In 1976, Stamatis Moraitis received life-changing news. The 53-year-old Greek immigrant living in New York had been diagnosed with lung cancer, and doctors gave him nine months to live. Several more physicians confirmed the diagnosis. Facing this prognosis, Moraitis made a decision: he would return to his native island of Ikaria, Greece, to spend his final months surrounded by family.
Years passed. Then decades. Moraitis didn’t just survive his nine-month prognosis, he thrived. When he finally passed away, he had outlived his original doctor’s prognosis by about 45 years. He was either 98 or 102 years old; he had stopped keeping precise track of time on an island where such details seemed less important than simply living well.
Moraitis’s story was documented by Dan Buettner, a researcher and author who found that Moraitis lived in what he termed a “Blue Zone”—one of five regions globally where people routinely live to 100 and beyond. All five areas are:
- Nicoya Peninsula, Costa Rica
Blue Zones have ten times as many centenarians as expected for a corresponding population size in the U.S. and often surpass the global life expectancy of 71.4 years.
The Blue Zone phenomenon
In Blue Zones, people don’t just live longer—they live healthier in that longer time. Rates of heart disease, cancer, and diabetes are dramatically lower than global averages. Aging to 100 is almost routine, and many residents maintaining independence and vitality into their final decades.
What makes these places so unique isn’t any secret transformative medical therapy. Instead, the secret lies in five common characteristics that Buettner and his research team identified across all Blue Zones:
- Diet: Predominantly plant-based diets rich in vegetables, fruits, legumes, and whole grains, with limited meat consumption.
- Physical activity: Regular, moderate physical activity as part of daily routines, such as walking, gardening, and manual labor.
- Social connections: Strong family bonds, social networks, and community involvement that provide emotional support and a sense of belonging.
- Purpose: A sense of purpose or “ikigai” (reason for living) that motivates individuals and gives their lives meaning.
- Stress reduction: Practices such as meditation, prayer, napping, and spending time with loved ones to manage and reduce stress.
Most importantly, these five characteristics are embedded in the physical and social environments where Blue Zone residents live. In Sardinia, daily life requires walking up and down hills due to the natural environment. In Okinawa, people gather in “moai”—social groups that provide lifelong support. In Loma Linda, a community of Seventh-day Adventists builds wellness practices around shared faith and values.
“In Blue Zones, people don’t try to be healthy—they just live in environments that make healthy living easy,” Buettner explains in his book Blue Zones: Lessons for Living Longer From the People Who’ve Lived the Longest.
However, the Blue Zones concept is far from universally accepted among scientists and demographers. Many experts challenge the accuracy of the reported lifespans in these regions, citing inconsistent or poorly documented birth and death records and questioning whether Blue Zones truly have more centenarians than neighboring areas. Some researchers point out that the diets and lifestyles popularly attributed to Blue Zones are not always supported by real-world data—for example, Okinawans have long consumed processed meats, such as Spam, despite claims of a vegetarian tradition, and rates of social distress like elderly suicide can be high in these locations. Counter-opinions on Blue Zones also warn that commercial interests and selective storytelling often shape the narrative, and that shifts toward Westernized living have eroded many of the conditions originally documented in these places that helped them achieve the designation.
Ultimately, experts urge caution in relying solely on Blue Zone cities and stress that healthy aging is multifaceted. While the broader lifestyle themes from Blue Zones—community, physical activity, and plant-rich diets—are well-supported, using these regions as complete scientific blueprints without acknowledging the changing local contexts could be unhelpful.
When zip code determines lifespan
Even acknowledging critiques of the study of Blue Zones, it is clear that your environment has a clear impact on your health. On the opposite end of Blue Zones, many people live in environments that make healthy living difficult. Place-based health recognizes that neighborhood characteristics directly influence residents’ wellbeing. As Dr. Megan Sandel, a pediatrician at Boston Medical Center, explained to HealthCity in 2021: “Place is where we concentrate inequity in this country. It is places and neighborhoods where systems don’t work and where policies perpetuate inequities.”
These “red zones,” which they’re sometimes dubbed by researchers, feature food deserts, unsafe environments, pollution, and chronic stress from discrimination and economic instability—and they’re often communities of color.
Historical policies like redlining concentrated these harmful conditions in communities of color, undermining the opportunities for health and wellbeing across generations.
The data in Boston is stark. Residents of the affluent and predominantly white Back Bay area have a life expectancy of 91.6 years, while those in the underserved and predominantly Black neighborhood of Roxbury live just 68.8 years—a 23-year gap spanning only two miles.
Dr. Sandel advocates for concentrated investment in specific zip codes.
“We want Nubian Square, Roxbury, 02119, to be the healthiest neighborhood in Boston. There is no reason it can’t be,” she said. “We just have to undo decades of racism to get there.”
The absence of Blue Zone-like conditions in many Black communities results from policy choices over a long term. Building environments that provide opportunity for health and longevity requires addressing root causes: ensuring food access, natural spaces for activity, stable housing, clean air and water, and social connections, as well as reducing discrimination-related stress.
It will require systems to treat the upstream health conditions that have led to these environmental and place-based disparities. Thea James, MD, director of BMC’s Health Equity Accelerator explains what upstream healthcare means: “Rather than treating the wounds and disease and sending people back where they came from, we can look upstream and ask, ‘What would it take for this never to happen again?”
Moraitis’ story teaches us that the right environment can defy the odds, but it also underscores the urgent need to address the environmental and social inequities that disproportionately affect Black communities, where access to health-promoting conditions is often limited.
This year Boston Medical Center will host its third annual EQTY conference, EQTY 2025: Progress Under Pressure, bringing together visionary leaders at a critical moment in health equity. To further explore the theme of longevity, we welcome you to join us for our thought-provoking panel, “Who Gets to Live Longer? Longevity Research, Systems, and Science.”