While each American has a responsibility to manage their own health, evidence-based modifications to the living environment can produce sustainable healthy habits and better outcomes, lower health-care costs, and increased economic returns.
Inspired by areas around the world that have achieved the world’s healthiest life expectancies, I developed a population health master plan that does not rely on individual responsibility or decades of sustained discipline. The Blue Zones Project instead engineers people’s environment so that they make better health decisions unconsciously. In the 72 US cities that have undertaken comprehensive, multiyear efforts to improve living environments, we have seen impressive measurable health results and economic returns.
Broadly speaking, these programs have helped people move more, eat healthier, connect socially, and live purposefully, resulting in a host of benefits, including greater life satisfaction, lower incidence of disease, and markedly fewer health-care costs. The approach invites local leaders from both the private and public sector to work together to implement evidence-based nudges and defaults that make it easier for people to make the healthy choices and avoid the harmful ones.
Municipalities adopting designs for healthier communities have measurably lowered obesity rates (and the related chronic diseases) while increasing quality of life. Moreover, this approach has yielded medical cost savings, improved workforce productivity, and regional economic impact estimated at $300 million per 100,000 people across a decade.
The key to the success in all of these cites involved a paradigm shift.
Effective community-wide designs focus on:
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Policy: Introduce best practices and drive consensus on municipal policies that favor health. Examples include designing streets for walkability and curbing junk food marketing to children.
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Places: Help schools, restaurants, grocery stores, and places of worship adopt the designs and policies that favor healthy eating, more movement, and social connectedness. For instance, schools limit junk food eating in hallways and classrooms, workplaces improve cafeteria options and remove sugar-sweetened beverages and snacks from vending machines, grocery stores make healthy foods more visible.
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People: Provide strategies to design homes and social networks to favor natural movement, better eating, and foster connectedness. All participation is voluntary and revolves around positively modifying surroundings to consciously and subliminally encourage behaviors and habits that improve mental and physical health.
Economic Case
The investments in the comprehensive community design-approach for better health have delivered a five-to-one return on investment (ROI) after five years.
Because these improvements are generally achieved through permanent or semipermanent changes in the environment (walkability, bikeability, food systems, tobacco policy, etc.), the value compounds over time. ROI at 7 years and 10 years averages between 9 to 1 and 13 to 1, respectively.
Communities that have followed this process have achieved gains in life satisfaction (as independently measured by Gallup) and a substantial drop in health-care costs.
For example, Albert Lea, Minnesota saw a 35 percent drop in smoking between 2010 and 2016. Corry, a small town in Pennsylvania that signed onto the project in 2019, has seen the number of residents reporting high cholesterol decrease from 27 percent to 12 percent. A study published in the medical journal BMJ found that the program improved life satisfaction and optimism among residents of three participating beach cities in California: Hermosa Beach, Manhattan Beach, and Redondo Beach.
The Southwest Florida Blue Zone region recently reported 23 percent lower obesity compared with the rest of the state. NCH Healthcare, the project’s main health-system partner based in Collier County, Florida, reported, in a New England Journal of Medicine research publication, a 54 percent decrease in workforce health-care expenditures over six years. There is a rich reservoir of data that delineates these improvements, which can provide a road map for the broad federal initiative here proposed.
The key to the success in all of these cites involved a paradigm shift. Instead of expecting Americans to muster heroic discipline and presence of mind and pursue the right diet and exercise program for decades, we shaped the environment so right behaviors ensue unconsciously for the long run.