Residents of Colorado’s most picturesque mountain towns in Summit, Pitkin and Eagle counties live longer than anyone else in the United States. Recent data collections, research and comparisons with the so-called Blue Zones – those few places where people live longer and healthier than anywhere else on earth – highlight why the Colorado Rocky Mountains offer such great health outcome and what needs to be done for this area to truly become an American Blue Zone for every who lives there.
Thursdays at Keystone resort in Summit County sees the Over the Hill gang head out to the slopes. Some ski like maniacs all day, others do a few gentle runs and then retire to the mountain house for hot drinks and conversation. You can qualify for this community group once you turn 55, but many are decades older. There are a number of people aged 90 and over who are out on the slopes skiing almost every day.
It’s true, there is an energising force in this lovely part of the world. The air is clean and clear, there are, on average, 300 sunny days a year, it’s cold but dry, and the scenery is spectacular. There’s a saying here: come for the winter but stay for the summer. There’s lots to explore and plenty of facilities for a huge range of physical activities. The community is friendly and welcoming and provides social activities for every taste and age group.
Evidence suggests that the most sustainable way to improve community life expectancy is to reshape the environment to steer people towards better habits and better lifestyles rather than any specific diets, vitamin regimes, exercise routines or other, more artificial methods of trying to live longer. This approach has initiated the Blue Zones project in Colorado.
The term “Blue Zone” was coined in a paper published in Experimental Gerontology in 2004; it was first used to describe specific areas with unusually high concentrations of male centenarians in Sardinia. Later research by Dr Dan Buettner looked wider afield and found four additional Blue Zones covering both men and women in Okinawa, the Nicoya Peninsula in Costa Rica, a Seventh Day Adventist community in Loma Linda, California, and Ikaria, an isolated Greek island.
These are communities where healthy lifestyle, diet and outlook are ingrained across the life spectrum, built into the culture and social order, and where a surprising percentage of people live to be 100 and over. Many of these centenarians have lives that are hard and notable only for their ordinariness, but they are purpose driven, family centred and busy to the end. People in Blue Zones don’t set out to healthier, live longer; it’s something that is so routine they don’t think about it.
On the island of Ikaria, nearly one in three people make it to their nineties and they do it in great health. The Islanders have about 20 percent lower rates of cancer, 50 percent lower rates of heart disease and almost no dementia. This is the other thing that sets Blue Zones apart and why they are the goal for longevity – it isn’t just that the people live longer, it’s that their lives are less blighted by chronic disease in their later years.
It’s clear that while the mountain towns of Colorado are doing well compared to the rest of America, they are not Blue Zones. Firstly, they would need something like ten times more centenarians to qualify as a Blue Zone. In some small villages in Sardinia, one in every 360 people is aged over 100. In the US in 2014 there was one centenarian for every 4413 people, and in Colorado as a whole, the ratio was nearly twice that, although this is expected to increase considerably by 2010.
The life expectancy in Colorado’s mountain towns is likely artificially inflated by a self-selection bias. People who value the outdoor life and have the resources (good health and finances) to do so, move to these areas and if, in later life, their needs cannot be met, they move away. These are the lucky people.
In contrast to the ski crowd, there are many poor, struggling communities in Colorado living side-by-side with the wealthy. You can see the trailer parks they live in on the drive from Vail to Aspen. These people often hold several low-paying jobs and struggle to afford accommodation and the necessities of life that are priced for affluent residents and visitors. It is estimated that a Summit County family of four needs an annual income of $59,595 (more than three and a half times the federal poverty level) to make ends meet.
One reason why these less affluent people – and Americans as a whole – don’t live long healthy lives is that they fall victim to preventable chronic illnesses. Their poor life expectancy is driven by behavioural issues such as obesity, poor nutrition, violence and accidents, excess drinking, and poor mental health. There is great healthcare in Colorado, but for many in Summit and nearby counties, access to needed care is unaffordable.
In the US there is a wealth of regular reports of health and healthcare data at the county level, and it is possible to use these to highlight how far ahead Colorado and especially mountain areas such as Summit County are from the worst performers nationally, see how the outcomes have changed over time, and provide some reasons why.
The most recent profile of Summit County from the Institute of Health Metrics of Evaluation shows female life expectancy there at 88.5 years (compared to 82.2 for Colorado and 81.5 nationally) and male life expectancy at 85.5 years (compared to 78.2 for Colorado and 76.7 nationally). The county has among the very lowest rates in the US for heart disease, stroke, lung cancer, breast cancer and diabetes. But there are downsides: the county has high rates of heavy drinking and mental health and substance abuse problems, reflected in the rates of self-harm, violence and accidents.
The good news part of the story is explained by an over-representation of higher-income, white residents relative to national averages and their healthy lifestyles. The state has the lowest adult obesity rate in the US and is the fifth happiest state in the nation.
The bad news is largely a reflection of the huge socio-economic and health disparities. Twenty-five percent of people in Summit County report housing problems (compared to 9 percent in Colorado and 17 percent nationally). The high cost of housing and childcare means too many families struggle to afford healthcare. The 2017 Colorado Health Access Survey reports that 93.3 percent of Coloradans had health insurance, but 20 percent of people in Summit County did not. Many of these people are Hispanics and the so-called “young invincibles”.
A serious problem to be reckoned with is why mental health indicators are so bad. The county has struggled to address them. Around 60 percent of people who need mental health services aren’t getting them. The county has no psychiatric beds and, in a crisis, it is law enforcement that often steps in. Over the past two years, the number of people being placed on mental health holds at the Summit County Jail spiked by 1,365 percent.
While health is correlated primarily to socio-economic issues, it is possible to be poor and healthy if you engage in the right behaviours. The Blue Zones demonstrate that perfectly. In the US, Yuma County in Arizona has a relatively low average income but has managed to raise life expectancy by eight years.
The focus for future efforts in Summit County is directed in several broad areas. One is around reshaping the environment. A common trait across all Blue Zone communities is walkability. There is a great network of trails and recreation paths, but they don’t link to all the places people need to go, especially to shops and services. And more needs to be done to improve access to nutritious foods – over one in twenty households don’t have access to a vehicle and live more than walking distance from a grocery store.
Another key focus is research on the impact of high altitude on physical and mental health. High altitude living can prolong your life – until it doesn’t. Less oxygen exacerbates cardiac and respiratory conditions and causes pulmonary and cerebral oedema. There is also evidence to suggest that sleep apnea and oxygen desaturation is linked to depression for people living at high altitude.
Finally, there is the acknowledgement that the high life expectancy may be something of a mirage due to the fact that many older people don’t die in Summit County because they have moved away to get access to the services they need. Since 2000 there has been a 29 percent increase in Summit County residents, and the area has changed from a place people visited to a place where people live. Those people, especially the burgeoning senior population, which has doubled over the past decade, need a raft of services which do not currently exist. Hopefully, the full implementation of the Summit County Community Health Improvement Plan will address these issues.
Written from our home at 9321 feet (2841 metres) above sea level in Keystone, Summit County, where every winter day is a ski day, except when it’s a snowshoe day.
Lesley Russell is an Adjunct Associate Professor at the Menzies Centre for Health Policy at the University of Sydney. She was the inaugural Menzies Foundation Fellow at the Menzies Centre for Health Policy and a Research Associate at the US Studies Centre at the University of Sydney. Prior to that, she was a health policy adviser to the federal Labor Party. She worked for seven years as health policy adviser on the Energy and Commerce Committee in the US House of Representatives, and has been a Visiting Fellow at the Center for American Progress and a Senior Adviser to the US surgeon-general.