Why Some People Live to Be 100 (with Dan Buettner)

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Author Dan Buettner has spent his career traveling to places where people have lived the longest, healthiest, and happiest lives. He found that much of what we think drives health and happiness is misguided or just plain wrong. This week, Dan shares the secrets to longevity and steps you can take to stack your deck in favor of happiness. Good news: you don’t have to put down your glass of wine or join a gym.

Follow Dan @thedanbuettner and @bluezones on Twitter.

Keep up with Andy on Post and Twitter @ASlavitt.

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Dan Buettner, Andy Slavitt

Andy Slavitt  00:52

This is IN THE BUBBLE with Andy Slavitt. Welcome to the show. Thanks for all your emails and staying in touch. andy@lemonadamedia.com is how you can reach me. So yesterday there was a big announcement at the White House. I’m not sure if you caught it. But it featured President Biden talking about the drug price negotiations. For the first time. We’ve now named 10 drugs that are due to be negotiated between the government and the pharma company. And look, if you’re someone like me, who’s been watching this for a couple of decades, this is something that has been a major battle of whether this could and would eventually ever happen between the pharmaceutical industry and people who think that we should have lower prescription drug costs, big debates, big fighting hundreds of millions of dollars spent sometimes in a single year by the pharmaceutical industry lobbyists. And you may recall if you listen to it on July 12, we had on our show Mina Sesha. Mani, who is the woman who is leading the negotiation, she is setting the course in go back and listen to it in the context of yesterday’s announcement from the President. But we’re on our way, today will be the seventh. I’ve counted now of our eight shows this summer on health and health care. We have been bringing to you we have really featured some really important shows including The first podcast from the new CDC director Mandy Cohen. This episode on drug costs as I talked about a couple of episodes on new boosters coming some updates on the COVID wave. Zeke Emanuel was on to talk about how the healthcare system is changing and will change in the future. And Monday’s episode was on some very specific proposed changes to the healthcare system. And we’ve also had plenty of non healthcare shows this summer. But I think all of them in some way, impact our well being probably the most notable show was the one we did with Congressman Adam Smith, on his battle with debilitating anxiety that he’s been going on for about 20 years. That’s, by the way, our June 14 show if you want to hear it, there’s probably no more bubbly episode than the one with Adam Smith, because we really kind of get to explore someone’s interior life who’s a very well known prominent person and discuss things that I think almost everybody can relate to. And if you know someone who’s struggling with any kind of mental health issue, or if you know anybody you want to introduce to this show, that’s probably the episode I would send them. Also episodes on climate on the border on affordable housing. One with Samantha B where we talked about just about everything. One on crypto and all the Hollywood stars that have been hogging crypto, and the debt ceiling, one with neither does the President’s closest adviser and one on Trump’s attacks in the Justice Department a pretty good slate this summer. So I’d ask you to leave a review on Apple. Also make sure you let me know and email me which of those shows you want to see more of that would be interesting to you. Today’s show is with Dan Buettner. And Dan has been studying an element of health that is very different even from what we’ve talked been talking about so far. It’s not a conversation about our healthcare system. It’s not a conversation about a threat like COVID, or Alzheimer’s. It’s not about policy. Put all that aside what Dan Buettner began doing a couple of decades ago, it’s asking you a very simple question. Where on the globe do people live the longest, and why? What habits cause people to stay healthy, and active into their 90s, and one hundreds. He’s written for best sellers on the topic, all around the theme of Blue Zones, including a cookbook on Blue Zones. And he has a new Netflix show that it’s out now. As well as an organization that works with communities to help them get healthier, a lot and I had a friend who lived to 113, she passed away last year in Minnesota, but led the most vibrant life of many of our friends, and a healthy one well into past 110. So I’m fascinated by this topic. And I want to know what we can learn from it. And look, whatever your health status, whether you’re bothered by something chronic, something that disadvantages you, or causes you pain of any kind, mental, physical or emotional, I want you to be able to get the most out of life. And I think this episode really allows us to think in those terms. So hope you’ll be inspired. By listening to the stories of what happens in those rare communities where health prevails. Couple hands, it’s becoming harder to do with technology and all the trappings of modern society. And you can’t do it alone. It takes all of us together to create something healthy. I know, Dan, you’ll you’ll be able to tell as we get into this, that we’ve had some interesting interactions before. I think you’re going to enjoy this and hopefully get a lot out of it. Let’s bring him in.

Andy Slavitt  07:19

Welcome to the to the bubble. By the way.

Dan Buettner  07:22

It’s good to be in the bubble.

Andy Slavitt  07:24

That we got the bubble, we’ll talk about this. We were just before we were setting our mics up, we were having an interesting chat and maybe a good place to begin, which is that you know so many of us who get to, you know, I’m 56 He spent a lot of our lives asking a lot of questions. How do I become successful? How do I have a family? How do I make ends meet? How do I do this or that? And it’s only for many of us, you don’t actually ever ask the question? What can I do to be happy? And that’s a harder question.

Dan Buettner  07:59

Yeah, EB White once wrote that when you wake up, trying to find the right mix between saving the world and savoring, it’s hard to plan your day. And I think especially if you reach a certain age, finding that sweet spot is ever more important. Of course, you want to be relevant, and you want to be productive, and you want to feel like you’re useful. But on the other hand, there’s so many other dimensions that make up a good life that we often overlook in our pursuit for success. And I’ve been very interested in that lately. Mostly a personal quest.

Andy Slavitt  08:31

Will you someone who thought about your own happiness and well being? Or were you like the rest of us and you you kind of thought about it, but not, you know, as a major, major focus?

Dan Buettner  08:43

I thought about it more than most people I spent about 10 years studying the statistical underpinnings of happiness. So not anecdotal or not positive psychology, I worked with worldwide surveying organizations, mostly the world poll, I wrote a cover story for National Geographic and two books on happiness and, and much of what we think drives happiness is misguided or just plain wrong. And I was interested in, you know, what exactly can we do to stack the deck in favor of happiness?

Andy Slavitt  09:18

Now, you’ve written a lot about it, I want to get into the blue zones, maybe as the right entry point to come back to the conversation about the importance of communities and kind of what surrounds you and your relationships with others in those communities and those habits that get formed by by building the right community. How much of that really is the key? Because, you know, we tend to think about the unit of measurement as ourselves. And as I’ve read things you’ve written over the years, you’ve kind of been saying a whole lot about what surrounds us. That’s really, really important.

Dan Buettner  09:58

Yes, so kind of spoiler alert here, I’m jumping right to the bottom line, I spent 20 years identifying and studying these populations that live statistically longer. And found that, you know, most of what we do behavior modification diets, exercise programs, getting the right health plan, taking the right supplement counts very little in the overall picture of our health and indeed, happiness in places where people are actually achieving disease free, long life expectancy, in other words, making it into their 90s, and hundreds without type two diabetes, heart disease, dementia are much lower levels. It’s never because they try. They’re never pursuing health, it ensues. And it ensues from a part of, you know, what you say the right community, it’s hard to define exactly community. But I argue more, it ensues from the right environment, your food environment, your built environment, your social environment. And if we really want to bend the curve on obesity and chronic disease in this country and start to tackle the $4 trillion problem we have every year, we have to shift the focus from trying to change people’s behaviors, trying to spend the money, it’s mopping up the problem after it happens, and get out in front of it by optimizing the environments, the ecosystems we live in. And that’s mostly what I’ve been studying the past 20 years.

Andy Slavitt  11:28

And for those who aren’t familiar with your work, and I think everybody, by now knows the concept of Blue Zones, but you know, I’ve explained it better for us, you know, you identified five and subsequently a six community where people live, disease free or relatively disease free, oftentimes 200 or more, but into their 90s. And I’m going to mention the places so you don’t have to, and but I would love you to pick on a couple of those places that that you could really express it illustrate what you’re talking about. So the places are Sardinia, Italy, Nicoya, Costa Rica, Loma Linda, California, which was a real surprise to me, not very far away. But an interesting one, Okinawa, Japan, Korea, Greece. And then the sixth is Singapore, which you call Blue Zone to point out, we’ll get to that later. So tell us what these places have in common and maybe illustrate what you’ve learned.

Dan Buettner  12:30

Well, we started first, working with demographers to confirm agents that a lot of places we’ve thought were long lived had been debunked places like the Vilcabamba Valley or the caucuses, and former Soviet Union. So we know for sure that these people have achieved the outcomes we want, which is living to the capacity of the human machine. So if we do everything, right, the average maximum life expectancy for the human species is to at this current state of sciences, probably 94. But in America, life expectancy is 78, or 79. So we’re losing about 15 good years of life. And so most of my pursuit is, is what they’ve done. So once you’ve identified the five places, I recruited a team of basically medical advisors to help me deploy scientific processes to find the correlations or to put in easier terms that common denominators, that’s the best we can do to kind of tease out the features or the characteristics of longevity. So to get at the diet, you know, you can’t just ask 100 year old what they’ve been eating, because people don’t remember, Andy, if I asked you what you ate for lunch a week ago, Tuesday, you probably couldn’t tell me. So you can’t really ask 100 year old What are you been eating over the course of your lifetime. And to get it that we found 155 dietary surveys done in all five Blue Zones over the past 80 years, they only go back about 80 years. And then with Harvard did a meta analysis. And we found that the diets that actually drive longevity are composed 90 to 98% whole plant based food. The five pillars of every longevity diet in the world are whole grains, believe it or not, corn, wheat and rice, greens, probably at varieties, tubers, like sweet potatoes, knots, and then the cornerstone of every longevity diet in the world is beans. And if you’re eating a cup of beans, there’s good evidence that shows that that’s probably adding about four years to your life expectancy, over eating less healthy protein sources of protein. And, of course they all eat seasonal fruits and vegetables. But notably they Much less meat than we do. The average American eats about 220 pounds of meat a year. And in Blue Zones, it’s closer to 20 pounds. So about 1/11 as much meat five times a month, very little seafood, which surprises people when you talk about Sardinia and Okinawa and so forth. No cows dairy. Until very recently, cows, dairy was largely unknown in the blue zones. And when you look at what they’re drinking, they’re drinking mostly water. Teas of all varieties, coffee, good news. For most of us, it’s probably the number one source of antioxidants in the American diet. And then as he takes a sip of coffee,

Andy Slavitt  15:41

Good reminder,

Dan Buettner  15:42

And then wine, and, you know, I know there’s lots of new studies, maligning alcohol and pointing out, but I could tell you beyond a shadow of a doubt that these blue zones are full of 90 and 100 year olds, who are drinking wine every day of their adult life and much of their, you know, even adolescent life, and they’re still making it into their ninth and 10th and even 11th decade, fully functional, full of vitality, mentally sharp.

Andy Slavitt  16:10

let me ask you about the about the wine not not that I’m overly focused on that. But do we do we think it’s because of the health properties of the wine? Or do we think that there’s something else going on relative to stress relief or relaxation, or the social elements? Do you have a perspective on that?

Dan Buettner  16:32

You bring up a good point, because people aren’t sitting alone in their house and drinking to their favorite TV show. Wine is almost always a social activity. So it may be that wine and social connections are going together. Also, there’s some pretty good evidence that drinking red wine with a plant base or Blue Zone diet, your your bulk, quadruple the the antioxidant absorption, then you would get from just drinking water, or could be the alcohol lowers cortisol, which is primary stress inducing compound, we don’t know for sure. But all this recent research hasn’t convinced me at all, to not enjoy my class or to have red wine every night.

Andy Slavitt  17:19

So amazing, you did a lot of work to find these commonalities, which I think you just laid down for us. And at least on the diet side, you also visited these communities. And he’s got a wonderful book, which I really enjoyed, that has just breathtaking photographs of these communities, and the people in Blue Zone secrets for living longer. What else did you observe by being there by talking to people that were some of the intangibles besides just the diet components? And how important are they relative to the diet components?

Dan Buettner  17:55

Okay, so I would say diets 50%. Overall, but there’s it’s more nuanced and complex than just that. So you know, I work for National Geographic, I write for them. And, you know, they don’t let you write anything that’s not underpinned with evidence or, or, you know, at least a recognized expert opinion. And my approach is not to go to Blue Zones and interview a bunch of people and draw conclusions. I aggregated the available academic research to find sort of the profile of longevity or to put another way, the ingredients to the recipe for living a long life. And, again, it’s not at all what you think they’re not on diets, they’re not, you know, doing CrossFit or yoga or running marathons or?

Andy Slavitt  18:47

But they’re all at Orangetheory. Right?

Dan Buettner  18:50

Very funny. You know, they don’t exercise in the way we exercise, which is a big epiphany to me, you don’t see any of them exercising. If you ask them how many hours a day they spend exercising, they’ll tell you zero, yet to get more physical activity than us. How do they do that? Well, every time they go to work, or a friend’s house or out to eat and occasions to walk, they have gardens Outback gardens are big parts of their culture, far more powerful than we think it’s not only a source of fresh fruits and vegetables. But every day they’re out there in their 80s 90s 100 doing low intensity physical activity range of motion, keeping their lower body strong, and they’re balanced up so they’re not falling down and breaking their hips at rates anywhere near the rates we have in the United States. They’re out there about an hour a day. And their houses aren’t full of the mechanical conveniences where we use to eat that engineers natural physical activity out of our lives. They’re still doing yard work by hand and, and housework by hand and kneading bread and grinding corn with a crank and we fail to recognize it Are they very significant caloric burn the sum of all these small, physical tasks, but more important, the fact that it keeps your metabolism operated at a much higher rate throughout the day, we evolved to be in constant motion. We didn’t evolve to, you know, be weekend warriors and try to make up for intense exercise. After hours and hours of sedentary life and in Blue Zone. On my team fingers, they were nudged into movement every 20 minutes or so. And that seems to be ideal for humans.

Andy Slavitt  20:34

Alright, so we’ve talked about diet. We’ve talked about movement and physical exercise. Let’s take a break and I want to come back. And I really want to ask you about Loma Linda, California, because it’s right here in the US. What’s different about Loma Linda, and I want to talk about the role that we all play in our social lives and social support system. In health and longevity, we’ll be right back. What about the social emotional components? I’m keeping this sort of rough formula in my head that 50% is kind of what we put in our bodies. It sounds like there’s a big portion of this, which is leading a non sedentary life carrying things walking, being physical, did you find and then maybe this is harder to study. But did you find that there were elements of friendship socialization, or other things that were influencers here as well?

Dan Buettner  24:46

So the one thing you have to remember when it comes to longevity, there’s no short term fix. There’s nothing you can do today or this month. That’s going to help you live longer and 50 years you have to think of terms of things you’re going to do You for years or decades or a lifetime. So a useful metaphor here we draw from the Blue Zones is to imagine a mutually supporting web of factors. And that’s just for the fun of it. Let’s put diet in the middle of this web. And around this web, you also have purpose, their lives are underpinned with purpose. They surround themselves with a social circle that helps them move naturally and eat this sort of whole food plant based diet. And they and they live in places where the healthy choice is not only the easy choice, you know, the Affer mentioned foods are the most available, there’s the cheapest, and they know how to make them taste the most delicious, that it’s the default. So you have this mutually supporting cluster of factors that help people do the right things, and avoid the wrong things for long enough. So they’re not developing type two diabetes or cardiovascular disease or dementia, all of which are largely avoidable.

Andy Slavitt  26:08

Let’s sewn in on Loma Linda, if you would, because I think what’s useful about it is without Loma Linda, you know, I can imagine people coming to your work and saying, okay, great, but these are idealized communities far away. They’re lower technology, they’re more social fabric, they don’t have all the distractions that we have in the US. We can’t do that here in the US quite as easily. And maybe that’s the case. Maybe that’s not the case. But Loma Linda is a very interesting example. Maybe you can explain, Well, what this community is and what makes it tick and what what we can learn from it.

Dan Buettner  26:47

First of all, let me just point out in the blue zone of Sardinia, which is in the highlands, you can see the coast and the highlands of Sardinia, they produce 11 times more male centenarian than anyplace than the United States, for example, yet where you can see on the coast of Sardinia, their life expectancy is no greater than the rest of Italy. Similarly, in Korea, Greece, you can stand on the shore, look across the Aegean Sea and within eyesight, you can see some most samosa doesn’t experience. So, you know, to the outside world, they’re the same culture in the same idealized you know, faraway spot, but no, there’s special things going on. Part of it is they these blue zones have been somewhat remote. So the corrosive impacts of the standard American diet and the American way of, of using gadgets and electronics to do our work for us have not invaded these places as much similarly, the Adventist you know, they celebrate their Sabbath on Saturday from Friday night until Saturday night. And they’re pretty, they’re pretty strict about that their their kids are aren’t going to dances and on Friday night, they’re not playing football on Saturday morning. So what you have is a culture slightly apart. And that’s kind of kept, I think some of the corrosive trends at bay. But adventus also take their diet directly from the Bible. Genesis chapter one verses 26 through 28 Every plant that bears seed, every tree that bears fruit, and green plants, this is right in the Bible, or the Old Testament and they actually follow that so the most of them are plant based eaters. And also Loma Linda University is one of the top academic centers in the country and they expend their you know, a lot of resource a lot of church resources by the way on studying and promoting eating plant based eating the Adventist Health System run 25 hospitals on the West Coast it’s a value driven health care system that has very good outcomes compared to other hospitals in America. So yeah, I guess they’re outliers but they achieve extraordinary longevity by the same means that people in in places like […] and Okinawa do.

Andy Slavitt  29:15

it gets you’re getting to what am I? Principal questions Dan, which is for all the positive things that they do in these communities. It also sounds like a lot of their success comes from keeping stuff out. And you know, as you pointed out, keeping out things like the the technology that allows us to be more dormant keeping out things like the car, which we were we you know, we drive for blocks instead of walk, keeping out things like more processed foods, etc, etc. all the modern conveniences is is really difficult in a modern society. And when I look at these communities and I listened to you, I wonder how much is it sort of through this stroke of kind of either the geography where they live, or their religious beliefs or some other reason, they just kept all this other stuff out. And it’s actually that stuff that’s leading to more chronic disease and shorter lifespan.

Dan Buettner  30:26

What? Yes, that’s true. But keep it we have plenty of tools in our communities to keep that stuff out if we want. Since 2009, I’ve run the Blue Zones, LLC. We’ve now worked in 72 American cities to bring the insights from Blue Zones into well, American cities and we have in every case, improve the health outcomes or improve the health of these communities as measured by Gallup and cities have the power to keep junk food at bay by a limited the number of licenses they give to new, you know, McDonald’s and KFC as they have the power to curb the usage by ordinances that prohibit drive throughs at fast food restaurants that limiting the size of signs at limiting billboard advertising. But by the way, Billboard advertises as when you have two identical neighborhoods, and one neighborhood allows billboard signs that neighborhood has a BMI of about 10% higher than the same neighborhood that that forbids them body mass index, yeah, body mass index or obesity rate. So what I’ve tried to do is aggregate all the things that help keep the unhealthy influences at bay. And I show up not wagging my finger and telling cities what to do. But I take them through a consensus process where each of these policies are assessed for one effectiveness in their community. I don’t tell them. But number two feasibility, is there a political possibility of getting this passed in five years, and then my team once the the bundle of policies are selected, we can help get them past and in most cases, the objective of this policy is to you know, keep the unhealthy thing at bay, or else make the healthy thing more salient, cheaper, more accessible, more attractive. And I’ll tell you in America, we’re not going to get any healthier by not trying some new things. If you look at the trends, and Andy, you’re on top of these obesity, overweight, we’re now at about 73% of people who are obese or overweight and diabetes, type two diabetes is on the rise, the chronic diseases on the rise, what we’re doing ain’t working. And and I make the argument that well wait a minute here we have populations of human beings with the same biology and genetic diversity that we have in Asia, Europe, Latin America, and even in the United States. Why aren’t we Why aren’t policymakers paying attention to what is working in these policies and putting it to work in our communities? And we overlooked out in this sort of pharmaceutical lurch, or biohacking or, you know, better health care plan, where there are much more cost effective ways to produce a healthier country.

Andy Slavitt  33:32

The fact that there’s only six Blue Zone communities. Should that create cause for pessimism?

Dan Buettner  33:38

No, but wait. I BlueZone is a construct I created and I just tried to highlight the pinnacle because it makes for an interesting story. You know, certainly as part of Italy, Italy’s life expectancy is five years greater than that of the United States. Nicoya Costa Rica, Costa Rica spends 115, the amount we do on health care, and they have half the rate of middle aged cardiovascular mortality, about a 2.5 times better chance of reaching a healthy age 90. Blue Zones are just the best example of a lot of better examples around the world. You started talking about Singapore, Singapore I call Blue Zone 2.0. It’s not like the other five blue zones. 1965 Singapore was a fishing village. The end of the Malay Peninsula had a life expectancy of about 25 fewer years than they have today. It is a melting pot. Almost as diverse as United States. It’s mostly Indian, the Malay Muslims and to Chinese. Lee Kuan Yew, the prime minister there and his ministers. Many of his ministers come from places like MIT and Harvard, they’re paid well. They went about to methodically create an invite They’re meant, where human beings can thrive. And today they enjoy the longest health adjusted life expectancy in the world. So they’re getting about a dozen more years in full health than we do in America. And it’s not some idealized, you know, Mediterranean island. This is one of the most successful economies in the world, on top of technology, and we ought to be paying attention what to what they do, instead of thinking, Well, if it isn’t made in America doesn’t work.

Andy Slavitt  35:32

It’s an amazing story. And that is an optimistic story. What are some of the most important things that they did in Singapore?

Dan Buettner  35:39

First of all, they made car driving very expensive. If you want to buy a car, it’s two or three times as expensive as the same automobile. In the United States. Gas is not subsidized. Like it is here in the United States. If you want to drive downtown, there’s heavy tolls. But what that does is okay, 90%, of Singaporeans don’t have a car or 89%. But within a few 100 yards of every home, there’s a fast, clean and efficient subway system goes very quickly. And that’s been paid for by you know, gasoline and car tax dollars. So instead of people sitting behind their car wheel, they’re on their feet walking. And by the way, when they’re walking, the sidewalks are safe, they’re tree covered, they’re often covered with water, it’s very hot in Singapore, it’s a very safe place. You know, so the people are about half the BMI of that in the United States, largely because they’re getting this non exercise physical activity. If you buy a Coca Cola, Coca Cola is not encouraged in, in fact, in fact, it’s dissuaded these sugar sweetened beverages. But they have rather ingeniously mandated that Coca Cola and Singapore has about 20% less sugar than the same Coca Cola in Great Britain. They subsidize brown rice, which is healthier than white rice, you pay full price for white rice. If you want to enjoy chocolate, there’s tax on chocolate. They were the first one of the first countries in the world to heavily tax cigarettes and put these Lord pictures of what mouth and lung cancer look like right on the package instead of a, you know, cartoon character of a camel. And interestingly, and we often overlook this, they’re very hard on drugs. You know, if you have more than 15 grams of an opiate you could be put to death. Sounds draconian. But last year, about 18 people died of drug overdoses. Whereas in the United States, we had over 100,000. And you know, the other thing they’ve made the decision I know, this is controversial in the United States, but you can’t own a gun in Singapore. And yes, they don’t have the freedom to have their pistol or their semi automatic machine gun. But only about a dozen people die every year in violent gun deaths and accidents and here in the United States is about 155,000 people. So you know, when you look at the statistics, you tell me what society is safer than the one that’s armed or the one that’s not armed?

Andy Slavitt  38:14

Okay, then let me take one final break. And then I want to come back and answer the question but I want to be as Blue Zone. How do I make my city or state or street or country into a Blue Zone? There’s good news. There’s people who are already putting this research into action, where they live and we’ll have some good tips for you. We’ll be right back after this. Is your proof point, you know, you, you mentioned that there are some 70 plus communities in the US that have essentially decided that they really want to move in this direction, that they want to be informed and have at least some of their policies informed by this. And you’ve pointed out that they’ve made a difference. And I take really take your point that you know, you don’t have to be Sardinia, to call it a success, you’ve got to make progress. There’s one community in particular in Minnesota, that I’m aware of that sort of one of the poster children if not the poster child for this effort, and wondering if you can either talk about that community or select a different one. And just talk about what that journey has been like, as community has tried to say, hey, we’re going to put the place in place the things that allow our people to live healthier, longer and better lives.

Dan Buettner  41:22

So […] was our first BlueZone project. And it was largely funded by AARP and somewhat by your old company, United Healthcare. And we partnered with the University of Minnesota and I brought this key insight that if you want to make places healthier, don’t try to convince everybody to change their behavior, change their environment, so they healthy choices, easy choice. And we set up a program that we know scaled, we come in with three separate teams. The first team has a policy team. We have policy bundles that favor healthy food over junk food that favor the pedestrian over the motorist and favor the nonsmoker over the smoker. We do a consensus process for feasibility and effectiveness. And then we the city itself chooses eight or 10 policies in each of those areas that they feel would help them. My team helps make sure it gets implemented and enforced. A second squad has a blue zone certification program for schools, restaurants, grocery stores, workplaces, and churches. And we get Blue Zone certification for places who optimize their policies and their designs. So that people move more, eat better, socialize more and know and live out their purpose. And again, we’re sort of engineering unconscious behavior, not conscious behavior, and then kind of a BlueZone ambassador program for people and we help them choose new friends to spend time with healthier friends know their sense of purpose, and then go into their home with checklists to optimize their kitchen in their home so they mindlessly move more. And we found that if using that same process, if we can get into a city for three to five years, in every case, we lowered the BMI. In the case of Elbert Lee, we saw life expectancy go up by three years. And the city government reported about 30% lower health care costs. And this is by the way, very well documented. So we’ve now scaled it to 72. Cities, one of the biggest we’ve completed is Fort Worth, Texas, almost a million people. They reported a BMI drop of about 3%, which doesn’t sound like a lot but it occasioned about a quarter of a billion dollars of lower health care costs projected lower health care cost. And now we’re working in Scottsdale, Arizona, Naples, Florida, Jacksonville, Florida. And in every case, we only go into the city. When the public sector says yes, we want this the mayor city council, they understand what we’re doing. And they agreed to work with us otherwise we don’t come in. And we’re always funded now by either the insurance companies Blue Cross Blue Shield plans, hospital systems or local health foundations. And all of our work is at risk gallop measures it and if we don’t produce an outcome, our fees are at risk. And we set off to change the environment for the long run so that when we leave, the healthful impact continues to live on for years or decades to come.

Andy Slavitt  44:50

It’s incredibly exciting and it it strikes me that change is hard. You know we could know the answer. But going from a ADB taking yourself from wherever you are the community, and moving yourself to a different place. Whether the topic is health, whether the topic is, if anything, is incredibly challenging, and I think it’s, it’s so commendable, and so encouraging for people to feel like you can’t they can’t control their own destiny that isn’t just some abstraction or some idealized set of circumstances. And the other thing I noticed, and correct me if I’m wrong here, Dan, is that this isn’t the kind of thing that requires a lot of privilege or wealth. It strikes me, for example, looking at the diet, that we’re not talking about rarified expensive foods. We’re talking for the most part, at least from what I see fairly simple foods. We’re not talking about gym memberships, we’re talking about communities set up so that people can walk and bike and do things that are that are prohibitively expensive playgrounds and such. Am I wrong and reach that conclusion?

Dan Buettner  46:00

You’re absolutely right. I mean, we’re marketed all the time that some package super food or, you know, you have to go to a boutique grocery store and buy organic food. But when you look at the diets of in blue zones, and I actually wrote a book called The Blue Zone kitchen, where I gathered 100 recipes, they’re eating peasant food, the beans, and whole grains. And these are the things you can buy for two bucks a pound, and then on the bottom shelf at the grocery store. An important thing is though, is paying attention to taste. And the true genius, the blue zone as they know how to make these simple peasant foods tastes delicious, to your point about gym memberships, and yoga and pilates, you know, they’re not a bad idea. And we should do them. But I hate to say it exercise has been an unmitigated public health failure in this country, fewer than 24% of Americans get even the, you know, the minimum amount of physical activity, which is a 20 minute walk a day, it ain’t working. On the other hand, a community that is in the highest quintile of walkability, there’s something called the Walk Score, which is a very good metric, those people are getting about 20% more physical activity than those people in the lowest quintile, and they don’t even realize they’re getting it, it’s just that it’s pleasant to walk down and pick up your coffee, it is safe to go over to your neighbor’s house. And that’s what we ought to be spending our money on instead of expensive gyms if we really want America to be more physically active.

Andy Slavitt  47:31

So do a couple more questions as we wind down in one of my principal questions is about stress. It seems like, you know, we all know, and we’re learning more and more about the physical effects of of stress, of trauma of kind of the things that affect us, the create inflammation and so on. I’m curious, both in what you’ve observed in these communities. These can’t be stress free communities. I mean, I know we talked, we like to think that there’s ideal places in the world, but everybody has stress. What in your view are the things that you’ve seen people do? Or that you do even that are most effective at managing stress, keeping stress away dealing with it appropriately?

Dan Buettner  48:19

Yeah, Andy, the question is insightful. These people are humans just like that. And they worry about their kids. They worry about their health, they worry about their finances, the same way we do. They’re not different people. They do have sacred daily rituals that help unwind some of the stress and the accompanying inflammation. You know, stress triggers inflammation, which is the root of every age related disease. In some of these communities, the Adventist have prayer. Prayer works at lowering stress. People go to church have higher life expectancy. In the acuity in Costa Rica, they take a nap. And we know napping is associated with lower dementia and also lower rates of heart disease. The Okinawans have ancestor veneration.

Andy Slavitt  49:06

So if you nap in church, you’re gonna double it when?

Dan Buettner  49:10

It works for me.

Andy Slavitt  49:14

That’s my dad. That’s my dad joke.

Dan Buettner  49:16

I like it. I’m gonna I’m gonna I’m gonna license that from you. You gotta give

Andy Slavitt  49:21

Zero license fee, zero fee.

Dan Buettner  49:23

Thank you. Happy Hour, I actually you and a drink. I hate to say it for as unpopular as alcohol right now it lowers cortisol. And if you’re doing it with your friend.

Andy Slavitt  49:33

Last time we were together with […].

Dan Buettner  49:36

That’s right, we were sitting on Mark Greene’s porch having a glass of wine and chewing the fat as it were. But you know in America here, Daniel Kahneman, Nobel Prize winner did a very careful study of our daily activities. The activity that creates the most unhappiness or generates the most stress is our automobile. commuting to and from work every day. The best way to get rid of that is a walkable community where it’s safe, easy. And you know, there’s enough concentration density that we can walk. And there are cities that have become miraculously walkable in the United States, Santa Barbara, California, Pasadena, by the way, look at pictures of Pasadena, where you are right now, in the 1980s. And look at it today, it’s a pleasant place to walk. Actually, a guy and my team, Dan Burton was partially responsible for the design that created walkable Pasadena, we can do it in America. So I argue that much, if not the majority of our stress in this country is from the environment we live in social environment and the built environment. And those are all changeable. And that’s what we ought to be focusing on.

Andy Slavitt  50:48

So then, as of today, as of today, you join the Elite, elite, elite Elite, having your own show on Netflix. First of all, congratulations. You know, that is the modern day talisman. And I look I’d been a little bit tongue in cheek. But the truth is, I think it is a pretty remarkable statement about the need and the hunger for people to look beyond the quick fixes. And try to understand this a little bit better. And some of the success that you’ve had to communities over the year, can you just spend a minute just telling us about the show that people can tune into?

Dan Buettner  51:29

It’s, it’s a four part series, a docu series. I’m very grateful they the idea of Blue Zones, you know, I’ve been at it for 20 years, and people don’t immediately grasp it. And it’s, you can’t really sell purpose. And it’s not the way we think of health. So it’s been slow to get traction. But the beauty of doing this Netflix show I don’t know if you’ve ever seen Chef’s Table, but they’re shot gorgeously very high production values. We got the director from Chef’s Table clay Jeter we got there, the director from photography, so it’s shot gorgeously. And, you know, a lot of I would say the the candy or the sugar that helps the medicine go down as the cinematography here. But it’s also a good, you know, kind of hero’s journey, quite honestly, not that I’m a hero. But I did go on a hero’s journey. I went out into the world and tried to bring back something that would be useful for the community. And this documentary series captures discovering these blue zones, bringing back their wisdom and their insights. And you know, as you get into the third and fourth episodes, it shows how you can put those insights to work in your life, and how American cities are actually putting these insights to work and Laurene chronic disease and obesity, and I’m very proud of the outcome.

Andy Slavitt  52:59

Well, whether it’s your Netflix series, your beautiful books, your wonderful cookbook, there’s a lot that’s accessible about the work you’ve done. Over the last few decades, it’s been quite a contribution, I’ll be honest, it’s a unique contribution. It’s moved the dialogue. And the ultimate compliment I can give you is this will have unpredictable positive consequences beyond what you could have imagined. well beyond your in my time. So congratulations. Thanks. And thanks for being in the bubble.

Dan Buettner  53:32

Well, you know, I lament that you’ve left my neighborhood, but very happy to be in your bubble. And by the way, if anybody has questions, I’m at Dan Buettner on Instagram. And I always answer people’s direct messages and be very happy to answer any questions people might have. And it’s great honor to see you and hopefully next time, it’ll be on a porch somewhere with a glass of wine.

Andy Slavitt  53:55

Fantastic. That’s a that’s a great ending. And that’s a great offer. Thank you, Dan.

Andy Slavitt  54:12

Okay, thank you to Dan. And, look, we’ve got a Labor Day weekend coming up. I hope you have a great one. On Wednesday, we are picking right up with a show with Elizabeth Cripps, with a show about parenting in the age of climate change. And it’s a very interesting topic to me. How do we talk to our kids about this, particularly as our kids get older and realize that we’re giving them a world very different than the ones our parents gave us and very different than the ones that we’ve lived in? Yeah, that’s right now you’re the boomer or the Gen X or or whatever in their eyes, and it’s a really important conversation and topic. And then Caitlyn Jenner Lena will be coming along to talk about this very much There is a new set of variants that we are seeing and what that could mean for COVID and for winter wave. So enjoy your time off. Thank you to everyone who worked so hard in this country and around the world. And we’ll talk to you next Wednesday.

Andy Slavitt  55:25

Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Martin Macias and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.

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