How Public Policy Can Prevent Heart Disease

Until last year, the residents of Albert Lea, Minn., were no healthier than any other Americans. Then the city became the first American town to sign on to the AARP/Blue Zones Vitality Project—the brainchild of writer Dan Buettner, whose 2008 book, The Blue Zones, detailed the health habits of the world's longest-lived people. His goal was to bring the same benefits to middle America—not by forcing people to diet and exercise, but by changing their everyday environments in ways that encourage a healthier lifestyle.

What followed was a sort of townwide makeover. The city laid new sidewalks linking residential areas with schools and shopping centers. It built a recreational path around a lake and dug new plots for community gardens. Restaurants made healthy changes to their menus. Schools banned eating in hallways (reducing the opportunities for kids to munch on snack food) and stopped selling candy for fundraisers. (They sold wreaths instead.) More than 2,600 of the city's 18,000 residents volunteered, too, selecting from more than a dozen heart-healthy measures—for example, ridding their kitchens of supersize dinner plates (which encourage larger portions) and forming "walking schoolbuses" to escort kids to school on foot.

The results were stunning. In six months, participants lost an average of 2.6 pounds and boosted their estimated life expectancy by 3.1 years. Even more impressive, health-care claims for city and school employees fell for the first time in a decade—by 32 percent over 10 months. And benefits didn't accrue solely to volunteers. Thanks to the influence of social networks, says Buettner, "even the curmudgeons who didn't want to be involved ended up modifying their behaviors."

Isn't it time we all followed Albert Lea's example? Diet and exercise programs routinely fail not for lack of willpower, but because the society in which we live favors unhealthy behaviors. In 2006, cardiovascular disease cost $403 billion in medical bills and lost productivity. By 2025 an aging population is expected to drive up the total by as much as 54 percent. But creative government programs could help forestall the increases—and help our hearts, too. A few suggestions:

Require graphic warnings on cigarette packages. It's easy to disregard a black-box warning that smoking is "hazardous to your health." It's not so easy to dismiss a picture of gangrenous limbs, diseased hearts, or chests sawed open for autopsy. These are exactly the types of images that the law now requires on cigarette packages in Brazil. In Canada, such warning images must cover at least half the wrapping. In 2001, the year after the Canadian law took effect, 38 percent of smokers who tried to quit cited the images. Think of it as truth in advertising.

Sponsor "commitment contracts" to quit smoking. Yale economist Dean Karlan spearheaded a test program in the Philippines in which smokers who wanted to quit deposited the money they would have spent on cigarettes into a special bank account. After six months those who had succeeded got their money back, while those who had failed lost it. Such a program could be run here by public-health clinics and offer greater incentives, such as letting winners divvy up the money forfeited by losers. Even without such an enhancement, says Karlan, "Filipino participants were 39 percent more likely to quit than those who were not offered the option."

Subsidize whole grains, fruits, and vegetables in the food-stamp program. The underprivileged tend to have disastrously unhealthy diets, and no wonder: $1 will buy 100 calories of carrots—or 1,250 calories of cookies and chips. The government should offer incentives for buying produce. The Wholesome Wave Foundation has shown the way in 12 states, providing vouchers redeemable at farmers' markets to people in the SNAP program (the official name for food stamps). "We've seen purchases of fruits and vegetables double and triple among recipients," says president and CEO Michel Nischan.

Set targets for salt reduction. The average American consumes twice the recommended daily maximum of sodium, most of it from processed foods. The result: high blood pressure, heart attacks, and strokes. But New York City is leading a campaign to encourage food manufacturers to reduce added sodium over the next five years. Consumers will barely notice the changes because they will occur so gradually. The FDA should follow New York's lead.

Incorporate physical education into No Child Left Behind. American children may be prepping like crazy for standardized tests, but they're seriously lagging in physical fitness. Regular exercise improves mood, concentration, and academic achievement. It can also help reverse the growing trend toward type 2 diabetes and early heart disease in children and teenagers.

Require that sidewalks and bike lanes be part of every federally funded road project. The government already spends 1 percent of transportation dollars on such projects. It should increase the level to 2 to 3 percent. When sidewalks are built in neighborhoods and downtowns, people start walking. "The big win for city government is that anything built to a walkable scale leases out for three to five times more money, with more tax revenue on less infrastructure," says Dan Burden, executive director of the Walkable and Livable Communities Institute. He recommends a "road diet" in which towns eliminate a lane or two of downtown traffic and substitute sidewalks. "When roads slim down, so do people," he says.

It's all reasonable. But Dan Buettner isn't waiting for any of these measures to surmount the inevitable industry hurdles. This year he's looking to scale up the Blue Zones Vitality Project to a city of 100,000 or more. "If this works, it could provide a template for the government that's replicable across the country," says his colleague Ben Leedle, CEO of Healthways, which is developing the next phase of the project. The challenges will be much steeper in large cities. But with measures like these, we could one day find ourselves growing fitter without specifically dieting or exercising. Finally, a New Year's resolution we can all keep.

Willett is a physician, chair of the department of nutrition at the Harvard School of Public Health, and coauthor of The Fertility Diet. Underwood is a NEWSWEEK contributor.

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