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This Midwestern city, supported by Blue Zones, climbs out of economic crisis with projected lifespans increased by nearly 3 years and economic value by the millions.

Suffering in the face of the 2008 economic downturn, Albert Lea, Minnesota, was determined to transform its situation. Its leaders eagerly teamed up with Blue Zones in 2009, making Albert Lea the first Blue Zones Pilot Project, applying principles from areas around the world where people lived longer, healthier lives. Pleased with the results of the nine month pilot, Albert Lea has continued on as a Blue Zones Project community addressing built environment, tobacco policy, citizen engagement, and bringing back the downtown.

The commitment to well-being has resulted in numerous measurable impacts for Albert Lea, such as:

$8.6 million -savings in annual health care costs for employers as a result of a decline in smokers

34th place -in the Minnesota County Health Rankings (up from 68 out of 87 counties)

2.9 years -added to lifespans (projected) within one year of participating in the Blue Zones Project

Leading incremental changes and sparking chain reactions

When Blue Zones and Blue Zones Project began working with Albert Lea in 2009 to transform its policies, places, and people, the focus was on helping people move naturally, eat wisely, connect, and have the right outlook-all of which can lead to living longer, better. To make transformation a reality, city leaders and the Blue Zones Project identified key opportunities for impact and sought pledges from businesses and residents.

Community Design Improvements

In 2009, Blue Zones' expert Dan Burden led a walking audit of Albert Lea, identifying ways to create more active and healthy living environments centered around people. A Bike and Pedestrian Master Plan was created that identified areas needing improvement to align with the Complete Streets Policy, which Albert Lea was an early adopter of in 2009.

Armed with inspiration and grant money, Albert Lea created bump outs to ensure safe pedestrian crossings and wider sidewalks that provided space for outdoor dining. A five-mile route that was added around a lake within the city was affectionately named the Blue Zones Walkway by Albert Lea, and it now connects to neighborhoods, parks, downtown and past the local hospital. Stop signs were replaced with traffic lights to maintain a smooth traffic flow. Community message boards were added, and a complete park renovation with amphitheater seating provided additional community gathering space.

The improvements sparked a chain reaction of economic development. New businesses relocated to downtown Albert Lea, and the city initiated a mixed-use project to open room for income-limited housing units and commercial space in the historic downtown area.

Healthier Workplaces: Blue Zones Project offered local businesses the opportunity to become a designated Blue Zones Worksite® by completing an assessment and improvements to increase the long-term well-being of employees, customers, or students.

The simple changes were designed to provide lasting benefits to people's physical health, emotional health and social relationships. More than 45 worksites have registered with Blue Zones Project and made varying levels of change, the City of Albert Lea being one.

Blue Zones Project also recommended worksite clinics for some of the larger employers in Albert Lea to increase well-being for employees and reduce healthcare costs. Five of the top 20 partnered together to provide their employees with a dedicated worksite clinic, serving approximately 1,650 employees. Two other area worksite also opened clinics. These efforts resulted in considerable savings.

Healthy Foods: To make healthy food the easy choice for everyone in the community, Blue Zones Project provided guidance on how to offer and bring attention to foods that are more nutritious and tasty.

As a result, one of the local grocery stores implemented changes to its environment, selection of healthy options, and education and promotions to make healthier choices easier for customers.

Grab-n-go breakfast and healthy snack cart programs were introduced in various public schools to help children create healthy habits, and they've been highly received by students, educators and parents. An indoor sports arena added healthier options to its concession stand and saw a bump in sales. And the City of Albert Lea has expanded the community garden space 150%, giving residents an opportunity to grow healthy food and socialize in an agricultural environment.

Tobacco Cessation: Starting in 2009, Blue Zones Project began working with the City of Albert Lea to drive policy and environmental changes for a measured reduction in tobacco usage.

This included changes for public housing, public parks and events, outdoor dining, as well as partnering with local businesses. Out of 18,000 residents, 4,140 were smokers in 2010, and success had the potential of reducing health care costs by $6,000 per year, per smoker. Given the challenge of trying to implement this change and provide a new outlook toward this important public health issue, the city chose to make incremental moves over time, which have made a big impact.

Measurable impacts that have transformed the community

The following progress indicators were reported by the City of Albert Lea in 2015, dating back to 2009 if the data was available.

Impact of Community Design Improvements

* Added more than nine miles of new sidewalks and three miles of bike lanes
* More than a dozen businesses relocated to downtown Albert Lea
* Outdoor dining facilities created by three restaurants
* 96% increase in pedestrian traffic on Broadway from 2014 to 2018
* 38% average increase in biking and walking throughout the community since 2009
* Ranked above the national and state average for people feeling active and productive according to the July 2014 Gallup-Healthways Well Being Index®
* More than $2.5 million invested in downtown building permits since 2013
* 25% increase in property value in the downtown area
* Year-over-year increase in lodging taxes due to an increase in visitors
* $400,000 in revenue and a return of a $1.2 million property to taxable status expected from the mixed-use downtown development
Impact of Healthier Workplaces
* 300% increase in funds given to the City of Albert Lea by its insurance carrier for its wellness program in 2014, and medical premium increases avoided for city workers in 2014 and 2015
* $128,000 in health care costs saved by a Blue Zones Project worksite within a year of opening a worksite clinic for its 500 employees
* The School District experienced no increase in Health Care Premiums and an 11% decrease in prescription costs as a result of their on-site clinic from 2014-2015
Impact of Healthy Foods Initiative
* Increase sales of 130.35% from the Health Market, 12% from produce, 35.31% from frozen fruit and vegetables, 52.3% from water, and a decrease of 4.66% in soda sales at the Hy-Vee grocery store from 2009 through 2015
* 59% increase in concession sales from 2014 through 2018 at City Arena after healthy options were added
* 60% increase in breakfast participation from 2014 to 2015 in schools where the Grab-n-Go breakfast program was implemented
* 17% increased participation in the Healthy Snack Cart program in the 2014 - 2015 school year

Results of Tobacco Cessation Initiatives

* Tobacco use eliminated at 550 units of public housing, 14 of the top 20 worksites as well as select other businesses, public parks, county fairs, other outdoor events, and outdoor dining
* Decline in smokers from 23% of adult residents in 2009 to 14.7% in 2016
* $8.6 million savings in annual health care costs for Albert Lea employers from the decline in smokers

* 2.9 projected years added to participants' lifespan within a year of participating in the Blue Zones Project
* $120,000 worth of media impact created from being featured in local and nationwide media, publications, and websites
* Jump to 34th place in the Minnesota County Health Rankings (previously 68 out of 87 counties)
* Ranked third in "The top 10 most affordable small towns in the United States that you would actually want to live" by Realtor.com in the fall of 2015 (lakes, parks, walking paths and Blue Zones Project listed as "quality of life" indicators)
Get a PDF version of the above results in Albert Lea
More on Blue Zones work in Albert Lea, MN

Models and Innovations: Albert Lea Blue Zones Project
The Secret all Cities Can Learn from Albert Lea, MN
Albert Lea Receives Tobacco-Free Cities Award
Albert Lea: Operation Transformation

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Blue Zones Results: Albert Lea, MN - Blue Zones

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This Midwestern city, supported by Blue Zones, climbs out of economic crisis with projected lifespans increased by nearly 3 years and economic value by the millions. Suffering in the face of the 2008 economic downturn, Albert Lea, Minnesota, was determined to transform its situation.

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Short Video: NBC News on Fort Worth, TX Blue Zone Solution

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Why Fort Worth, Texas could be an example for cities trying to get healthy

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When Cynthia McFadden last visited Fort Worth in 2015, it was one of the unhealthiest cities in America. The mayor took inspiration from "Blue Zones" and has helped to transform the lives of many of her citizens.

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(short video)

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Blue Zones Grocery Store Successes in Iowa

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Fort Worth's 'Blue Zones' Initiative Aims to Get City Healthy

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The Texas town teamed up with National Geographic fellow Dan Buettner who studies places on earth where people live longer and healthier.

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Local officials engaged Blue Zones Project because their childhood obesity levels were higher than the national average (pre 2010). Stress levels were high, particularly in affluent Manhattan Beach, measuring the same as New Orleans post-Katrina, or in Detroit.

Since Blue Zones Project deployed in 2010:

OBESITY + OVERWEIGHT RATES

25% drop in obese and overweight adults (between 2010-2017). At 12.1 percent, the rate of obesity in the Beach Cities is less than half of the U.S. rate of 28.1 percent - meaning just one in eight Beach Cities residents are obese compared to one in four Americans nationally.

68% reduction in childhood obesity from 2007 to 2019 at Redondo Beach K-5 schools. The number of Beach Cities residents who are above normal weight (obese or overweight) fell from 60 to 50.8 percent. In contrast, 63.7 percent of U.S. adults and 58.7 percent of Californians are above normal weight.

SMOKING RATES

36% drop in smoking (between 2010-2017). The smoking rate in the Beach Cities fell to just 8.9 percent of residents - a rate significantly lower than the U.S. (18.8 percent) and California (13.7 percent).

EXERCISE

Now, 65.8 percent of Beach Cities residents report exercising at least 30 minutes a day, three days a week-a 9 percent increase since 2010-compared to just 53.2 percent of adults nationally and 57.7 percent statewide.

OVERALL WELL-BEING SCORE

The Beach Cities collectively earned the highest 2015 Well-Being Index score (65.9) in the U.S., outpacing all 190 metropolitan areas measured.

Individually, Manhattan Beach (68), Hermosa Beach (67) and Redondo Beach (64.8) placed first, second and fifth in the U.S. respectively.

CREATING VALUE FOR BEACH CITIES:

Since the inception of Blue Zones Project in 2010, improvements in community well-being are valued at:

* Savings of $21M in direct medical expenses
* Reductions in projected lost productivity of $21M
* A cumulative total of $42M in value
* $341 average annual per capita value

Based on trends over the past 5 years, we project the total value of well-being improvement by 2020 to be:

* Savings of $74M in direct medical expenses
* Reductions in projected lost productivity of $51M
* A cumulative total of $125M in value
* $1,011 average annual per capita value
Click here for more information and to view detailed results from the Blue Zones Project in Beach Cities, CA.

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Blue Zones Project Results: Beach Cities, CA - Blue Zones

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Local officials engaged Blue Zones Project because their childhood obesity levels were higher than the national average (pre 2010). Stress levels were high, particularly in affluent Manhattan Beach, measuring the same as New Orleans post-Katrina, or in Detroit. Since Blue Zones Project deployed in 2010: OBESITY + OVERWEIGHT RATES [...]

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Since the launch of Blue Zones Project in Fort Worth, the health and well-being of residents has surged while the U.S. overall health score has dropped. According to the annual Gallup-Sharecare Well-Being Index®, Fort Worth's overall 2018 Well-Being Index score rose to 62.5, a gain of nearly four points since 2014, when the city began working with Blue Zones Project®.

Each point increase in well-being for a population leads to approximately a two percent reduction in ER visits and hospital utilization, and to approximately a one percent reduction in total health care costs. This equals tens of millions of dollars of healthcare savings per year.

Meanwhile the U.S. Well-Being Index score-which outpaced the Fort Worth score by 3 points in 2014-is 61.3, a decline of 0.5 over the same period. Compared annually to close to 190 metro areas reported nationally, Fort Worth's equivalent rank for well-being rose from 185th in 2014 to 58th in 2017.

According to the Gallup-Sharecare Well-Being Index (WBI):

Adult residents of the Fort Worth have reported substantially elevated levels of overall well-being in the four years since measurement began in 2014.

Fort Worth's Well-Being Index score 2018 = 62.5
Fort Worth's Well-Being Index score 2014 = 58.8

*This occurred during a period of decline in well-being nationally, with the U.S. Well-Being Index score dropping from 61.8 in Q2-2014 to 61.3 in Q2-2018.

Fort Worth moved from 185th to 58th in the Gallup-Sharecare annual database of around 190 U.S. communities. Fort Worth has also had statistically significant improvement in all five elements of well-being since baseline year.
Reduced Smoking Rates in Fort Worth, TX:
Adult Smoking Rate in 2018 = 13.5%
Adult Smoking Rate in 2014 = 19.6%

Fort Worth has saved an estimated $268 million in 2018 compared to 2014 based due to the reduced smoking rate among its adult residents.

Gallup estimates Fort Worth's lost productivity due to smoking (at a rate if 19.6%) was about $602 million per year across all of its employers in 2014. In 2018 Gallup estimates that these lost productivity costs were reduced by about $187 million per year as a function of the lower smoking rate, likely representing a substantial boost to the economy.

In Fort Worth, the 6.1 percentage point estimated reduction in adult smoking translates to 38,074 fewer smokers than in 2014, yielding a savings in health care utilization of about $81 million per year compared to that year.
Other well-being improvements:
Exercise 30 plus minutes, 3x days, week: Improved 9 points from 53% in 2014 to 62% in 2018

Agree city/area is perfect place for you: Improved from 61.9% in 2014 to 65.6% in 2018

Agree proud of community: Improved 5.6 points from 63.8% in 2014 to 69.4% in 2018
Schools & Youth Impact
Won $3.2 Million in Safe Routes to School funding for seven FWISD schools

Youth smoking decrease: Percentage of youth who report currently smoking cigarettes at least once in the last 30 days has declined from 9% in 2015 to 5.5% in 2017, according to the Youth Risk Behavior Surveillance Survey (YRBS)

Youth e-cigarette decrease: Percentage of youth who report currently using electronic vaping products at least once in the last 30 days has declined from 19.9% in 2015 to 7.4% in 2017, according to the YRBS Policy Impact & Funding

Partnered with City and community partners to secure over $9.9 Million in funding for built environment policies and infrastructure projects and $656 Thousand in funding for community and school gardens, increasing fresh fruits and vegetables in schools, and a corner store transformation

$15 Million allocated for sidewalks and bicycle infrastructure and $5 Million allocated for Safe Routes to School improvements out of 2018 bond, ten-fold increase in SRTS funding from previous bond

Significant increase in the number of miles of bicycle infrastructure: Miles of bike lanes have increased from 9.6 miles in 2010 to 86.8 miles in 2018, and miles of bike routes (sharrows or bike route signage) have increased from 68 miles in 2010 to 87.2 miles in 2018.

"Fort Worth showed early promise in its efforts to improve the well-being of its residents with impressive gains in 2015 and 2016 compared to its baseline year of 2014. After mirroring national trends and taking a step back last year, Fort Worth's latest jump in well-being in 2018, as the U.S. continues to decline, securely establishes it as a best practice example of what a community can accomplish when it sustains a focused commitment to well-being. The work of the Blue Zones Project in Fort Worth is playing an important role in the improving well-being culture and associated outcomes of the community."- Dan Witters, Principal at Gallup
More on Blue Zones Project in Fort Worth, TX:
Smoke-Free and filled with Blue Zones makes for a healthier Fort Worth
NBC News visits Fort Worth Blue Zones Initiative
Building a more livable Fort Worth through Complete Streets
Tarrant County recognized for healthy living
Fort Worth: A Certified Blue Zones Community

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Blue Zones Project Results: Fort Worth, TX - Blue Zones

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Since the launch of Blue Zones Project in Fort Worth, the health and well-being of residents has surged while the U.S. overall health score has dropped. According to the annual Gallup-Sharecare Well-Being Index®, Fort Worth's overall 2018 Well-Being Index score rose to 62.5, a gain of nearly four points [...]

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Spencer Community Story Blue Zones Project

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Sharing Spencer's comprehensive transformations in the way community members live, eat, work, play and go to school to be healthier and happier.

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The Seventh-day Adventist church in this sunny pocket of Southern California was founded in the 1840s. The church flourished through the 20th century - and so did its members who view health as central to their faith.

Today, a community of about 9,000 Adventists in the Loma Linda area are the core of America's blue zones region. They live as much as a decade longer than the rest of us, and much of their longevity can be attributed to vegetarianism and regular exercise. Plus, Adventists don't smoke or drink alcohol.

Read more below about the lessons that Loma Linda, California can teach you about longevity.

Videos From Loma Linda, California

Maria Shriver Reveals Secrets Of 'Blue Zones' Where People Live To 100 | TODAY

Dr. Ellsworth Wareham - Loma Linda Centenarian

How can you live like the American longevity all-stars? Try these tactics practiced in Loma Linda to live measurably longer.

Find a sanctuary in time.

A weekly break from the rigors of daily life, the 24-hour Sabbath provides a time to focus on family, God, camaraderie, and nature. Adventists claim this relieves their stress, strengthens social networks, and provides consistent exercise.

Maintain a healthy body mass index (BMI).

Adventists with healthy BMIs (meaning they have an appropriate weight for their heights) who keep active and eat meat sparingly, if at all, have lower blood pressure, lower blood cholesterol, and less cardiovascular disease than heavier Americans with higher BMIs.

Get regular, moderate exercise.

The Adventist Health Survey (AHS) shows that you don't need to be a marathoner to maximize your life expectancy. Getting regular, low-intensity exercise like daily walks appears to help reduce your chance of having heart disease and certain cancers.

Spend time with like-minded friends.

Adventists tend to spend time with lots of other Adventists. They find well-being by sharing their values and supporting each other's habits.

Adventists who consume nuts at least five times a week have about half the risk of heart disease and live about two years longer than those who don't. At least four major studies have confirmed that eating nuts has an impact on health and life expectancy.

Like many faiths, the Seventh-day Adventist Church encourages and provides opportunities for its members to volunteer. People like centenarian Marge Jetton stay active, find a sense of purpose, and stave off depression by focusing on helping others.

Many Adventists follow a vegetarian diet. The AHS shows that consuming fruits and vegetables and whole grains seems to be protective against a wide variety of cancers. For those who prefer to eat some meat, Adventists recommend small portions served as a side dish rather than as the main meal.

Eat an early, light dinner.

"Eat breakfast like a king, lunch like a prince, and dinner like a pauper," American nutritionist Adelle Davis is said to have recommended -an attitude also reflected in Adventist practices. A light dinner early in the evening avoids flooding the body with calories during the inactive parts of the day. It seems to promote better sleep and a lower BMI.

Put more plants in your diet.

In support of a biblical diet of grains, fruits, nuts, and vegetables, Adventists cite Genesis 1:29: "And God said, Behold, I have given you every herb bearing seed, which is upon the face of all the earth, and every tree, in which is the fruit of a tree yielding seed; to you, it shall be for meat." The Adventists encourage a "well-balanced diet" including nuts, fruits, and legumes, low in sugar, salt, and refined grains. Studies have shown nonsmoking Adventists who ate 2 or more servings of fruit per day had about 70 percent fewer lung cancers than nonsmokers who ate fruit once or twice a week. Adventists who ate legumes such as peas and beans 3 times a week had a 30 to 40 percent reduction in colon cancer.

Adventist women who consumed tomatoes at least 3 or 4 times a week reduced their chance of getting ovarian cancer by 70 percent over those who ate tomatoes less often. Eating a lot of tomatoes also seemed to have an effect on reducing prostate cancer in men. A new study has found that adherents to this way of life have the nation's lowest rates of heart disease and diabetes and very low rates of obesity.

The AHS suggests that men who drank 5 or 6 daily glasses of water had a substantial reduction in the risk of a fatal heart attack -60 to 70 percent-compared to those who drank considerably less.

This is an excerpt from Blue Zones: Lessons For Living Longer From The People Who've Lived The Longest by Dan Buettner, copyright 2008, all rights reserved.

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The Seventh-day Adventist church in this sunny pocket of Southern California was founded in the 1840s. The church flourished through the 20th century -

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Dan Buettner: How to Live to 100 (TED-Ed Video)

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Dan Buettner: How to Live to 100 (TED-Ed Video)

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The islands at the southern end of Japan have historically been known for longevity, once called the land of immortals. Okinawans have less cancer, heart disease and dementia than Americans, and women there live longer than any women on the planet.

Perhaps their greatest secret is a strong dedication to friends and family. They maintain a powerful social network called a "moai," a lifelong circle of friends that supports people well into old age. Okinawans also have a strong sense of purpose in life, a driving force that the Japanese call "ikigai."

Read more below about the lessons that Okinawa, Japan can teach you about longevity

Videos From Okinawa, Japan

Despite years of hardship, Okinawans have established a lifestyle and environment to live long, healthy lives. Follow these common centenarian practices to promote your own longevity.

Embrace an ikigai.

Older Okinawans can readily articulate the reason they get up in the morning.

Their purpose-imbued lives gives them clear roles of responsibility and feelings of being needed well into their 100s.

Rely on a plant-based diet.

Older Okinawans have eaten a plant-based diet most of their lives. Their meals of stir-fried vegetables, sweet potatoes, and tofu are high in nutrients and low in calories.

Goya, with its antioxidants and compounds that lower blood sugar, is of particular interest. While centenarian Okinawans do eat some pork, it is traditionally reserved only for infrequent ceremonial occasions and taken only in small amounts.

Get gardening.

Almost all Okinawan centenarians grow or once grew a garden. It's a source of daily physical activity that exercises the body with a wide range of motion and helps reduce stress. It's also a near-constant source of fresh vegetables.

Eat more soy.

The Okinawan diet is rich in foods made with soy, like tofu and miso soup. Flavonoids in tofu may help protect the hearts and guard against breast cancer. Fermented soy foods contribute to a healthy intestinal ecology and offer even better nutritional benefits.

Maintain a moai.

The Okinawan tradition of forming a moai provides secure social networks. These safety nets lend financial and emotional support in times of need and give all of their members the stress-shedding security of knowing that there is always someone there for them.

Enjoy the sunshine.

Vitamin D, produced by the body when it's exposed on a regular basis to sunlight, promotes stronger bones and healthier bodies. Spending time outside each day allows even senior Okinawans to have optimal vitamin D levels year-round.

Stay active.

Older Okinawans are active walkers and gardeners. The Okinawan household has very little furniture; residents take meals and relax sitting on tatami mats on the floor. The fact that old people get up and down off the floor several dozen times daily builds lower body strength and balance, which help protect against dangerous falls.

Plant a medical garden.

Mugwort, ginger, and turmeric are all staples of an Okinawan garden, and all have proven medicinal qualities. By consuming these every day, Okinawans may be protecting themselves against illness.

Have an attitude.

A hardship-tempered attitude has endowed Okinawans with an affable smugness. They're able to let difficult early years remain in the past while they enjoy today's simple pleasures. They've learned to be likable and to keep younger people in their company well into their old age.

This is an excerpt from Blue Zones: Lessons For Living Longer From The People Who've Lived The Longest by Dan Buettner, copyright 2008, all rights reserved.

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The islands at the southern end of Japan have historically been known for longevity, once called the land of immortals. Okinawans have less cancer, heart disease and dementia than Americans, and women there live longer than any women on the planet. Perhaps their greatest secret is a strong dedication to [...]

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Blue Zones Life: Why, What, Where, Who, How?

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Blue Zones Life: Why, What, Where, Who, How?

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Rooted in our groundbreaking research of the healthiest, longest-lived people on earth, the Blue Zones Challenge is four weeks toward a better you. This is not an elimination diet. This is not a reset. This is a new way to look at your health that will change your life for the better in nearly every way.

Over four weeks and in small steps, you will introduce beneficial changes one at a time. You'll build as the days and weeks progress. Each new habit and improvement to your environment supports the rest, each one easier to add than that last, all working for your health. Together they function as more than the sum of their parts, ultimately providing a lifestyle change that will be sustainable for the rest of your life.

You might come in with goals like weight loss, but your health is oh-so-much more than a number on the scale. You might lose weight, yes. Over time you will realize that weight loss is but one small benefit in a landslide of great outcomes. Consider the amazing long-term benefits that a Blue Zones life can help you achieve:

To live a longer, better life

To have more energy, feel stronger, and gain health

To have better sleep and feel rested every day

To meet new people and nurture supportive relationships

To discover your purpose and put it to work

To be a change agent to help better your community

WHAT makes the Blue Zones and the Power 9® work?

The blue zones areas of the world share and benefit from a set of habits that we call the Power 9: practices that-together-increase longevity, health, and happiness. Our research has shown that these sets of behaviors and outlooks benefit people in these ways:

Longer, healthier life. Not just longevity for the sake of a number, but vitality. Engagement with family, friends, and daily routines into your 90s and beyond.

Lower rates of chronic diseases, such as Alzheimer's, cancer, depression, and dementia.

Quality relationships: part of the key to a life in alignment with blue zone habits is active engagement with community, friends, and family. These relationships work in a virtuous cycle of happiness and health: spending quality time with others is not just enjoyable in the moment but it contributes to your overall health and that of your circle, too!

Adding life to your years, while adding years to your life. All of the Power 9 components help you to build a longer AND better life.

Life satisfaction increases when you have a purpose and are engaged in a spiritual practice. Both of these are important to your quality of life and how you demonstrate outwardly your health and well-being.

WHERE Can We Find Blue Zones in Action?

The original five blue zones can be found all over the planet, demonstrating how we can live healthy lives no matter what climate or country we are in. We started Blue Zones Project® to use the wisdom of the original blue zones to tackle our current health crisis. It's now a solution in almost 50 communities around the country, and has been able to improve population health and reduce healthcare costs in a groundbreaking way.

Blue Zones Projects are places where whole communities come together with guidance to encourage all community members-as well as local policies and infrastructure-to grow into thriving places where the healthy choice is easy. Where are some of the current projects?

Albert Lea, Minnesota (the first location, where lifespan and community physical activity rocketed up and has stayed for a full decade)

Beach Cities, California (where childhood obesity declined by 50%, smoking declined by 17%, stress by 8%)

Fort Worth, Texas transformed from one of the unhealthiest cities in the nation (the city's well-being rank rocketed to 58th from 185 out of 190 in the nation)

These Blue Zones Project communities have shown that the benefits of blue zones can be built from the ground up.

WHO practices the Blue Zones Power 9 and HOW has it changed them?

The four week Blue Zones Program is based on our research: identification of the world's most extraordinary cultures whose health and longevity and happiness are outsized. People in blue zones didn't have to embark on a special program to transform their lives. Luckily for them, they live in places where moving naturally all day, eating healthy, and connecting with neighbors is the norm. In the spirit of those areas, we have brought environmental and cultural change to new places with the Blue Zone Project. We help to change health and well-being by showing communities how they can re-make their environments, social groups, and individual lifestyles.

When creating the Blue Zones Life Challenge, we looked to the original blue zones as well as each Blue Zone Project community. We used research-backed and evidence-based interventions in all our work.

How the Power 9 principles enhance life, longevity, and happiness:

Dig Deeper into the Blue Zones Life

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1. Blue Zones Life: Why, What, Where, Who, How? - Blue Zones

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Rooted in our groundbreaking research of the healthiest, longest-lived people on earth, the Blue Zones Challenge is four weeks toward a better you. This is not an elimination diet. This is not a reset. This is a new way to look at your health that will change your life for the better in nearly every way.

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Main Dish

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Ingredients

1⁄2 cup dried peeled fava beans

1⁄2 cup dried cranberry beans

1⁄3 cup dried chickpeas

7 tablespoons extra-virgin olive oil

1 medium yellow or white onion, chopped (about 1 cup)

2 medium carrots, peeled and chopped (about 2⁄3 cup)

2 medium celery stalks, chopped (about 1⁄2 cup)

2 teaspoons minced garlic

1 (28-ounce) can crushed tomatoes (about 31⁄2 cups)

3 medium yellow potatoes, peeled and diced (about 11⁄2 cups)

1 1⁄2 cups chopped fennel

1⁄4 cup loosely packed fresh Italian flat-leaf parsley leaves, chopped 2 tablespoons

chopped fresh basil leaves

2⁄3 cup of Sardinian fregula, Israeli couscous, or acini di pepe pasta

1⁄2 teaspoon salt

1⁄2 teaspoon freshly ground black pepper

1⁄4 cup finely grated pecorino Romano (about 2 ounces)

Directions

1. Soak the fava beans, cranberry beans, and chickpeas in a large bowl of water for at least 8 hours or up to 16 hours (that is, overnight). Drain in a colander set in the sink. Rinse well.

2. Warm 3 tablespoons of the olive oil in a large soup pot or Dutch oven set over medium-high heat. Add the onion, carrots, and celery; cook, stirring often, until soft but not browned, about 5 minutes. Add the garlic and cook until fragrant, about 20 seconds.

3. Stir in the tomatoes, potatoes, fennel, parsley, and basil, as well as the drained beans and chickpeas. Add enough water (6 to 8 cups) so that everything is submerged by 1 inch.

4. Raise the heat to high and bring to a full boil. Reduce the heat to low and simmer slowly, uncovered, until the beans are tender, adding more water as necessary if the mixture gets too thick, about 1 1⁄2 hours.

5. Stir in the pasta, salt, and pepper. Add up to 2 cups water if the soup seems too dry. Continue simmering, uncovered, until the pasta is tender, about 10 minutes.

6. Pour 1 tablespoon of olive oil into each off our serving bowls. Divide the soup among them and top each with 1 tablespoon of the grated cheese.

Tip: You can vary the beans in the minestrone: pinto beans make a good substitute for cranberry beans; great northern or cannellini beans, for the favas.

Tip: Use the stalks and fronds that come off a fennel bulb for the most intense flavor. No feathery fronds on the bulb? Add a teaspoon of fennel seeds to the aromatic vegetables you sauté to begin the dish.

Tip: Add other fresh vegetables from the garden or market, such as zucchini, cabbage, green beans, and cauliflower or broccoli florets.

Tip: Want a stronger tomato taste? Stir in a tablespoon or two of tomato paste. You get the idea!

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A bountiful dish that is eaten every day for lunch by some of the world's longest-lived families in Sardinia, Italy. It can be made with seasonal vegetables from the garden, but always includes beans and fregula, a toasted pebble-size semolina pasta that is popular in Sardina. Serves 8-10

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The Danish Twin Study established that only about 20 percent of how long the average person lives is dictated by genes, while about 80 percent is influenced by lifestyle and environment, said keynote speaker, Dan Buettner, founder of the concept of Blue Zones ®. To better understand the role of lifestyle and environment, Buettner set out to "reverse engineer longevity." In association with National Geographic and with funding from the National Institute on Aging, Buettner and a team of demographers studied census data and identified five pockets where people are living verifiably longer lives by a number of measurements (Ikaria, Greece; Loma Linda, California; Nicoya, Costa Rica; Okinawa, Japan; Sardinia, Italy; see Box 2-1). A team of experts then used established methodologies to try to determine why people had such remarkable longevity in these areas, which were dubbed "blue zones." The intent, Buettner explained, was to identify lessons or principles that could be applied to build healthier communities and to help people live longer and better lives. In describing the five blue zones, Buettner shared the stories of several individuals, each close to or more than 100 years of age. He showed photos of them swimming, surfboarding, lifting weights, working, and volunteering in their community. Health information is boring, he said, even in the cases of the best research and data. Using a human story to present health information increases audience engagement.

POWER 9® PRINCIPLES

In meeting numerous centenarians, Buettner realized that in no case did they reach middle age and then decide to pursue longevity through a change in diet, taking up exercise, or finding some nutritional supplement. The longevity occurred because they were in the right environment-an environment that fostered a lifestyle of longevity. Regardless of location, the same nine lifestyle characteristics were identified across all five blue zone environments, which Buettner termed the "Power 9 ®" principles. Activity, outlook, and diet are key factors, and the foundation underlying behaviors is how people in blue zones connect with others (see Figure 2-1).

PRINCIPLES INTO ACTION: LIFE RADIUS

Americans spend more than $100 billion annually on diets, exercise programs and health club memberships, and nutritional supplements, Buettner said. And while proper nutrition and exercise are good, this approach leads to short-term successes and long-term failures. Interventions need to last decades or a lifetime to affect life expectancy and lower rates of chronic disease, he said. Within 3 months of starting a diet, about 10 percent of people will quit. Within 7 months only about 10 percent will remain on the diet, and by 2 years less than 5 percent will still be adhering to the diet. Exercise programs show a similar pattern, Buettner said. Many people start exercise programs after the end-of-year holidays and have quit by autumn. Adherence to daily medication regimens also drops off over time.

With additional funding from National Geographic, Buettner set out to identify populations that were unhealthy but were able to improve their health and to determine what led to lasting improvement. In general, public health initiatives for non-infectious diseases have not been successful, he said. Tens of millions of dollars have been spent on major initiatives (e.g., for heart disease prevention), and while there is sometimes initial success in changing health behaviors, once the spotlight is off and the health researchers and media are gone, people revert to their baseline behaviors. One successful example Buettner did identify took place in North Karelia in Eastern Finland. In 1972 this region had the highest rate of cardiovascular disease in the world. A team led by Pekka Puska reduced the incidence of cardiovascular disease by 80 percent over 30 years and reduced the incidence of cancer by more than 60 percent. Puska's approach, Buettner explained, focused not on the individual but on the environment and the systems around the individual.

GOING TO SCALE

Buettner closed his presentation by sharing some lessons learned from working with 20 cities through six iterations of the project. Scale is the hardest aspect of the project, Buettner said. The first lesson in achieving scale is to start with "ready" communities. Unlike public health, where interventions are targeted at the most at-risk populations, prevention targets the people who are most ready for it. It takes some time to find that readiness, he said, and you have to say no to some communities. Invest in rigorous measurement. "If you can't measure it, you can't manage it," he said, and data are needed to back up the approach. Orchestrate "the perfect storm," he recommended, engaging the schools, restaurants, grocery stores, city council, and the media, so that everyone is hearing about blue zones everywhere they go. Finally, the process takes time. A workplace may be able to institute effective interventions in 1 year, but communities really need 3 to 5 years, often longer, in part because policy change can be a slow process.

There is no downside to any of the interventions, Buettner concluded. He suggested thinking about programs as an operating system, and striving to make permanent or semi-permanent changes to the system.

DISCUSSION

The open discussion that followed expanded on the concepts of readiness and scale. Buettner emphasized the value of a few successful demonstration projects in creating broad interest. Engaging everyone at once is generally not successful, he said. When working with communities, one should try to identify those employers who are most committed, and who are willing to commit some of the budget from human resources, marketing, their foundation, or other departments and orchestrate that perfect storm. He added that data on workplaces suggest that the main determinant of whether or not an employee likes his or her job is whether he or she has a best friend at work. Businesses have an enormous opportunity to connect people strategically so that their relationships transcend the commercial or business relationships. Set up those networks internally, make small changes to the policies and the built environment, and measure rigorously. Once you have shown what works, distill that into a scalable model for other companies, starting with the companies that are most ready and most committed, he said.

A participant expressed concern that some of the most at-risk communities may never be as "ready" as Albert Lea and that not including them might exacerbate some of the disparities further. Buettner clarified that blue zones tries to intervene at the whole city level, adding that 15 percent of the population of Albert Lea is Hispanic migrant workers who are very poor. Although the Blue Zones project may not necessarily be working in the poorest neighborhoods, the policy changes made (e.g., de-normalizing tobacco, making healthy foods more accessible and affordable) should benefit all of the communities in a city. Another participant suggested that some of the concepts about readiness are related to equity. How do we create more readiness in communities so that they are more prepared to change? Buettner clarified further that the Blue Zones project does not necessarily assess individual readiness as much as leadership readiness and whether the private and public sectors are open to innovation. Sign-on from the leadership components usually reflects the support of a larger population, he said.

A participant observed that for the original blue zones there was the sense of population homogeneity and a common culture and wondered whether more diversity within a city affects the outcomes. Buettner responded that it is easier if the population is more homogeneous, has a strong sense of civic unity and pride, and speaks a common language. However, the Los Angeles Beach Cities are very diverse and the initiatives have been very successful.

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The Danish Twin Study established that only about 20 percent of how long the average person lives is dictated by genes, while about 80 percent is influenced by lifestyle and environment, said keynote speaker, Dan Buettner, founder of the concept of Blue Zones®.11See http://www.bluezones.com (accessed December 12, 2014).

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This Central American nation isn't that far from the U.S. geographically, but it is way ahead of us in longevity. The Caribbean nation is economically secure and has excellent health care. But other factors are at play, especially in Nicoya, an 80-mile peninsula just south of the Nicaraguan border.

One is the " plan de vida," or reason to live, which propels a positive outlook among elders and helps keep them active. Another is a focus on family and a special ability to listen and laugh. Nicoyan centenarians frequently visit with neighbors, and they tend to live with families and children or grandchildren who provide support, as well as a sense of purpose.

Read more below about the lessons that Nicoya, Costa Rica can teach you about longevity.

Videos From Nicoya, Costa Rica

We have obtained information from Nicoya, Costa Rica on ways to live longer and be happier. This information has been translated into lessons that can be implemented into your everyday life.

Have a plan de vida.

Successful centenarians have a strong sense of purpose. They feel needed and want to contribute to a greater good.

Nicoyan water has the country's highest calcium content, perhaps explaining the lower rates of heart disease, as well as stronger bones and fewer hip fractures.

Nicoyan centenarians tend to live with their families, and children or grandchildren provide support and a sense of purpose and belonging.

Eating fewer calories appears to be one of the surest ways to add years to your life. Nicoyans eat a light dinner early in the evening. For most of their lives, Nicoyan centenarians ate a traditional Mesoamerican diet highlighted with the "three sisters" of agriculture: squash, corn, and beans.

Maintain social networks.

Nicoyan centenarians get frequent visits from neighbors. They know how to listen, laugh, and appreciate what they have.

Centenarians seem to have enjoyed physical work of all their lives. They find joy in everyday physical chores.

Nicoyans regularly take in the sunshine, which helps their bodies produce vitamin D for strong bones and healthy body function. Vitamin D deficiency is associated with a host of problems, such as osteoporosis and heart disease, but regular, "smart" sun exposure (about 15 minutes on the legs and arms) can help supplement your diet and make sure you're getting enough of this vital nutrient.

Embrace a common history.

Modern Nicoyan's roots to the indigenous Chorotega and their traditions have enabled them to remain relatively free of stress. Their traditional diet of fortified maize and beans may be the best nutritional combination for longevity the world has ever known.

[Try this 5-Minute Tasty Squash and Beans for a taste of Costa Rican homecooking.]

This is an excerpt from Blue Zones: Lessons For Living Longer From The People Who've Lived The Longest by Dan Buettner, copyright 2008, all rights reserved.

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This Central American nation isn't that far from the U.S. geographically, but it is way ahead of us in longevity. The Caribbean nation is economically secure and has excellent health care. But other factors are at play, especially in Nicoya, an 80-mile peninsula just south of the Nicaraguan border.

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This tiny island's long history has been as rocky as its topography. The outcropping in the Aegean Sea has been the target of invasions by Persians, Romans and Turks, forcing its residents inland from the coasts. The result: An isolated culture rich in tradition, family values - and longevity.

Today, Ikarians are almost entirely free of dementia and some of the chronic diseases that plague Americans; one in three make it to their 90s. A combination of factors explain it, including geography, culture, diet, lifestyle and outlook. They enjoy strong red wine, late-night domino games and a relaxed pace of life that ignores clocks. Clean air, warm breezes and rugged terrain draw them outdoors into an active lifestyle.

Read more below about the lessons that Ikaria can teach you about longevity.

Videos From Ikaria, Greece

Ikarians have woven the recipe for longevity into their culture and lifestyle. Follow these common practices to cultivate your own centenarian lifestyle.

The longest-lived Ikarians tended to be poor people living in the island's highlands. They exercised mindlessly by just gardening, walking to their neighbors house or doing their own yard work. The lesson to us: Engineer more mindless movement into our lives.

Eat a Mediterranean-style diet

Ikarians eat a variation of the Mediterranean diet, with lots of fruits and vegetables, whole grains, beans, potatoes and olive oil.

Try cooking with olive oil, which contains cholesterol-lowering mono-unsaturated fats.

People in Ikaria enjoy drinking herbal teas with family and friends, and scientists have found that they pack an antioxidant punch. Wild rosemary, sage and oregano teas also act as a diuretic, which can keep blood pressure in check by ridding the body of excess sodium and water.

Take a cue from Ikarians and take a midafternoon break. People who nap regularly have up to 35 percent lower chances of dying from heart disease. It may be because napping lowers stress hormones or rests the heart.

Ikarians have traditionally been fierce Greek Orthodox Christians. Their religious calendar called for fasting almost half the year. Caloric restriction - a type of fasting that cuts about 30 percent of calories out of the normal diet - is the only proven way to slow the aging process in mammals.

Make family and friends a priority

Ikarians foster social connections, which have been shown to benefit overall health and longevity. So get out there and make some plans.

Choose goat's milk over cow's milk

Instead of cow's milk, Ikarians use grass-fed goat's milk. It provides potassium and the stress-relieving hormone tryptophan. It's also hypoallergenic and can usually be tolerated by people who are lactose intolerant.

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This tiny island's long history has been as rocky as its topography. The outcropping in the Aegean Sea has been the target of invasions by Persians, Romans and Turks, forcing its residents inland from the coasts. The result: An isolated culture rich in tradition, family values - and longevity.

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A cluster of villages in a kidney-shaped region on this island make up the first Blue Zone region we ever identified. In 2004, our research team set off to investigate a rare genetic quirk carried by its inhabitants. The M26 marker is linked to exceptional longevity, and due to geographic isolation, the genes of the residents in this area of Sardinia have remained mostly undiluted. The result: nearly 10 times more centenarians per capita than the U.S.

But even more importantly, residents of this area are also culturally isolated, and they have kept to a very traditional, healthy lifestyle. Sardinians still hunt, fish and harvest the food they eat. They remain close with friends and family throughout their lives. They laugh and drink wine together.

Read more below about the lessons that Sardinia, Italy can teach you about longevity.

Videos From Sardinia, Italy

Set up your lifestyle and environment like a Sardinian centenarian to live a longer, healthier life. Following these practices will promote habits that can keep you living well to 100+.

Eat a lean, plant-based diet accented with meat.

The classic Sardinian diet consists of whole-grain bread, beans, garden vegetables, fruits, and, in some parts of the island, mastic oil.
Sardinians also traditionally eat pecorino cheese made from grass-fed sheep, whose cheese is high in omega-3 fatty acids. Meat is largely reserved for Sundays and special occasions.

Put family first.

Sardinia's strong family values help assure that every member of the family is cared for. People who live in strong, healthy families suffer lower rates of depression, suicide, and stress.

Celebrate elders.

Grandparents can provide love, childcare, financial help, wisdom, and expectations/motivation to perpetuate traditions and push children to succeed in their lives. This may all add up to a healthier, better adjusted, and longer-lived children. It may give the overall population a life expectancy bump.

Take a walk.

Walking five miles a day or more as Sardinian shepherds do provides all the cardiovascular benefits you might expect, and also has a positive effect on muscle and bone metabolism without the joint-pounding of running marathons or triathlons.

Drink a glass or two of red wine daily.

Sardinians drink wine moderately. Cannonau wine has two or three times the level of artery-scrubbing flavonoids as other wines. Moderate wine consumption may help explain the lower levels of stress among men.

Laugh with friends.

Men in this Blue Zone region are famous for their sardonic sense of humor. They gather in the street each afternoon to laugh with and at each other. Laughter reduces stress, which can lower one's risk of cardiovascular disease.

Drink goat's milk.

A glass of goat's milk contains components that might help protect against inflammatory diseases of aging such as heart disease and Alzheimer's.

This is an excerpt from Blue Zones: Lessons For Living Longer From The People Who've Lived The Longest by Dan Buettner, copyright 2008, all rights reserved.

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A cluster of villages in a kidney-shaped region on this island make up the first Blue Zone region we ever identified. In 2004, our research team set off to investigate a rare genetic quirk carried by its inhabitants. The M26 marker is linked to exceptional longevity, and due to geographic isolation, the genes of the ...

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Main Dish

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This recipe was inspired by an Okinawan soup recipe made for us by Kae Izena, who owns a cooking school on Okinawa. Mushrooms are a prized ingredient on the island since they add a deep, umami flavor to dishes, and dried varieties are even beautifully wrapped and given as gifts. They are incredibly low in calories and high in protein, antioxidants, and vitamin D.

Yield: 2 servings

Ready in 20 minutes

Photo by David McLain

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Okinawan Cream of Mushroom Soup - Blue Zones

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This cream of mushroom soup was inspired by a traditional Okinawan dish. Mushrooms are a prized ingredient on the island since they add a deep, umami flavor to dishes, and dried varieties are even beautifully wrapped and given as gifts.

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Main Dish

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In the Blue Zones area of Loma Linda, Seventh-Day Adventists gather for community meals after church or host family dinners on the Sabbath. By surrounding themselves with like-minded friends and family, they support each other's healthy behaviors and create strong relationships. This potato and vegetable soup recipe can feed a crowd, so gather your friends and share a cozy evening together.

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Big-Batch Adventist Vegetable Soup Recipe - Blue Zones

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In the Blue Zones area of Loma Linda, Seventh-Day Adventists gather for community meals after church or host family dinners on the Sabbath. By surrounding themselves with like-minded friends and family, they support each other's healthy behaviors and create strong relationships.

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Video: Oklahoma City, OK

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Mick Cornett: How an obese town lost a million pounds

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Oklahoma City is a midsized town that had a big problem: It was among the most obese towns in America. Mayor Mick Cornett realized that, to make his city a great place to work and live, it had to become healthier too.

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Breakfast

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Corn is one of the most prevalent ingredients in the Blue Zones region of Nicoya, where they often make their own tortillas from maize nixtamal daily.

While cornbread has to be eaten right out of the oven or it dries out, these corn cakes stay moist and delectable for ages. Serve these with a fruit sauce for the perfect morning delight. -Kim Campbell, PlantPure Kitchen

Yield: 4 servings

Prep Time: 10 minutes

Cook Time: 15 minutes

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Blueberry Corn Cakes Recipe - Blue Zones

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Corn is one of the most prevalent ingredients in the Blue Zones region of Nicoya, where they often make their own tortillas from maize nixtamal daily. While cornbread has to be eaten right out of the oven or it dries out, these corn cakes stay moist and delectable for ages.

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Main Dish

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Main Dish / Side Dish / Vegetarian / Plant-based / Vegan

Most of the food eaten in Ikaria is harvested from seasonal gardens, which provide the purest form of the Mediterranean diet in the world. Summer plots feature arugula tomatoes, peppers, eggplant, and varieties of citrus fruits. This Ikarian variation of an iconic Turkish eggplant recipe is a celebration of Ikarian summer vegetables and offers antioxidant-rich anthocyanins from the popular nightshade eggplant. Add the heartiness of potatoes and you have another one-pan meal that won't leave you wanting. This is a chewy, richly textured entree that's hearty enough to satisfy even your biggest carnivores at dinner time.

Ingredients

5 medium eggplants, ends cut off, scored deeply four times lengthwise

1 cup parsley, chopped

2 large tomatoes, diced

2 onions, diced

4 cloves garlic, sliced in thirds

1 cup extra-virgin olive oil

1 potato, peeled and thinly sliced

1 bell pepper (green, red, or yellow), diced

Salt and pepper to taste

Directions

1. In a large pan, sauté eggplants in olive oil for about 10 minutes, rotating often.

2. In a medium bowl, mix together parsley, tomatoes, onions, garlic, bell pepper, and 1 cup olive oil as your stuffing mixture.

3. In a separate pan, sauté stuffing for 6-8 minutes, or until onions are tender.

4. Add the stuffing mix on top and into the eggplants. Place potatoes around the eggplants in the pan.

5. Cook over low heat for about 30 minutes, checking the pan for liquid and basting with cooking liquid, if needed.

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Ikarian Stuffed Eggplant (Imam Bayildi) - Blue Zones

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Most of the food eaten in Ikaria is harvested from seasonal gardens, which provide the purest form of the Mediterranean diet in the world. Summer plots feature arugula tomatoes, peppers, eggplant, and varieties of citrus fruits. This Ikarian variation of an iconic Turkish eggplant recipe is a celebration of Ikarian [...]

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Cost-effectiveness of community-based childhood obesity prevention interventions in Australia

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Cost-effectiveness of community-based childhood obesity prevention interventions in Australia

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" Our analysis showed that CBIs implemented in Australia are likely to be cost-effective, representing good ‘value for money’ if the intervention effect is maintained into adulthood "

DOI: 10.1038/s41366-019-0341-0