In one of the first scenes of a new Netflix series about finding the secrets to longevity, a 101-year-old woman in Okinawa, Japan plays a banjo-like instrument called a sanshin. She then playfully balances a bottle on her head as she dances with her family.
The series is the latest effort from author Dan Buettner to promote the concept of Blue Zones – his trademarked term for a handful of global locales where people are said to enjoy longer, healthier lives. In addition to Okinawa, these zones include Ikaria, Greece; Sardinia, Italy; the Nicoya Peninsula in Costa Rica; and Loma Linda, a community of Seventh-Day Adventists in California. Buettner’s company, also called Blue Zones, seeks to bring lessons from these areas to cities across the U.S. by helping to implement large-scale public health projects.
Now, Eleonora Tornatore-Mikesh, CEO of the Alzheimer’s nonprofit CaringKind, is on a mission to bring the Blue Zones team to New York City, where she believes it could help reduce the burden of Alzheimer’s disease – although her efforts are still in the early stages. A July study estimated that in the Bronx, about 1 in 6 seniors has Alzheimers, giving the borough one of the highest rates of the disease in the country among counties with 10,000 or more people over the age of 65.
That’s partly because the Bronx also has higher rates of health issues like diabetes, heart disease and high cholesterol, which are risk factors for Alzheimer’s, said Dr. Jessica Zwerling, director of the Memory Disorders Center at Blondell Avenue at Montefiore Medical Center.
Buettner has generated significant traction in recent years for his idea that the secrets of long life – including a strong sense of community, a mostly plant-based diet and natural forms of daily exercise – can be distilled from these Blue Zone communities and then imported elsewhere. His company has so far partnered with more than 70 communities across the U.S. on policy and infrastructure projects designed to promote healthier populations. The projects the company promotes can range from smoking bans and healthy-eating initiatives to long-term infrastructure projects such as giving kids a walkable route to school.
Tornatore-Mikesh wants to bring some of the vitality of the Blue Zones to New York and has coordinated preliminary meetings this year between city officials and Nick Buettner, Dan’s brother and Blue Zones’ vice president of community engagement, to start to “plant the seed” about the concept.
“I really believe this could be transformational for New York,” said Tornatore-Mikesh. CaringKind provides resources to the often stressed-out New Yorkers caring for loved ones with Alzheimer’s disease and other forms of dementia.
Tornatore-Mikesh said she believes that Blue Zone’s principles could be applied not only to create stronger support networks for caregivers but also to prevent New Yorkers from developing Alzheimer’s in the first place.
But the process of launching a Blue Zones partnership is not an easy one. The model involves finding funders with a stake in creating a healthier population, such as local employers or health insurance companies — and getting buy-in from a broad network of local entities, including nonprofits, schools, businesses and worksites.
“We talk to the City Council, the Chamber of Commerce, the big CEOs, the mayor, the superintendent of schools, and we basically show them these policies that favor healthy eating, favor the pedestrian, favor the non-smoker,” Dan Buettner explained in an interview with Gothamist. “We say, ‘Is there an appetite to consider these for effectiveness and feasibility here?’”
Mayor Eric Adams has made healthy eating as a way to combat chronic disease a centerpiece of his political platform and personal brand, so he would appear to be the perfect partner for such a program. He is already implementing policies that appear to align with the Blue Zones program on his own – including providing meat-free meals in public schools (which initially received a lukewarm response from students) and expanding the public hospital system’s focus on lifestyle medicine, a discipline that uses behavior changes to combat chronic disease.
More work could be done to address the significant disparities in health outcomes and life expectancy between different New York City ZIP codes. But some skeptics question whether it’s necessary to rely on Blue Zones-branded programs to implement new public health initiatives.
When the New York Times recently asked City Councilmember Charles Barron about a health-focused housing project in East New York whose developer cited Blue Zones as its inspiration, he said, “We don’t have to look to Okinawa. We know how to build healthy communities. There’s nothing new and magical about that.”
Tornatore-Mikesh said she hosted a dinner party attended by Adams earlier this year where Nick Buettner presented the concept of Blue Zones – but the encounter doesn’t seem to have made a big impression. Asked what the mayor thought of the idea, City Hall spokesperson Jonah Allon said Nick Buettner had met with members of the administration but not the mayor.
In a statement, Allon said “making New York the healthiest big city in America is a priority for this administration, and we are always open to new ideas on how to improve public health outcomes, including promoting mental wellbeing, reducing rates of chronic disease, and more.”
What does the Blue Zones model add?
After working with demographers to identify five communities with disproportionately high numbers of centenarians in the early 2000s, Dan Buettner spent years visiting these places to distill common habits around diet, exercise and socialization – tenets that he has since dubbed the Power 9. These principles help guide Blue Zones’ partnerships with different cities, though each one has a different focus crafted with local input. Outcomes are assessed in partnership with the research firm Gallup.
Beneath the Blue Zones branding and Dan Buettner’s observations about islands where people “forget to die” are lifestyle practices that are largely supported by other scientific research, according to doctors who spoke with Gothamist. These include eating a mostly plant-based diet with lots of beans, finding routine ways to get physical activity in everyday life rather than stressing about getting to the gym, reducing stress, and having a core group of people to socialize with on a regular basis – a concept known in Okinawa as moai.
“We are in a crisis of loneliness and isolation and there is more and more data on the protective effects of social connection,” said Dr. Michelle Loy, a physician at Weill Cornell who focuses on lifestyle and integrative medicine. She added that the Blue Zones diet overlaps with the Mediterranean diet, which has been shown in clinical trials to help combat diabetes and cardiovascular disease.
Loy said she finds the stories about how people live in Blue Zones useful because they provide a compelling narrative. “I speak about [Blue Zones and the Power 9] continuously with my sufferers and every time I do medical schooling on way of life medication,” Loy stated.
Tornatore-Mikesh also said she was partly drawn to the model because it had good branding. CaringKind already offers support groups for caregivers, which Tornatore-Mikesh said helps create community. But she likened the Blue Zones movement to SilverSneakers, a popular exercise program for seniors that is now funded by some Medicare plans and has been shown to increase physical activity and decrease social isolation.
“There’s something about labels that people identify with,” Tornatore-Mikesh said.
In practice, Blue Zones projects involve a lot of the work associated with any public health initiative, such as gathering together the right stakeholders to campaign for a particular policy change. In Fort Worth, Texas, for instance, Blue Zones helped create support for an ordinance to ban smoking in bars and bingo parlors, which was still allowed until 2018. The ban contributed to a 31% reduction in Fort Worth’s smoking rate, according to Blue Zones’ case study on the city.
“Historically, there was grassroots and political resistance to that for a number of reasons,” said Matt Dufrene, who was originally hired by Blue Zones and now works for Texas Health Resources, the nonprofit health system that took over the project. “Part of the work was just navigating the right time to implement different policies.”
After the Blue Zones initiative began, Fort Worth’s ranking in the Gallup-Sharecare Wellbeing Index, which surveys people about their diets, health and wellbeing, also went up.
But Fort Worth is still waiting for some of the projects that Blue Zones put in motion to bear fruit, including a grant-funded initiative to create walkable routes for kids to get to school. “We began that work way back in 2015 and the actual construction is still happening today,” Dufrene said.
In general, Dan Buettner said he tries to focus on initiatives that create the right environment for people to live healthier lives, rather than pushing them to make the right choices.
Tornatore-Mikesh said she would want to launch a Blue Zones project in the Bronx, given the high rates of Alzheimer’s disease. But Dan Buettner said a Blue Zones partnership is typically with a whole city. Asked whether the model could be applied to a city as large and diverse as New York, he expressed confidence that it’s “infinitely scalable.”
But while New York officials are routinely pushing new public health initiatives, it’s still unclear whether the city needs – or wants – to become a trademarked Blue Zone.