by Rich Eisenberg. This article originally appeared on Next Avenue.
(In 2008, National Geographic writer Dan Buettner published his bestselling book, The Blue Zones: 9 Lessons for Living Longer From the People Who’ve Lived the Longest, about the five “longevity pockets” around the world. For this weekly series, Next Avenue Money and Work & Purpose editor Richard Eisenberg, a Gerontological Society of America Journalists in Aging Fellow, takes a different look at the Blue Zones — places where there’s a high concentration of people living past 90 without chronic illnesses. Rather than focusing on the residents’ diets, he reports on how the oldest people in the Blue Zones make their money last and what Americans and America can learn from this. This installment, Part 2, is about the Blue Zones of Okinawa, Japan; Sardinia, Italy; and Ikaria, Greece. Part one and part three of the series are also available on the DEC blog.)
The Blue Zone of Okinawa, Japan
An archipelago of 150 small, rural islands south of mainland Japan, Okinawa is best known to Americans for two things: Its horrific World War II battle and the “Okinawa Diet.” That plant-based diet (big on sweet potatoes) is believed to be a key reason for the residents’ exceptional longevity. I was curious to learn how the centenarians and nonagenarians there make their money last and spoke with several experts who know them well and have spent a good deal of time with them.
Okinawa, the subtropical area sometimes called the Japanese Hawaii, has roughly 25 centenarians per 100,000 inhabitants — and they’re mostly healthy centenarians. Rates of heart disease, strokes, prostate cancer and dementia are far lower than for people their age elsewhere. Frequent walking, as well as physical labor from agricultural work, fishing and gardening, keeps them in good shape.
But two other factors help explain why, as Francesc Miralles (co-author of Ikigai: The Japanese Secret to a Long and Happy Life), told me, the oldest Okinawans “don’t worry about money” — even though they live in one of the poorer parts of Japan.
One is ikigai (pronounced EYE-kih-guy). Loosely translated as the happiness of always being busy, Buettner said it’s more about having a reason to get up in the morning. Miralles believes ikigai is why Okinawa’s centenarians “are free of stress.” Dr. Craig Willcox, a gerontologist and co-principal investigator of the Okinawa Centenarian Study, described them to me as “happy-go-lucky,” confident that “it will all work out in the end.”
In Okinawa, people often work into their 90s. But work isn’t the only reason for their ikigai. Nearly all the oldest Okinawans also take enormous pleasure in the vegetable and medicinal gardens they maintain outside their small houses. Many continue earning income selling what they grow.
The other key factor helping make Okinawans’ money last is one I found especially fascinating: the financial and personal safety net known as a “moai” (pronounced mo-AHY).
It’s a group of about 20 close-knit older friends who look out for each other. They typically get together every afternoon to talk and play games. Moai participants also contribute about $40 to $50 a month to their communal pot. When one has a money emergency, he or she can pull money out, which reduces financial stress. It’s something older Americans might want to create to help lessen their anxiety about outliving their money.
The moai is especially important because Okinawans’ incomes and assets are small. Annual incomes are almost half of those in Tokyo, and assets are only a third as large as for people in Japan overall, said Takaoh Miyagawa, a retirement researcher at the Japanese insurance company AEGON Sony Life.
The community moai is a stand-in for the kind of care and assistance family members provide in other Blue Zones. “People in Okinawa usually don’t have relatives in their village,” said Miralles. “And some don’t have children. The relationships with their neighbors are like family.”
As one Okinawa centenarian from Ogimi (nicknamed “the Village of Longevity”) told Miralles and his co-author Hector Garcia: “Getting together with my friends is my most important ikigai.” (You can watch the intriguing video, above, that Miralles and Garcia made of their interviews with Blue Zone Okinawans; be sure to turn on the subtitles.)
A low cost of living also helps keep the oldest Okinawans afloat financially.
“They don’t need to spend very much,” said Miralles. While an apartment in Tokyo might cost $3,000 a month, an Okinawan house runs closer to $300 a month, Miralles noted. Due to their vitality, the oldest Okinawans “don’t take as many medicines as in the U.S.” said Buettner. And they generally don’t buy on credit, either, avoiding interest charges.
Japan’s government-provided health care — including its 19-year-old long-term care program — helps avoid costly out-of-pocket medical expenses. “Japan has quite a good long-term health care system,” said Willcox. Everyone over 40 pays in and anyone can draw money out for home care or institutional care, when necessary, starting at 65. In America, by contrast, the Medicare health system for people 65 and older generally doesn’t cover long-term care.
The Blue Zone of Sardinia, Italy
Roughly 120 miles west of mainland Italy lies the isolated, rugged Blue Zone island of Sardinia, Italy. It’s actually the first place that was labeled a Blue Zone, which happened in 2000 when demographers drew a blue circle on a map around this low-income area peppered with male centenarians. Unlike the other Blue Zones, researchers found that in Sardinia, it’s mostly the men who live especially long, healthy lives. So it’s the men who’ve been the prime subjects of analysts of the Ikarian Blue Zone. No one yet knows exactly why older women there generally don’t share the same characteristics as the men.
Like the Blue Zones of Nicoya Peninsula, Costa Rica; Okinawa, Japan; and Ikaria, Greece, the oldest (and often quite healthy) residents of Sardinia are often able to make their money last due to: government-provided universal health care and pensions; a low cost of living and income from produce they grow in their gardens.
Experts who have studied and talked with these Sardinians told me that they’re especially frugal, too. If they do own cars, the vehicles are about 20 years old. Few older Sardinians save or invest regularly, as we in America are frequently told to do. Their wealth typically accrues from owning farm property, animals and equipment.
“If you asked them, ‘Would you rather have another 10 sheep or X dollars in the bank, they’ll probably pick the sheep,” said Paul Hitchcott, a University of Pisa Research Fellow who has studied Sardinia’s centenarians. “That is wealth for them. It means safety and security.”
Belgian demographer Michel Poulain, who helped coined the term Blue Zones, told me: “I have never heard of anyone [there] who wanted to save and put money in the bank.”
The 2018 study of 160 of Sardinia’s oldest residents done by Hitchcott and fellow researchers found its men to be resilient and upbeat. “We noticed they seemed to be better cognitively and with lower levels of depression,” said Hitchcott. “People who are depressed are more likely to die sooner.”
As in the Blue Zones of Costa Rica and Greece, children of the centenarians and nonagenarians (usually daughters, as in Costa Rica and Greece) here frequently provide unpaid caregiving. Often, the oldest Sardinians live in their children’s homes.
There are no long-term care facilities in Sardinia. “It would bring shame to a family to put an aging parent in a nursing home in Sardinia,” Buettner told me.
Community support of the Sardinian Blue Zoners is very strong here, too. “People are literally on their doorstep who’ve got their back,” said Hitchcott. “There’s an incredibly rich network of close family members and friends who are very much out looking after each other.”
Spending time there, Hitchcott said, reminded him of the TV show Cheers. “Everybody knows your name — and your family and your ancestors and your children,” he joked.
Most of the male centenarians spent their working lives as shepherds and farmers. Some, Poulain said, stop working at around 50 because they can’t continue doing the difficult, physical labor. “Then they take on another job, like bus driver,” he noted.
Others continue working in fields and farms for decades, as elder advisers. Buettner told me that in Sardinia, 80-, 90- and 100-year olds “meet with farmers to help them deal with pests and bad weather.”
Said Hitchcott: “They don’t retire; they kind of get promoted.”
The Blue Zone of Ikaria, Greece
Dubbed “The Island Where People Forget to Die,” the Blue Zone of Ikaria, Greece (pronounced ih-kir-EE-a), is a small (pop. 8,300), rocky collection of villages, 30 miles off the coast of Turkey, in the North Aegean Sea.
People in Ikaria, I learned, reach age 90 at 2 ½ times the rate they do in America; the average life expectancy in Greece overall is 80. They eat a version of the Mediterranean diet and frequently climb up and down the island’s 20 steep hills, giving them exercise and strength. One study found that 60% of Ikarians over 90 are physically active.
In Ikaria, people tend to live eight to 10 years longer than elsewhere before succumbing to cancer or cardiovascular disease, if they ever get either. Researchers of the oldest Ikarians have found their blood pressure is low and they’re less likely to suffer from depression than others their age elsewhere. Only 20% of Ikarians over 80 have dementia (compared to 50% in Athens).
But, Ikaria researchers told me, this island — whose residents are often subsistence farmers — is much different from the rest of Greece in other, surprising ways, too.
“It’s a really weird place,” Platon Tinios, a Piraeus University economist who studied the oldest Ikarians, told me. Howie Litwin, head of the Israel Gerontological Data Center, who has spent time in Ikaria, said: “Ikaria is a mind-blowing experience for someone used to an urban, tense atmosphere.”
Here, stress is practically non-existent. Practically everyone takes a midday nap. And, Litwin said, “Time is a different entity on this island.” As an example, Tinios said, “One village has reversed day and night; shops open at 11 at night and people go to sleep at 8 in the morning.”
It’s also a left-wing island. The Greek government exiled 13,000 communists and radicals to Ikaria in the 1940s and 1950s, which is why some call the place “Red Rock.” Many of those exiles are among the oldest-old living there.
“The old people in Ikaria are from a very unique brand of people who struggled in the early parts of their lives,” said Litwin. “They’re used to fairly harsh conditions and, as a result, it affected their way of life and it positively affected their longevity.”
Their don’t-worry-be-happy attitude goes a long way in explaining why the nonagenarians and centenarians in Ikaria rarely worry about running out of money. That’s an attitude I found is typical in all five Blue Zones.
In Ikaria, “they don’t pay attention to money or artificial things,” said Dr. Christina Chrysohoou, an Athens cardiologist who has studied the health of the oldest Ikarians. “They live poor, but happily.”
The oldest in Ikaria are frugal, partly because of where they live. “They don’t have places to spend money,” said Chrysohoou. And, said Litwin, “They’re not governed by a drive for status symbols.”
They’re anything but prodigious savers, though. “Greece is not a saving culture,” said Tinios. “People don’t think old age is something they have to save for.”
Instead, the oldest Ikarians rely on modest government pensions, the Greek National Health Service for their medical bills, property they own and assistance from extended family members.
Unlike in Japan, there is no national long-term care system from the government. Due to Greece’s high unemployment and economic troubles, Tinios said, the government thinks it “has other things to worry about.” Here, though, local municipalities pitch in, partly through a home-care program — often underfunded, due to Greece’s financial woes — called Help at Home.
In Ikaria, caregiving provided for the oldest inhabitants by their children, nieces and nephews, is de rigueur, however. Often, Ikarians in their 80s, 90s and 100s live with their caregiving daughters, or with a child and grandchildren. In this way, “Ikaria resembles how Greece used to be 50 or 60 years ago,” said Chrysohoou.
Liz Mestheneos, a founding member of the Hellas 50 initiative to support Greeks over 50, describes the implicit understanding this way: “It’s a two-way process. They helped their children when they needed it, now their children help them. It’s a family savings bank.”
This article was written with the support of a journalism fellowship from the Gerontological Society of America, Journalists Network on Generations and The Commonwealth Fund.
The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.