For Your Health
For Your Health

News from the University of North Dakota School of Medicine & Health Sciences

Get in the Zone

A collection of Grand Forks agencies partners with the Blue Zones Project to help make Grand Forks one of the healthiest cities in the United States.

It does stand out on a list of larger and predominantly coastal communities. But there it is – Grand Forks, North Dakota – alongside Napa, California; Fort Myers, Florida; Dallas/Fort Worth, Texas; and Walla Walla, Washington.

Linking each of these American cities, plus a handful of others, to the city hosting the main campus of the University of North Dakota is an affiliation with the Blue Zones Project.

Led by Altru Health System and the North Dakota Department of Health and Human Services, with representatives from UND pitching in, a team of supporters on the eastern side of North Dakota is looking to increase the health and longevity of those living in the region. The team hopes to do so not only to give people living in the state both more and more healthful life choices, but to make the more healthful life the more obvious and simple choice.

“When we think about what this could mean long-term for the community of Grand Forks and really our whole region, it’s incredibly transformational,” explained Kristi Hall-Jiran, chief philanthropy & partnership officer at Altru, adding that North Dakota Gov. Doug Burgum referenced “blue-zoning” North Dakota in his Main Street initiative as early as 2017. “If we can start with these small changes, and if we can build a community where making the healthy choice is the easy choice, we can help people start to embrace that. This can lead to longer lives for generations to come.”


A what zone?

So what exactly is a “Blue Zone”?

Back in 2005, writer and entrepreneur Dan Buettner teamed up with National Geographic magazine to study aging around the world. The initial result of that partnership was an article, published under the title “The Secrets of Long Life,” focusing on five regions around the world with an atypically high number of centenarians: persons who live to age 100 and beyond. These regions – Loma Linda, California; Sardinia, Italy; Okinawa, Japan; Nicoya, Costa Rica; and Ikariya, Greece – produced longevity not so much out of any obsession to vigorous weight training, vegetarianism, or building top-tier health systems, Buettner argued, so much as for their commitment to nine modest, overlapping factors, including minimizing stress, prioritizing plant-based diets, staying active generally, maintaining close contact with friends and family, and cultivating a positive attitude and a sense of purpose in life.

These factors, wrote Buettner in his first book The Blue Zones, amount to “a de facto formula for longevity – the best, most credible information available for adding years to your life and life to your years.”

What began as a one-off article and a book, then, has since evolved into both a brand – cookbooks, “longevity foods,” and apparel – and a global initiative that, as the Blue Zones website puts it, “is a community-led well-being improvement initiative designed to make healthy choices easier through permanent changes to a city’s environment, policy, and social networks.”


Longevity lifestyle

So did Team Grand Forks bring the concept home in 2022, recognizing that enabling people to make healthier choices is not only in everyone’s literal self-interest, but the state’s broader economic interest.

“We want the community to be vibrant, healthy, and economically strong,” explained Audrey Lorenz, director of strategy and regional development at Altru, which has taken the lead on Blue Zones in Grand Forks. “Everything we talk about from a Blue Zone perspective helps to support all of that in terms of improving the well-being of people, which creates a positive spin that’s attractive to families who want to live here because there’s something happening here that’s different.”

Referencing the “health in all policies” philosophy that has gained ground in public health circles over the past decade, Lorenz and Hall-Jiran note that Blue Zones Project in Grand Forks is not about telling anyone what to do or taking anything away. Instead, it’s about giving the community more and better choices at all levels, from more access to healthier foods to embedding more movement-based programs in the community to addressing stress reduction in workplace routines.

“At Altru, for example, you see a sign indicating how long it would take to walk a half-mile if you have a few minutes, even inside the building since it’s the middle of winter,” continued Hall-Jiran. “Or I run down to the cafeteria and here’s the Blue Zones Project-approved menu that I can pick from, or we have a room to de-stress where there’s a yoga mat, and we’ve also encouraged employees to take care of each other and give each other a break. It’s just making those choices everywhere. They’re just available all the time, if you want them.”


The science of aging

For his part, Dr. Don Jurivich, chair of the Department of Geriatrics at the UND School of Medicine & Health Sciences (SMHS), added that scads of research – including some of his own – shows that such expanded choices can literally slow down the human “biological clock,” helping all of us age more slowly.

“The singular intervention that will move the needle towards making the biologic clock younger for people is physical activity,” said Jurivich, whose own research of late has centered on building the Dakota Geriatrics program and helping communities and providers become more “age-friendly” by focusing on the geriatric “4Ms” framework – What Matters, Medication, Mentation, and Mobility. “That’s true for healthy people and those with chronic conditions: increasing opportunities to provide more physical activity is really essential.”

But exercise is only one part of the equation, he admitted. Encouraging activity and age-friendly communities notwithstanding, implanting other Blue Zones Project “traits” into communities may be trickier. What about the unemployed middle-aged person or senior citizen who no longer works, both of whom may be on the lower end of the socioeconomic scale and more isolated? What if healthier food options are hard to come by for certain demographic groups or neighborhoods?

“Well, you can combine some of these health promotion ideas, embedding physical activity in public events or in spaces with healthy food options,” he says, answering his own question. “At the [UND] medical school and in the allied health professional schools, there are discussions about rolling out a health promotion program through public housing, and this is an extension of a program that already exists focused on older adults.”

That is to say, the team is looking to expand health programs to all ages, from children through the older adult, and allow students in UND’s physical and occupational therapy, public health, and nutrition and dietetics programs to participate in health promotion “coaching” with multiple populations in a variety of settings.


On the ground

Nicole Benson, Community Program Manager & Policy Lead and a student in the SMHS Public Health Program, noted that because Blue Zones Project is community led, it begins with the hiring of a local team that works side-by-side with volunteers and committees to bring together a collective focus on community well-being.

Blue Zones Project is an investment for the long-term and a focus on helping to reverse the trends that impact our overall well-being, not just physical health, she says.

This frame means that the shape blue zoning takes on-theground varies by community. In Grand Forks, the task of getting the Blue Zones Project “blueprint” developed fell to Benson, Organization Lead Ashlee Kleveland, and Whitney Miller, Community Engagement Lead. The Blueprint is a detailed implementation plan for the Project, with goals, strategies, and metrics to guide the community transformation over the years of the project.

“I’m talking with worksites, schools, grocery stores, restaurants, and other face-to-face organizations on all of this to impact not only employees but also those people these employers serve,” Kleveland says. “At their invitation, our group looks at an organization’s practices to try to find those opportunities where we could add more choice.”

Using restaurants as the example, Kleveland, a graduate of the SMHS Public Health Program, adds that if a default side dish to a meal is something fried, maybe a restaurant would consider a fresh or steamed vegetable side as another option, in addition to the fried option.

“No one is saying that those fries aren’t going to be available, but we’re making the healthier choice a little bit easier by just flipping the script a bit,” she says.

“Ashlee talked about working with local organizations,” Benson adds. “I’m working in the policy sector, focusing on three policy areas, Built Environment, Food, and Tobacco. We’re really taking the information from the experts, but also leaning on the community to decide what efforts we’re going to push forward. Working hard to understand the assets that we have in our community, we look for ways we can leverage that, work together, and build on work that’s already being done.”

The Project’s efforts are informed by community input and tailored to address the needs of Grand Forks and reach all segments of the population through policy changes that will impact everyone in the community. In other words, it is Benson’s job to help connect the Grand Forks Public Health Department to the Grand Forks School District to the City of Grand Forks to UND – and so on – trying to get everyone on the same page.


Community Kick-off

To that end, the group kicked off its efforts more formally in January 2023 at Empire Arts Center in Grand Forks. By all accounts, the inaugural Blue Zones Grand Forks event was a rousing success.

“It was unbelievably inspiring!” beams Hall-Jiran. “To begin to see changes in the health and well-being of our residents is going to be transformational for our entire community and region. I really believe our success as the first community in the state to implement this program will inspire other projects to launch across the state, and will lead to North Dakota truly being a destination state as we become the best place to live, learn, work, and play.”

Lorenz agreed, smiling that the Grand Forks kick-off broke the Blue Zones record for RSVPs.

“The previous record had been about 100, but we had over 200 people RSVP,” she grins. “And show up. Hearing how other communities have been transformed via their commitment to the Blue Zones Project is powerful. It’s really exciting to be at this point of kicking-off the work, and I can’t wait to see what we can accomplish!”

By Brian James Schill