By carrot or stick, the Blue Zones Project is offering Grand Forks a chance to change how residents think about health, should city leaders engage the well-being nonprofit.

In some cities, the stick approach – changing speed limits, for example – has worked to create a more healthy community. For others, it's probably best for residents to take ownership of their own health.

What form a local approach could take was discussed during a meeting Monday at the Alerus Center in Grand Forks, where Dan Buettner Jr., director of solutions at Blue Zones, led a group of company representatives to discuss the possibility of contracting with local government to develop a plan to encourage residents and employers to change how they think about health. City, county, business and health care leaders have a limited amount of time to decide whether to engage with the organization before federal funds, allocated by the state to help pay for the effort, expire at the end of August.

“This is kind of our last hurrah, our last sales pitch to the community, saying we’ve done a lot of time here,” said Buettner. “We'd love to launch this here, unfortunately there's a fuse on (federal funding) and Blue Zones just doesn't have the capacity to continue to develop, if the community isn’t ready.”

Janna Pastir, director of health promotion for the North Dakota Department of Health, has long been interested in bringing the Blue Zones Project to North Dakota. She got the ball rolling two years ago, when she contacted leaders in Grand Forks, Fargo, Bismarck and Mandan about participating in the project. Assessments for each community were completed last September and indicated Fargo and Grand Forks could pilot the program in North Dakota.

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Blue Zones

The Blue Zones Project is an extension of work carried out by Buettner's father, Dan Buettner. In 2004, the elder Buettner worked with National Geographic and the National Institute on Aging on identifying the five communities across the world where people tend to have longer-than-average lifespans. Those communities include Ikaria, Greece; Okinawa, Japan; Sardinia, Italy; Loma Linda, Calif., and Nicoya, Costa Rica. Residents of those areas share certain characteristics, ranging from appropriate diet to exercise to having a sense of belonging and purpose in their community.

Buettner’s research spawned three best-selling books and widely-read articles in National Geographic. In 2009, The Blue Zones Project launched in Albert Lea, Minn. The city ranked low in state health rankings, which improved after becoming involved with the program. According to the Blue Zones Project, city residents’ lifespans improved by almost three years, medical costs for city workers decreased significantly, and productivity saw a boost.

But how did that happen?

Carrot, stick

Buettner said part of the change in Albert Lea revolved around a simple ordinance change. City officials wanted to increase the speed limit on the main street. Blue Zones Project staff advocated for a speed limit of 15 mph. The change encouraged residents to get out of their cars and walk the main drag. Increased foot traffic led to a domino effect of health and economic activity.

“Guess what happened?” Buettner asked at Monday’s discussion at the Alerus Center. “Foot traffic came back, then retail business came back, then property values in those businesses came back.”

The organization achieves its goals by creating a plan addressing local officials’ concerns about public health. That could be reducing smoking, encouraging more exercise and better diet or reducing alcohol use. Increased healthy options – default healthy menu choices at restaurants or a walk-to-school program, represent the proverbial “carrot” to make healthy choices. The “stick” could come in the form of ordinance changes, like the reduced speed limit in Albert Lea.

Altru Health System President Steven Weiser said it is a fine line balancing more health options with potential rule changes. The latter, he said, could have a negative impact. It’s more important, Weiser said, to have a group dedicated to carrying out a public health program, while giving people the space to make their own decisions.

Buettner disagreed with the notion of Blue Zones being associated with any legal corrective action, such as fines for smoking in an area that disallows it. For him, it’s all about providing more healthy choices in a community, to improve overall health. People who live longer-than-average lifespans, he said, are able to do so because they live in a culture that allows them to make the healthiest choice, rather than the easiest.

“I don't love that characterization, no,” Buettner said. “I think it's less about carrot and stick, and more about choice architecture.”

Next steps?

Leaders in Grand Forks need to decide if they want to shell out cash to contract with the Blue Zones Project. The contract runs $6.76 million for four years. More than $1 million in federal funds are available to offset that cost, and Altru has committed to providing additional funds, though the amount needs to be finalized. The city, Grand Forks County and business entities would need to contribute the rest.

The matter is set to be discussed at an upcoming City Council meeting. The deadline on federal funds expires at the end of August.