[Music] for the past ten years or so I've been working with National Geographic to identify geographically defined demographically confirmed parts of the area where people live measurably longer these are populations not just individual experience tens of thousands of people in most examples and then working with other experts to find their common denominators I wrote this up in a book called Blue Zones you don't have to buy the book because in the next 90 seconds I'm going to tell you all the essential secrets no matter where you go in the world whether it's Okinawa Japan certainiy Italy the highlands Nicoya Peninsula Costa Rica the Katya Greece I'm on the seventh-day adventists you see the same nine things happening over and over and over among the longest live people a lot of these things are very intuitive eating a plant-based diet lo and simple carbohydrates high in things like beans and nuts the ever-popular prescriptive to have a couple glasses of wine a day and no you can't save up all week long and have 14 on the weekends people actually ask me that but the really cool findings come from the counterintuitive things you do you know that people who have a strong sense of purpose and can articulate it live about seven years longer than people who don't people who belong to a faith-based community and actually show up four times a month lift four to 14 years longer than people who don't and none of the longest-lived people in the world and I interviewed 253 of them ever exercise in the way we think of exercise they did however live in environments that constantly nudge them into physical activity they burnt about five times as many calories as we do in non exercise physical activity they lived anywhere from 7 to 11 years longer than we did with a fraction of the rate of chronic disease these are populations one of them is even an American population that was a decade longer than the rest of us but as you know you can tell people all day long the things they ought to do to live longer and to be healthier but how do you actually get a population to do them we spend almost a trillion dollars a year and largely preventable diseases cancer diabetes heart disease largely preventable diseases but I assert we not only are spending too much but we're aiming at the wrong target if you look at what really drives disease and costs in this country about 80% of it is lifestyle and environment only about 10% is genes this is on a population as a whole and healthcare accounts for another 10% of it but now look at the way we spend our money this incidentally comes from the CDC we spend only about 4% of our our healthcare dollars on on prevention and then we spend 88 percent of them on cleaning up the problem if the problem has happened we're aiming at the wrong target instead of the downstream problems we should be aiming at what to do before they happen I think most of us know that we do spend over a hundred billion dollars a year on prevention so you may say Dan you know we're are an overweight population here in America we don't move enough we nudists we should be focusing on diets and exercise and supplements the problem is by and large they don't work when you think of things that are going to truly add to longevity to truly lower your chances of getting a chronic disease you cannot think in months or in years you have to think in decades or a lifetime so you say well diets a pretty good idea but no diet in the history of the world has ever worked for a significant proportion of people who started we could come up right now we could spend the next three days and come up with the TEDMED diet the best minds on the planet when it comes to medicine come down and come to Ted come up with a TEDMED diet we get mark up here and J up here and we do a man hug and we get people all pumped up about it but the reality of diets if a hundred people start a diet 'day within seven to ten months you'll lose 90 of them and within the next two years you'll lose all but about percent of them so when it comes to a long-term strategy diets don't work no diet in the history of the world exercise has a similar recidivism curve we were able to find data on gym memberships on out of a hundred people who start a gym membership today in three years you'll learn lose about 90 percent of them this is a bit of a heresy I know but when it comes to public health exercise just isn't working the average American only burns 100 calories per day engaged in willful physical activity exercise supplements whether they're medicinal or nutraceutical about the same thing we may say Stanton's and aspirin are really good for people to take but you don't get a critical mass you don't get enough people taking them over time so based on these findings I went back to National Geographic and I proposed another blue zone type worldwide search but this time I wanted to find communities that were unhealthy and got themselves healthier and God blessed that rectangular yellow heart of National Geographic they funded me one all over the world and found out two remarkable things number one of the tens of millions of dollars we spend on public health and different initiatives for that Amed chronic disease none of them have worked there's one in Minnesota the heart healthy there's the one in Stanford Connecticut another one in California what happens is more or less the health care equivalent of the Hawthorne effect as long as the experts are there paying attention and the TV cameras are rolling people will do what they ought to do but as soon as they leave people revert back to their baseline so as a long-term strategy it just the simply don't have them worked here in America there are two places in the world where projects have started out with unhealthy people and made their populations healthier one in France northern France the e-poll project brought down the rates of childhood obesity and maintain them for eight years and the second place was in Scandinavia they brought down the rate of cardiovascular disease by 90 percent and maintained it for decades and I was able to spend several months with these projects and really take a look at how they executed them how they made them work and I realized that the essence of their success hinged on a tenant that's very different than that attendant many of us subscribe to these projects did not rely on individual responsibilities to be successful they didn't look at you and say it is up to you to get yourself healthier they realized that we're all part of a system and you need to address the system so based on that I used some of the money of that grant to hire who I think are the greatest experts in America when it comes to optimizing an American system this by the way is not a program it's not a template it's an operating system it's a way of thinking and I pulled together six people from various different disciplines to help me think about how do you optimize an American community for health and our first finding was that we all live in a life radius we most of us spend about 80% of our lives within about 20 miles of our homes and works so that's the area that we're trying to make better now what sorts of things influence a life radius well number one you have policy is it easy to smoke in this community can i smoke indoors and out is soda pop and salty snacks are they cheap do day care centers allow the licensed daycare centers allow little kids to watch TV before age - is there an opt-in or opt-out policy when it comes to organ donation state these things make a huge difference on a statewide level the built environment is it easy to walk downtown our parks neat and alluring is it safe you know the number one inhibitor to old people going out and getting extra the perception of safety doesn't even have to be safe just cleaning up cleaning up graffiti will get more older people out Robert Wood Johnson Foundation found that if you can just make the after active option the easy option in communities you raise the physical activity level of that community by thirty to forty percent no gym memberships no yoga classes no AB master just make the active option the easy option social networks another thing that you can modify at an environment if your three best friends are obese is a hundred and fifty percent better chance that you'll be overweight how do you help people optimize their social networks or expanded if necessary then there's structures we spend our daily life's in schools restaurants you know we eat out a hundred and ten times a year you could have a perfect kitchen but if if you're eating out a third of the time in places where they're over serving you it for every meal there's a problem there schools workplaces and then sense of purpose how do you in view people with a clear idea of what their values are and what they're good at and give them an outlet so this was a nice theoretical construct this is where we got the name silver buckshot evidence-based ways unleash him on an environment well thanks to AARP and the University of Minnesota School of Public Health we got another big grant to actually audition five cities and come into the city most ready to adopt this blueprint Albert Lee Minnesota one and they mainly one because the mayor the city manager the head of public health the superintendent of schools had a Chamber of Commerce signed a pledge saying we're on board for changing the environment our experts came in and we just listened we found out for example that they wanted to widen Main Street and raise the speed limit something that we believe would tear the social fabric in half instead we convinced them to use some of that money to create one walking vector from every neighborhood downtown there was a beautiful place to recreative on this beautiful lake but you couldn't get around it so we took some of the street Wyatt E money and we created a path which is now full all the time optimizing the built environment we built for community gardens this is a city of only 19,000 people dr. Brian Watson came in and helped us optimize food environments do you know the one adjectives that most assures that you will not order an entree on a menu the healthy choice nobody wants a damn healthy choice they want something good adjectives like crispy and fresh will get people eating the same food that was otherwise mislabeled we have dozen tweaks we can do to restaurants when in all the grocery stores got them to flag healthy foods and even create checkout lanes where the impulse buys were all healthy we went in all seven schools and got them to adopt nine policies the most powerful one of which a simple policy that prohibits kids from eating in classrooms and hallways that one policy alone much more impactful than whatever you put in the school lunch that one policy alone will lower the BMI of that school by about 11% and it's permanent we went into about half the workplaces appeal to individuals and got them to sign a pledge to make permanent changes to their homes everybody took a risk a risk assessment longevity compass we call the vitality compass so we could get a baseline we got them to do permanent things like grow gardens let our experts come into their kitchens and trade out the 14 inch blades for 10 inch plates and do things like put signs on the counter reminding people to pre plate their food those two habits alone equate to about a twenty to thirty percent fewer calories in any given sitting and then we went and helped people optimize their social environment we took the people or ready to change their behaviors and fostered long-term friendships with them over the course of 18 months we got phenomenal media coverage USA Today Good Morning America Nightline Walter Willett the Dean of Harvard School of Public Health came in and wrote a two-page story on our on our little experiment and found the results stunning US News and World Report's came in a year and a half later and found out that everything we put in place was still working and then our numbers I think mirrored the success of the idea people's life expectancy went up people's weight went down and there was a 40% drop in city workers health care cost that ladies and gentlemen is where the rubber hits the road I don't have to tell this audience that we have a healthcare problem in our country 68% of us our beefs are overweight and that numbers going up along with cost diabetes is on the way up and for the first time in living history life expectancy of our children is supposed to go down is that because we're stupid or if somehow undergone a degradation of our moral character or we have less discipline or love our children less than our grandparents or kids did now we live in an environment of ease and abundance we are evolutionarily hardwired to crave fat and to crave sweetness and to crave rest when we can get it but we cannot go to a pharmacy to fill up our car with gas to rent a DVD without being routed through a gauntlet of salty snacks or sugar sweetened beverages every single day 278 images rinse over our brain telling us to buy it stuff we largely don't need and to eat food that isn't all that good for us raise your hand if you walk to school when you're a kid go ahead rage and look around almost every hand is up now raise your hand if your children walk to school 1970 50% of American children walk to school we're now down to about 10% just engineered three miles of free physical activity out of kids is daily a weekly life when it comes to making this country healthier and getting health care cost under control there is no silver bullet it's silver buckshot its unleashing evidence-based long-term ways to change people's environments and it's doing it one ready community at a time thank you [Applause] [Music]