Lessons From Blue Zones on How to Increase Healthy Life Expectancy

The concept of a "blue zone" was put out there more than a decade ago by demographer Michel Poulin at the University of Tallinn in Estonia. These are places of validated extraordinary longevity of people, measured in terms of the likelihood of people born in a place making it to age 100 (e.g., what percentage of people alive at age 60 are still alive at age 100). They are called Blue Zones simply because researchers circled the places in blue on a map! Poulin and his colleagues have focused especially on a mountainous area on the Italian island of Sardinia. Another demographer, Luis Rosero-Bixby, and his colleagues have investigated the Nikoyan region of Costa Rica. Other investigated and validated Blue Zones include the Greek island of Ikaria, the Japanese island of Okinawa, and perhaps most surprisingly, the community of Loma Linda, California. Academic papers describing the first four of these places can be found in the 2013 Vienna Yearbook of Population Research, published by the Vienna Institute of Demography. There is an especially good introductory paper to this special issue on longevity by Graziella Caselli and Marc Luy.

These places offer an interesting opportunity to figure out the explanations for people being able to survive in greater proportions, and presumably in better health, than most of us can currently expect to do. Genetics probably explains about one-third of this, as Caselli and Luy note, but are there lessons beyond "choosing your parents well" that can benefit the rest of us? Dan Buettner has become a successful writer of NYTimes bestseller books by trying to answer that question and his latest book, The Blue Zones Solution, offers the recipes (both figuratively and literally):

No one thing explains longevity in the Blue Zones. It's really an interconnected web of factors--including what we eat, our social network, daily rituals, physical environment, and sense of purpose--that propels us forward and give life meaning. But food is at the center of that ecosystem, and food may be the best starting point for anyone seeking to emulate the health, longevity, and well-being found in the world's Blue Zones.

Buettner then summarizes those major components of health and well-being and provides what amounts to a cookbook of 77 recipes (and, no, I don't think that there is any magic in that number!) that emphasize a diet that is largely, but not necessarily exclusively, vegetarian, emphasizing things like beans, lentils, and nuts--along with a glass or two of wine with dinner. This is essentially what we typically call a "Mediterranean diet."

Diet is an important thing to change in our lives, but there are other elements to this potentially healthier lifestyle, as described by Buettner. His list of the "Power Nine" includes (1) moving naturally (natural exercise, rather than a forced workout at a gym), (2) having a sense of purpose in life, (3) trying to limit stress in your life [and see this piece in today's Washington Post for more on this topic], (4) stop eating when you are 80 percent full, (5) have a diet with a "plant slant", (6) have one or two (but no more than that) glasses of wine in the evening with friends and/or food, (7) choose your friends carefully (you can do that, even if you couldn't choose your parents) because friends reinforce both good and bad behavior, and (8) commit to a life partner and have them come first in your life. In a very real sense, these are words to live by.

Your Health Literacy Can Improve Your Healthy Life Expectancy

Chris Murray and his group at the Institute of Health Metrics at the University of Washington have repeatedly shown that while global life expectancy is increasing (i.e., we are dying at ever older ages), the number of healthy years we live is not increasing as quickly. This week they released their latest Global Burden of Disease study in The Lancet, and Reuters picked up the story.

People around the world are living longer, but many are also living sicker lives for longer, according to a study of all major diseases and injuries in 188 countries.

General health has improved worldwide, thanks to significant progress against infectious diseases such as HIV/AIDS and malaria in the past decade and gains in fighting maternal and child illnesses.

"The world has made great progress in health, but now the challenge is to invest in finding more effective ways of preventing or treating the major causes of illness and disability," said Theo Vos, a professor at the Institute of Health Metrics and Evaluation at the University of Washington who led the analysis.

The study's main findings were that global life expectancy at birth for both sexes rose by 6.2 years -- from 65.3 in 1990 to 71.5 in 2013. Healthy life expectancy at birth rose by 5.4 years -- from 56.9 in 1990 to 62.3 in 2013.

One of the problems is an increasingly less nutritious diet around the globe, as these same researchers pointed out earlier this year.  But a broader issue that actually encompasses the changing diet is that of health literacy. I thought about this last week when I saw a National Academy Press report on this topic. The volume is a bit dry (albeit literate), but the topic is huge. Think about the people who don't understand the importance of vaccines, or cultures whose practices dealing with dead bodies contributes to the spread of disease (e.g., ebola in west Africa), or the lack of appreciation for the value of condoms in casual sexual intercourse. In our own research in Accra, the capital of Ghana, we  found that adults in the city were not always sure how malaria is transmitted nor how best to protect themselves and their children from it. That is only a small step from those people who don't follow a prescribed medical regimen because they really aren't sure why they should--this is mainly what the National Academy of Sciences workshop report was about. We readily take for granted the things that others do for us that keep us healthier, but we aren't always so good at figuring out what is best for ourselves. In short, if we all became more health literate we would almost certainly close the gap between actual and healthy life expectancy.

Europe's Migrant Culture Clash and Mash

Over the past two years or so, I have blogged increasingly often about the undocumented migrant situation facing Europe. This is largely a result of the economic and political mess in the Middle East and Africa, but it is aided in some ways by the limited willingness or inability of at least some European nations to take in refugees. Today's news brought two very contrasting reactions to these migrants. In Hungary, the government is thinking about deploying troops to deal with the migrant crisis, as reported by the Financial Times.

Janos Lazar, a senior Hungarian minister, said the government had discussed a possible military build-up following police reports that more than 2,500 migrants had penetrated the country’s border with Serbia on Tuesday. One official said the numbers were the highest in the country’s history.

Unfortunately, not all those migrants heading north from Serbia (as I discussed a couple of days ago) were still alive when they made it north. CCTVAfrica posted a photo of a truck in which 50 migrants had been found dead in Austria. They had been trapped in the back of the truck and suffocated during the journey. The driver abandoned the truck and is now being sought.

At a press conference in Eisenstadt, Interior Minister Johanna Mikl-Leitner said it demonstrated “the despicable methods used by Mafia traffickers in all their ugliness in Austria”. “Today is a dark day,” she added and vowed there would be zero tolerance shown towards any that were caught.

A different approach to dealing with migrants is being tried at least in a small way in Italy, where OZY reports that families are taking in refugees and providing them with an informal introduction to Italian language and culture. Families receive a monthly stipend for doing this, much as foster families do in the U.S. for caring for children who have been abandoned by their parents. It's not clear that this will catch on in a big way, but it is a step in the direction of coping with the cultural differences that exist between sending and receiving nations and which are almost certainly the biggest challenges anywhere in the world to the issue of migration.

UPDATE: Foreign Policy reports that:

In the Austrian case, three people in Hungary have been arrested in connection to the truck deaths. Authorities believe a Bulgarian-Hungarian trafficking ring is responsible. The victims are believed to be Syrian, police said.

Are "Anchor Babies" Really a Problem?

As I've noted before, Donald Trump has stirred up the immigration pot with his racist rhetoric aimed especially at undocumented immigrants from Mexico. Note, by the way, that not all undocumented immigrants are from Mexico--check out the infographic I referenced a few days ago). Note also that a large fraction of undocumented immigrants arrive on planes, rather than crossing the U.S.-Mexico, as my son, Greg Weeks, pointed out today. One of the issues raised once again by Trump is the fact than anyone born in the U.S. is automatically a U.S. citizen. The 14th Amendment to the Constitution was passed after the Civil War to make sure that former slaves would not be denied U.S. citizenship. Since U.S. laws also allow U.S. citizens to apply for legal admission for their close relatives (the "family preference" provisions of U.S. immigration laws), it means that eventually a child born in the U.S. could apply to bring their parents legally into the U.S. But the key here is "eventually." The child will have to be at least 21 years old when they make the application (as a result of laws passed during the Jimmy Carter administration) and it will likely take many years for an entry visa to be issued because they are subject to annual limits. So, even if an undocumented woman did choose deliberately to have her baby born in the U.S. in order to "link" her to a U.S. citizen, she will probably have to wait a minimum of three decades for that to come about. For a good background on these issues, I recommend Leo Chavez's 2008 book, The Latino Threat: Constructing Immigrants, Citizens, and the Nation.

In the meantime, however, the fuss is not really about anchor babies or even about undocumented immigrants. Eric Posner of the University of Chicago has a very good op-ed piece in Slate in which he argues that the issue that Trump has raised is about differences in culture. That's what this is all about--a classic case of xenophobia. Every immigrant group coming to the U.S. has been discriminated against and bullied by the "mainstream" until finally making it into the mainstream--and changing American culture in the process. Think about it--Ben Franklin was worried about German immigrants more than two hundred years ago. Now, the census data show that more Americans claim some German heritage than any other ethnic origin. They became part of the mainstream along with the Irish, Italians, Poles, Chinese, Vietnamese, Koreans, and--increasingly--Mexicans (and, of course, I've left lots of cultural backgrounds off the list for sake of brevity). Posner very cogently concludes that "...defenders of immigration might do best to thread their way through the minefield of culture—to argue that immigration does not harm American culture and probably enriches it—rather than pretend that these concerns do not exist.

Anchor babies are not the problem--fear of cultural differences is the problem, and every human society has this same problem. We need to talk about it, so we can deal with it.

Learning to Manage Demographic "Shrinkage"

The Financial Times has recently had a string of articles highlighting the demographics of low fertility European countries, as I noted recently with respect to Portugal. Yesterday they turned to Germany, highlighting a northern German town that is trying to attract immigrants in order to keep its schools open.

When the quiet village of Ottenstein, in northern Germany, was faced with its school closing for lack of children, Manfred Weiner, its mayor, hit upon a novel way of attracting young families. Instead of renting out village land to farmers, he is giving it away for free to people willing to move to the picturesque hamlet. Successful applicants will be awarded a building plot on one condition: that they have young children and, preferably, intend to have more. About 30 couples have responded.

This is not quite as novel as the FT might think. Let's go back to Dayton, Ohio, just a couple of years ago, as reported by the NYTimes:

Fighting back from the ravages of industrial decline, this city adopted a novel plan two years ago to revive its economy and its spirits: become a magnet for immigrants.Other struggling cities are trying to restart growth by luring enterprising immigrants, both highly skilled workers and low-wage laborers. In the Midwest, similar initiatives have begun in Chicago, Cleveland, Columbus, Indianapolis, St. Louis and Lansing, Mich., as well as Detroit, as it strives to rise out of bankruptcy.

In many ways, this is all about "managing shrinkage," as the FT article noted:

[A]s a rich country with a highly- educated population, Germany has the opportunity to become an innovator in how to manage an ageing population. “Demographic change need not be a catastrophe. The question is how to react,” says Reiner Klingholz, director of the Institute for Population and Development. “Governments are all used to managing growth. They must now learn how to manage shrinkage. We need a complete rethink in our societies.”

And how is another rich, well-educated country, Japan, coping? At the moment, Tokyo is dealing with a growing number of abandoned homes.

These ghost homes are the most visible sign of human retreat in a country where the population peaked a half-decade ago and is forecast to fall by a third over the next 50 years. The demographic pressure has weighed on the Japanese economy, as a smaller work force struggles to support a growing proportion of the old, and has prompted intense debate over long-term proposals to boost immigration or encourage women to have more children.

I'm betting on the idea that these unoccupied homes will be demolished, and probably at public expense. That's a lesson in shrinkage management. Tearing down an unoccupied home is a lot cheaper than raising children or integrating immigrants.