Some years back, the Blue Zones book caught my eye. Since I’m interested in optimum health, who better to learn the tricks of long life than from the people who live the longest on earth? The Blue Zones: Lessons for Living Longer from the People Who’ve Lived the Longest1 identified five places in the world where people live the longest. The researchers compared these cultures and found common themes. Perhaps these characteristics could be the key to long, happy lives for the rest of us.
The five cities with the longest life expectancies in the world are:
- Sardinia, Italy
- Okinowa, Japan
- Nicoya Pensinsula, Costa Rica
- Loma Linda, California
- Icaria, Greece
And these are the characteristics that all five Blue Zones shared in common:
- Moderate, regular physical activity
- Life purpose
- Stress reduction
- Moderate caloric intake
- Plant-based diet, low in meat
- Moderate alcohol intake (frequently wine)
- Engagement in spirituality or religion
- Engagement in family life
- Engagement in social life
Nine commonalities of the Blue Zones. https://bluezones.com/live-longer-better/#section-2
My focus in this blog is not the Blue Zone diet or their activity levels, albeit fascinating. I want to talk about their social engagement and how this improves physical health. People who lived inside of these Blue Zones had a sense of belonging. Their social relationships were an important and constant feature in their lives. They were involved in family life, community, and in spiritual or religious life.
Ninety-eight percent of the 100-year-olds interviewed for the book belonged to a faith-based community. They put their families first. They kept elderly family members close by. They had life partners and they invested time and love with their children. Finally, the people who lived longest had social circles that supported healthy behaviors. Sounds like a very busy social and family life!
The psychological research also tells us that social engagement helps you live longer. A meta-analysis published in 2015 showed that social isolation and loneliness increased the odds of dying, especially for people under 65 years old. The researchers analyzed 70 independent prospective studies, which encompassed a whopping 3.4 million people, who were followed for an average of 7 years. The researchers accounted for age, socioeconomic status, and of course health status, among other factors to determine of loneliness or social isolation affected mortality. 2
Loneliness and social isolation are not the same thing. Social isolation is characterized by living alone, having infrequent social contact, and few social network ties. It is an objective measurement. On the other hand, loneliness is a subjective emotional state. It is the perception of social isolation. A person may be socially isolated and not feel lonely. The reverse is also true: A person may feel lonely even while they are socially connected. The meta-analysis showed that regardless, either objective measures of social isolation or subjective feelings of loneliness, increased the chances of death at 7 year follow-up by 29% or 26%, respectively. Living alone increased the odds of death by 32%.2
Being lonely and isolated is as bad for your health as well-established risk factors for mortality such as smoking, obesity, substance abuse, or lack of physical activity.2 Social isolation is highest in affluent countries and it’s climbing. While living alone has its perks, physical health is not one of them.
We are social creatures. The Blue Zones teach us that social connectedness is fundamental to a long and healthy life. Indeed, social connectedness increases survival rates. Perhaps loneliness is an adaptive signal that nudges us to seek out connection in order to increase our chances for survival and reproduction.2
If we live alone, then we need activities that connect us to others: church, support groups, sports, etc…If we feel lonely, then perhaps we need more meaningful connection or emotional intimacy. The Blue Zoners are connected to family, faith-based groups, and social groups. I think this is an important reminder when aiming for comprehensive health for ourselves and our patients. We need to focus not only on diet, nutrition, and physical activity but the social connectedness of our patients. Do they feel lonely? Are they socially isolated? These areas need just as much attention as smoking, obesity, or a sedentary lifestyle. It can make the difference between life and death.
- Buettner D. The blue zones: lessons for living longer from the people who’ve lived the longest. Washington, D.C.: National Geographic Society; 2008.
- Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on psychological science : a journal of the Association for Psychological Science. 2015;10(2):227-237.