On Okinawa’s main island, there is a small stone marker with a few sentences written in Japanese, “At 80, you are merely a youth. At 90, if your ancestors invite you into heaven, ask them to wait until you are 100—then, you might consider it.” This quote appropriately reflects the reality for this Japanese island. It is known for the highest concentration of centenarians in Japan. Okinawans are less exposed to heart disease, cancer, and dementia compared to Americans. According to government data, in Okinawa, there were almost double the number of centenarians per 100,000 people in 2015.

The village of Kitanakagusuku ranks first for Japanese women’s longevity for the past decade. Okinawa is labeled a “blue zone,” a term for a place where people live healthy and longer. Many wonder what it is about this island that makes its inhabitants live longer and happier lives even with a shortage of doctors.

Dr. Suzuki has collected the medical, nutritional, and social data of over 1000 centenarians in Okinawa for over four decades. He explains that four factors contribute to longevity: diet, physical activity, self-help, and mutual help systems. His team has studied more than 1,000 100-year-olds to understand the genetic and environmental lifestyle factors responsible for healthy aging. Most importantly he mentions Ikigai, a word that means having a sense of purpose in life, which Suzuki says is the key to a long and happy life. He explains, “We call Ikigai the object of your spiritual health. It’s close to a personal mission, and it’s something only you can do. When we lose Ikigai, we die.”

Yukiko Kina, a 84-year-old resident of Kitanakagusuku recounts her personal experience with Ikigai and how it helped her and her husband to achieve health and longevity. She says, “I adore my great-grandchildren and grandchildren; they are my Ikigai. Being close to them is a secret to my health.”

The Okinawa Centenarian Study founded by Dr Suzuki in 1975, shared its findings in a 2001 book. His study showed that these individuals had clean arteries, low cholesterol, low risk of hormone-dependent cancer, 80% fewer individuals with breast and prostate cancer than North Americans, strong bones with half the risk of hip fractures than those of North Americans, lean and fit bodies, and remarkable mental clarity. These features of the centenarian population mean that they are less of a burden on the Okinawa healthcare system.

According to the World Economic Forum, a healthier lifestyle also contributes to economic benefits. University of Hawaii geriatrician and Director of the Kuakini Center for Translational Research on Aging, Dr Bradley Willcox agrees with this, saying, “If you can extend not just lifespan but human ‘healthspan,’ you can get more productivity; people will be happier and have less risk of dying of cancer or cardiovascular diseases.”

Knowing that ikigai is the primary reason for a healthy lifespan, it becomes necessary to understand the many secrets to living a long and healthy life—the Okinawan way. Apart from the genetic booster, they treat their food as medicine. The Okinawan diet consists of more than five servings a day of fruits and vegetables and incorporates more heart-healthy fish rather than meat. Foods like sweet potatoes, seaweeds, and green leafy vegetables, which make up the majority of their diet, provide anti-aging benefits as they reduce inflammation and oxidative stress.

In addition to diet, the Okinawans have developed a moai or a social network mechanism that involves bringing groups of people together who lend emotional and financial support to each other. Moai gives all of its members the stress-shedding security of knowing that there is always someone there for them. Socializing is one of the reasons many Okinawans live healthy lives to 100 and older. Nobu Higa, who is 100 years old expresses the satisfaction in this lifestyle saying, “I have a lot of friends and I enjoy seeing them and going for walks. We trade old stories.”