Wellness Wonders

Project Overview

Blue Zones" are regions where the citizens live long, happy lives and is a term coined by Dan Buettner, a researcher of this phenomenon. The five original Blue Zones are in Okinawa, Japan; Sardinia, Italy; Ikaria, Greece; Loma Linda, California; and Nicoya, Costa Rica, which is where we visited. Through correlational studies, researchers have found that these regions share a number of similarities such as healthy diets, active lifestyles, and effective healthcare policy. 

Along with three more friends from CC who also received venture grants, we traveled to Costa Rica over spring break ‘24 to learn about the Blue Zone there. This project came about after group members had read Dan Buettner's book, The Blue Zones of Happiness, and were enthralled with the idea. Our group was formed, and we decided that with the numerous ways one could approach this subject, we could do three projects! We looked into the healthcare aspect of the Blue Zones, specifically, whether the healthcare structure and policy in Costa Rica contributes to the longevity of its citizens. 

This project combined our interests of the healthcare system and policy as well as preventative care treatment and longevity. We are both pre-medical students, interested in going to medical school, and this venture grant was a wonderful opportunity to dip our toes into the water.

Research Questions

1. What unique preventative measures (house visits, vitals checks, technology, workflow, wait times, ect.) do health-care professionals implement in Costa Rica in comparison to the United States?
2. How do the attitude of patients and doctors towards healthcare policy (cost, efficiency, influence on work/life balance, and overall satisfaction) in the United States differ from those in Costa Rica?
3. Which preventative healthcare measures from Costa Rica can we implement or promote at Colorado College and our home communities?

Project Goals

• Practice Duolingo and leave Costa Rica knowing more Spanish than when we arrived 
• Shadow preventative healthcare practitioners (ATAPs) as they complete their daily house-to-house rounds and record observations 
• Interview healthcare practitioners, patients, and local citizens to examine their attitudes and impressions of the preventative healthcare system
• As pre-medical students, gain an understanding of the work-life balance of healthcare professionals in Costa Rica

Methodology

Our research methods were based on observations and ethnographic data to obtain a holistic analysis of the Costa Rican healthcare system. This kind of ethnographic study in the Blue Zone of Costa Rica is rare and not often documented in research papers. 

We were able to interview three healthcare providers in Costa Rica. All three of the doctors were private healthcare providers, as they were most able to accommodate us into their schedules. Two of the doctors were interviewed in clinics in Sámara and the third was in a clinic in Coco. Both of these towns are in the Blue Zone region of the Nicoya Peninsula of Costa Rica.

We asked each provider some pre-set questions such as “what does a typical day in your life look like?” and  “What is your work/life balance like?” We also allowed for a natural flow of conversation. Meanwhile, we took notes on our physical observations, such as the number of people in waitrooms, to answer our research question one. The first-hand exposure to clinical environments allowed us to witness healthcare professionals' day-to-day activities and routines and gauge the relative efficiency and atmosphere of healthcare environments.

Furthermore, we obtained some insight on patients’ perspectives of the Costa Rican healthcare system through conversations with locals, such as our taxi driver and people at restaurants. These conversations were natural and included questions such as “what do you think keeps the Costa Rican people so healthy?” and “how often do your grandparents see a doctor?”  This led to success in answering our second research as it allowed us to gain a primary resource of the thoughts and feelings of the Costa Rican citizens. Although the healthcare system may be effective, we found that citizens' opinions are equally important in determining the overall impact of preventative healthcare.

While we felt that we gained so much incredible knowledge from these interviews, we recognize that our sample size is small and that there is still so much to learn about the Costa Rican preventative system. We were disappointed that we couldn’t reach our goal of five doctor interviews, as we both experienced personal health-related issues during the trip. Additionally, we planned to interview doctors in the public healthcare system, but due to a large volume of patients, we were not able to fit into their schedules. Luckily, all three of our interviewees had previously worked in the public system and were able to offer many insights. 

This exposure helped us demystify the preventive system and provided a realistic view of what medical care in Costa Rica entails. 

Findings and Personal Impact

After speaking with numerous healthcare professionals, our personal observations, and discussion with other group members, we came to the conclusion that healthcare is not the key contributor to the Blue Zone. We interviewed three doctors, two general practitioners and a family doctor, one of whom worked both in the private and public sector, while the other two worked in public and private, respectively. At each interview, we asked if they believed the healthcare system contributed to the longevity of its citizens, and three times we heard the answer no. While government policy and preventative care and access does contribute to the health of its citizens, we found that the healthcare system is not the reason that Costa Ricans live longer and happier lives than the average citizen. 

The doctors that we spoke with had many positives to say about the system, but they also had criticisms, which were illuminating. Common themes of critique that all three doctors mentioned were the long-waiting times to see specialists, pay disparity in the public system, and government corruption large enough to affect the healthcare system. On the flip side, a positive that we encountered was that the preventative healthcare system works as the government has directed numerous resources for decades to this cause.

This project was very significant to us, as we both are pre-medicine and planning for a future in healthcare. Costa Rica is a pioneer in medicine, boasting a preventative system and providing government funding for all public medical procedures. By examining these practices first-hand, we gained a wider perspective on healthcare practices and media portrayal of certain systems. For example, we noticed that our findings didn’t perfectly align with those claimed by the famous Blue Zones books and netflix documentary written and narrated by Dan Buettner. Specifically, how the degree of influence of the healthcare system versus the culture and attitude surrounding healthcare practices. This was an enlightening observation and prompts further study and analysis. 

Furthermore, we felt that learning from diverse providers and patients is invaluable in an increasingly global healthcare landscape. It fosters an open mind and enhances cultural competence, which will be crucial skills as a doctor.

Our experiences in the United States working as EMT-Basics, volunteering in hospitals, and being engaged in the medical landscape also allowed us to make informed comparisons between Costa Rica and the US. This comparative nature enabled us to start to gain some awareness of the inefficiencies and inequalities in the United States system and appreciate some systems that we often take for granted. We plan on bringing this knowledge with us to the future to create a more equitable and optimal medical landscape. 

In conclusion, our project on Costa Rica's Blue Zone allows us to highlight some critical differences between the very different Tico and US healthcare systems. Through this research, we feel that we better understand and can inspire health-and-happiness-giving practices from the unique attitudes and practices from the Blue Zone of Costa Rica. In doing so, we feel that we have placed ourselves at the forefront of just and globalized medicine.

General Takeaways from Interviews of Healthcare Professionals

Thoughts from a general physician: A big reason why people are so healthy is that the public opinion of getting treated for physical ailments is so positive. When a person gets hurt in Costa Rica, their thought is to go see a doctor as soon as possible. Whereas, Americans come in after they have been sick for a week and seem embarrassed about asking for help. A large motivation behind Costa Ricans so willingly asking for help is the importance of spending time with their family and community.

The issue of long wait-times to see specialists and public physicians is not due to a lack of healthcare professionals, but is instead due to disparities such as pay allocation, government corruption, and public policy surrounding the healthcare system. 

From talking with healthcare professionals in Costa Rica and reading about its history, we learned that the country has put a sizable portion of its funds into preventative and primary health care treatments since the 1970s. This decision has had an enormous impact on the system and peoples priorities. In fact, economically, it was a very smart decision, because government outlays on healthcare can reduce income inequality in the long run as.

Next Steps for Mary and Rose 

Continue to learn Spanish through adjuncts and general resources 

Explore the aspect public health in the healthcare system through readings and experience 

Delve into learning about preventative care and public health policy for both individuals and larger populations

Create a Blue Zones Club at Colorado College 

Most Important Implications 

Family and community is incredibly important for one's mental and physical health and happiness 

Prioritizing one's health and well-being will help not only oneself but everyone else in your life 

Do not be ashamed to ask for help

Acknowledgements

We would like to give a huge thank you to the Keller Family for the financial support to carry out this exploration.

We would also like to thank Lisa Schwartz for the feedback during the editing process of the grant application.

One final thank you to our families and friends for the support before and during the trip.