Mountain counties among tops for longevity, physical activity, thinness
But link between health & altitude remains unclear
by Allen Best
You might wonder whether the Elk Range between Aspen and Crested Butte has inherently salubrious qualities. According to a new study of life expectancies in the United States, Crested Butte’s Gunnison County has the second highest longevity in the United States for men, 81.65 years. Aspen’s Pitkin County is third.
For females, Gunnison and Pitkin are 7th and 8th among the nation’s counties, according to the study by the University of Washington’s Institute for Health Metrics and Evaluation.
Eagle County (Vail) and Teton County (Jackson Hole) are in these top-10 longevity lists, too.
The University of Washington study is among several new studies that explore the connection between location and health.
A study published in the International Journal of Obesity earlier this year more narrowly probed the connection between obesity and elevation. There is a correlation, and it’s an inverse one. The higher you go, the thinner the people. That’s relevant to longevity, in that obesity is one of the top risk factors for premature death.
The University of Washington study found that the longest-lived people are found both at sea level, particularly in or near big cities, and in mountain communities.
In regards to the longevity of those living in mountain communities, some self-selection is obviously involved. Dr. Ali H. Mokdad, the corresponding author of the study, readily concedes that mountain towns attract healthy people.
They hike, ski and altogether sweat like crazy. Attitudes of mountain towns further reinforce healthy habits. Smoking is frowned upon by laws, culture, or both, and healthy eating is extolled. Fast-food restaurants can be found, but their niche is more narrow.
Conversely, if you’re sick, you tend to leave mountain towns. People who have high blood pressure and heart problems often move to lower elevations and the greater concentration of hospitals.
This story originally was published in the August 1, 2013, issue of Mountain Town News, a subscription-based e-zine. To get a sample copy, write to firstname.lastname@example.org.
But there is a clear link between higher elevations and thinner bodies. What is true in mountain towns is also true, if to a lesser extent, for all of Colorado, which has the nation’s highest mean elevation, 6,800 feet. Obesity rates have been rising everywhere, but Colorado was the last to reach 20 percent. The same for the next threshold, 25 percent.
“If you live in Denver and you decide tomorrow to be physically active and eat right and exercise, you might have more of the ingredients to do so,” says Mokdad.
Thin air is not a prerequisite, however. Seattle, where Mokdad lives, is similar to Denver, in that it has trails for walking, jogging and biking, and the social culture encourages healthy habits and discourages risk factors, such as smoking.
“Colorado has a healthier lifestyle, and then from within Colorado, it’s mainly coming from higher-altitude counties. And it’s a combination of the factors we talked about,” he told MTN, referring to higher physical activity, fewer risk factors, and lower obesity.
Conversely, living in a place without the infrastructure for physical activity and the laws and culture that discourage risks dampens life expectancy.
“If I live in a place where smoking is allowed in public places, such as a restaurant—even if I quit and where I go to eat there is smoking, that doesn’t help,” says Mokdad.
Reducing risk factors is the single biggest determinant of longevity. Poor diet, alone is responsible for 1 of 4 deaths in the United States. Smoking accounts for about 1 of 5 deaths. Physical inactivity is linked to nearly 1 in 10 deaths.
Risk factors alone explain much of why people in some areas live longer than those in others.
“While income, education and economic inequality are likely important factors, they are not the only determinants of outcomes,” the study notes. “The consistently high life expectancies seen in rural and below-median-income counties in Minnesota, Iowa and parts of the Dakotas indicate that are more complex factors that may also be important.”
But education and income do matter. People with advanced education are more likely to seek health-care advice. The quality of medical care matters. Health-care systems that follow up with those that have high-blood pressure, for example, nudge life expectancies higher.
Thinner air = longer lives?
Can mountain living give you a longer life? Dr. Peter Hackett, director of the Telluride-based Institute for Altitude Medicine, has explored that question. The answer is yes, at least as regards heart disease. The latest study, in the International Journal of Obesity, adds to the accumulating evidence, finding a clear, inverse relation between high elevations and obesity. Lack of obesity means less risk of heart disease. Ergo, life expectancies increase.
“These studies certainly suggest that living at high altitude diminishes the incidence of obesity and improves longevity because of less heart disease,” says Hackett. “It’s not entirely proven to my satisfaction that physical fitness isn’t also important factor in that.”
Hackett certainly has been a fitness buff in his life. He has climbed Mt. Everest twice and for many summers attended climbers on their way up and down Denali, North America’s highest peak. He also attended Keith Richards several years ago when the Rolling Stones performed in Mexico City, elevation 7,600 feet. Richards, with furrows in his face deeper than some of those in Canyonlands National Park, seems to have riffed without complaint.
Hackett says living at higher altitude suppresses appetite. That should decrease levels of obesity. There seems to be no magic threshold for this effect. According to the new study, the effect can be seen at just 1,000 feet above sea level.
There may be an additional connection between thin air and longevity. One thing already understood is that the basal, or resting, metabolic rate in people, is reduced at higher elevations, if just slightly. In other words, your heart burns a few more calories even when resting.
Other things are at work, too. “People at higher altitude make more blood vessels in their heart,” says Hackett. “That’s one mechanism by which higher altitude may be protective for the heart. And the other mechanism is that living in a low-oxygen environment, the cells adjust for a lower level of oxygen. If there is coronary disease, the cells are already primed to do better than somebody from sea level who has a heart attack.”
What isn’t clear is whether there’s a genetic component to this adaptation. That genetic susceptibility to altitude sickness is being explored in studies at the Colorado Altitude Research Center at the University of Colorado Medical Center in Aurora. That research is being supervised by Dr. Robert Roach, a mentee of Hackett. The work is being funded by the U.S. Department of Defense, which wants to get a better handle on which soldiers can be dispatched to high-elevation places like the mountains of Afghanistan without risk of suffering illness.
Can this link between thinner bodies and higher elevation be reduced to a pill? That sounds like a joke, but it’s not. Hackett explains that if ways can be found to trick the body into appetite suppression experienced at high elevations with a pill that can be ingested at sea level, somebody will likely make a fortune.
As reported by Reuters, a new deal between bioengineering firms that could potentially be worth more than $815 million is n the works.
The medicine, known as FG-4592, is designed to boost production of red blood cells by making the body think it is at high altitude. It could be used to treat anemia and other serious conditions, including circulatory problems.
Long lives at sea level, too
But the University of Washington’s study reveals you can live long, healthy lives at sea level, too. The study’s larger take-home message is that while the United States spends the most money of any nation on health care, it ranks only 39th for females and 40th for males in terms of longevity among the world’s 189 countries.
From 1985 to 2010, life expectancy gained 5.2 years for males and 3.0 years for females during that quarter century. That’s good, but gains were not equal across the country. A few places actually declined in life expectancy.
A female in California’s Marin County, located just north of San Francisco, has a life expectancy of 85 years. It’s 12.3 years less in Kentucky’s Perry County. The gap for men is even greater, 17.8 years.
Study results could be summarized as “death by zip code,” Dr. Nancy Snyderman, the chief medical correspondent for NBC News.
The lowest life expectancies are seen in the South, the Mississippi River Basin, West Virginia, Kentucky, and some selected counties in the West and Midwest that have large Native American reservation populations.
However, substantial improvements have occurred in parts of California, most of
Nevada, Colorado, rural Minnesota and Iowa, but also in several urban areas, especially in and around New York City, Washington D.C. and San Francisco.
Why do the cities do so well?
“Let’s talk about New York,” says Mokdad. “They have fairly aggressive prevention programs. If you go back 15 years, New York City was the first to implement requirements of caloric levels on menus. New York City was more aggressive in banning tobacco and more aggressive in limiting smoke from tobacco. They are excellent about giving people access to health care. In large cities, as a result of money and policy, the public health (advances) are a great success story,” says Mokdad.
But the successes need to be more broadly shared, he says.
“Whatever success stories we have achieved, we have not done a very good job of applying them throughout the country. I hope our finding and our work will allow people to say, ‘Why, why can’t we achieve more success everywhere in this country. We have the most resources in the world.’”
Also of note
• Douglas County, located in the southern part of metro Denver, which has elevations of 6,000 feet and above, is also on the low-obesity top 10. It has many of the attributes found in ski towns except for its politics. It instinctively veers right, while ski towns favor the left lane.
• Very prominently, a Harvard University School of Medicine study detailed the correlation between elevation and longevity in a study released a decade ago. That study had a statistical sleight of hand, aggregating counties to achieve minimum populations of 50,000. As such, San Miguel County (Telluride) was pooled with Ouray and San Juan counties. Using different statistical methods, the University of Washington study was able to use individual populations of down to 10,000, and most of these mountain-resort counties hit that mark. The authors say the level of uncertainty is acceptable when including smaller counties among large ones, such as urban and suburban counties with populations of 600,000 to 700,000.
• In the meantime, Mokdak sees the greater longevity and healthier infrastructure found in the West to suggest more rapid business development. Healthy lifestyles attract major businesses, and relocating employees will likely choose a neighborhood or community with high levels of physical activity. Look at almost any ski town—Steamboat, Jackson and Bozeman all come to mind—and you can see that idea already in action.