50% of American kids walked to school. We’re down to about 10% right now. We’ve just engineered 3 to 5 miles of exercise out of our kids’ weekly lives. And that exercise costs 0.
You cannot get cough medicine at a pharmacy, rent a DVD, or fill up your tank with gas without being routed through a gauntlet of salty snacks or sweetened beverages. We might all like to think we’re disciplined creatures, but discipline is a muscle that fatigues. You cannot bombard a population with all sorts of enticements and say no constantly – or to expect them to say yes to positive messages.
Every single day, 275 messages rinse over our psyche. Most of them are telling us to buy things we don’t need and to eat food that isn’t all that good for us. There’s no profit in broccoli. There’s very little profit in whole grain rice. The foods that make money are the processed foods, which on a whole are not all that good for us.
The secret to the $2 trillion annual health care problem in America is not a silver bullet. If somebody tells you they have a silver bullet, they’re reaching their hand in your pocket and looking for money. The secret is silver buckshot. It’s identifying evidence-based ways to change people’s environment for the long term, unleashing those, and doing it one ready community at a time.
