The Blue Zones Solution: Eating and Living Like the World’s Healthiest People

BY JENNIFER PRITCHARD, MHA, RN, CCM, CPHQ, CDCES, AND JENNY QUIGLEY-STICKNEY, MSN, RN, MHA, MA, CCM, ACM-RN, CMAC, FCM

Introduction

The pursuit of longevity and well-being has long fascinated public health researchers, clinicians, and policymakers. Where do the longest-lived people reside, and what secrets underpin their vitality? National Geographic fellow Dan Buettner explored these questions with his team, identifying five geographic areas with unusually high concentrations of centenarians. These regions—Ikaria, Greece; Okinawa, Japan; Sardinia, Italy; Loma Linda, California; and the Nicoya Peninsula, Costa Rica—became known as the “Blue Zones” (Buettner, 2012).

Buettner’s book, The Blue Zones Solution: Eating and Living Like the World’s Healthiest People, synthesizes lessons from these populations, emphasizing the role of diet, physical activity, and community in achieving long life. He has also collaborated with municipalities to translate these insights into community health initiatives, reshaping environments to support healthful living. This paper explores how the Blue Zones model can inform community transformation, align with Centers for Medicare & Medicaid Services (CMS) initiatives, and illustrate the power of addressing the social determinants of health (SDOH).

Community Interventions: Lessons From North Karelia

One of Buettner’s most frequently cited case studies is Finland’s North Karelia Project. In the 1970s, men in this region faced heart attack rates 30 times higher than those in Crete (Buettner, 2012, p. 91). Initial top-down interventions were unsuccessful. A shift occurred when public officials and community members collaborated to create systemic change across the food industry, restaurants, supermarkets, and schools.

Key strategies included the recruitment of 1,500 lay ambassadors who educated residents on reducing dietary fat, salt intake, and tobacco use. Local farmers were incentivized to cultivate berries for year-round consumption, providing healthier alternatives to high-fat dairy. These grassroots changes resulted in remarkable outcomes:

• Male smoking prevalence declined from more than 50% to approximately 20%.
• High-fat dairy consumption dropped from 70% to under 10%.
• Average cholesterol decreased by 20%.
• Male heart disease mortality fell by 85% (Buettner, 2012, pp. 96–97).

Eight critical lessons for community transformation emerged:

1. Focus on the ecology of health by altering environments rather than relying on individual responsibility.
2. Develop flexible systems that encourage innovation.
3. Collaborate with local healthcare providers to disseminate evidence-based practices.
4. Persistently push for cultural change through grassroots engagement.
5. Identify charismatic leaders to champion initiatives.
6. Ensure community ownership of change.
7. Integrate both top-down and bottom-up strategies.
8. Rigorously measure outcomes to track progress and validate strategies.

The success in North Karelia ultimately informed Finland’s national health strategy.

Replication in the United States: Minnesota Case Study

Buettner later applied similar strategies in Minnesota, focusing on two phases: food environment transformation and building “circles of friends.”

Phase One: Food Makeover
Nutrition experts partnered with restaurants and schools to promote healthier meals, showing that reduced operating costs could coincide with improved dietary quality. Within months, more than 30 restaurants adopted healthier menus, and schools incorporated improved nutrition policies.

Phase Two: Walking Moais
Drawing from Okinawa’s tradition of moai—lifelong friendship groups that foster mutual support—Minnesota leaders encouraged residents to form walking groups. More than 800 individuals joined walking moais, reinforcing the idea that healthy behaviors are socially contagious. Complementary initiatives, such as “walking school buses,” encouraged children to walk to school with adult supervision, increasing active transportation rates to approximately 30%.

These interventions highlight the importance of leveraging both policy reform and community engagement to build sustainable cultural change (Buettner, 2012, p. 113).

Measuring Community Well-Being

To evaluate impact, Buettner’s team employed the Gallup Well-Being Index, which measures six domains: life evaluation, emotional health, physical health, healthy behaviors, work environment, and basic access (Gallup, as cited in Buettner, 2012, p. 122). This approach provided evidence to policymakers and stakeholders, guiding local ordinances such as smoke-free beach policies in Hermosa Beach, expanded bike infrastructure in Redondo Beach, and restaurant menu reform across California’s Beach Cities.

Critiques and Scientific Debate

While the Blue Zones concept has gained global popularity, criticisms have emerged. Newman (as cited in Al Jazeera, 2019) raised concerns about flawed demographic records and potential overestimations of centenarian prevalence. Genetics and chance may also contribute to longevity, complicating causal interpretations.

Buettner (2024) counters these critiques by noting that Blue Zones are validated through strict demographic criteria, reliable census data, and robust age-verification methods. Regardless of debate, Blue Zone interventions reinforce evidence-based principles: Plant-forward diets, physical activity, and strong social ties are consistently linked to improved health outcomes.

Legislative and Policy Support

Creating modern Blue Zones requires supportive policies:

1. Complete Streets and zoning reforms: Encourage mixed-use, walkable neighborhoods (CDC, 2022).
2. Tobacco control laws: Smoke-free parks, higher tobacco taxes, and stricter sales regulations (Blue Zones Project, 2022).
3. Healthy food policies: Limit fast-food density, support farmers’ markets, and require healthy fundraisers in schools (Blue Zones, 2020).
4. Alcohol regulation: Reduce outlet density and restrict advertising while encouraging moderation (Blue Zones Project, 2022).
5. Worksite wellness incentives: Tax credits for employers offering active commuting options and wellness programs (CDC, 2022).
6. Social infrastructure: Support for community centers, libraries, and intergenerational mentorship (Buettner, 2012).
7. Healthcare and education initiatives: Incentivize preventive care, lifestyle medicine, and nutrition education (UCLA Health, 2021

Blue Zones, Social Determinants of Health, and CMS Initiatives

The Blue Zones model serves as a living demonstration of SDOH in practice. SDOH—such as economic stability, educational access, healthcare access, neighborhood design, and social connection—directly influence population health outcomes (Centers for Disease Control and Prevention [CDC], 2020).

CMS policies increasingly integrate SDOH into healthcare delivery. Examples include:

• Accountable Care Organizations (ACOs): Addressing food insecurity, housing, and transportation.
• Medicare benefits: Expanding nonmedical supports such as transportation, pest control, and home modifications.
• Medicaid 1115 waivers: Covering housing, nutrition, and community-based programs.
• Accountable Health Communities (AHC) Model: Testing SDOH screening and referral systems for Medicare and Medicaid beneficiaries (CMS, 2025).

Though CMS does not explicitly endorse Blue Zones, parallels exist in policy priorities: prevention, lifestyle medicine, population health, and community integration. Legislative tools such as complete street policies, zoning reforms, tobacco control, and healthy food regulations further align U.S. communities with Blue Zone principles (CDC, 2022; Blue Zones, 2020).

Conclusion

The Blue Zones provide a compelling framework for aligning daily habits, social support, and environmental design with health promotion. When combined with CMS-driven reforms—such as ACOs, value-based care, and SDOH education in communications can create healthier, more resilient populations. While debates regarding longevity data persist, the enduring lessons of the Blue Zones underscore the power of prevention, social connectedness, and supportive policy in advancing longevity in healthcare.

References

Chat GPT AI APA format (2025)

Al Jazeera. (2019). Japan’s centenarians questioned amid fraud cases. https://www.aljazeera.com

Blue Zones. (2020). Power of 9: Lessons learned from the world’s healthiest people. https://www.bluezones.com

Blue Zones Project. (2020). Policy initiatives for community transformation. https://www.bluezonesproject.com

Buettner, D. (2012). The Blue Zones: 9 lessons for living longer from the people who’ve lived the longest. National Geographic Books.

Centers for Disease Control and Prevention. (2020). Built environment and health. https://www.cdc.gov

Centers for Disease Control and Prevention. (2022). Complete streets and zoning reforms. https://www.cdc.gov

Centers for Medicare & Medicaid Services. (2025). Accountable Health Communities model. U.S. Department of Health and Human Services.

Poulain, M., Pes, G., & Salaris, L. (2024). The Blue Zone: Areas of exceptional longevity around the world. Experimental Gerontology, 39(9), 1423–1429.

UCLA Health. (2021). Secrets of the Blue Zone longevity. https://www.uclahealth.org

Buettner, D. (2024). The science behind Blue Zones: Demographers debunk the critics.

Jenny Quigley-Stickney, RN, MSN, MHA, MA, CCM, ACM-RN CPHM FCM, professional case manager Cape Cod Healthcare, has been active with CMSA/CMSNE for over 25 years serving currently as CMSA President-Elect 2025-2026 and prior to this role, served as CMSA Treasurer, Board of Director for CMSA from 2021-2023. Prior to working for CMSA National, she served as the President of CMSNE & Chair for both CMSA and CMSNE Public Policy Committees.

Jenny is active in the CMSNE New England states, serving as co-chair for Public Policy promoting the advancement of the Nurse Licensure Compact, and Telehealth legislation for health care professionals. She has a passion for public policy and believes that legislation helps advance the field of professional case management. Jenny expanded her role, working on the National Board to becoming a member of CMSA Editorial Board 2021-current, CMSA Strategic planning committee for organizational development, Chair CMSA Finance Committee 2023-2026 and CMSA Sponsorship Committee 2022-current.

Jenny has been employed at all levels of the transitions of care, working with traumatic brain Injury, stroke and spinal cord for over 25 years in acute rehabilitation hospitals, hospital at home program and Outpatient Program Director for traumatic brain injury. She recently has shifted her work in professional case management back to her first love, acute care, focusing on vascular and trauma care in ICU and step-down unit for Cape Cod Healthcare.

Jennifer Shand Pritchard is a nurse with over 40 years’ experience in a wide variety of specialties. She graduated from the University of Ottawa, Canada with a Bachelor of Science in Nursing and later received her master’s in healthcare administration from Simmons University. She has worked in a variety of settings that include public health (Canada), school nursing, neonatal intensive care, home care, general med-surg, utilization management, case management, quality, and diabetes self-management. She is certified in Case Management, (CCM) and  Certified Healthcare Professional (CPHQ) in Quality. She is currently working for a large primary and specialty care physician network in Massachusetts as Director of Case Management.

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