Devi Sridhar argues that we have misaligned health priorities. Many of us obsess over personal choices like diet and exercise while ignoring the crucial role of government in health outcomes. This crucial factor: effective governance.

Public health initiatives—including universal healthcare, access to clean drinking water, breathable air, and safe transportation—actually have a far greater effect on longevity than individual commodities like gym memberships or health food. As a professor of global public health at the University of Edinburgh, Devi has authored a new book titled How Can I Not Die (Too Early), which builds a compelling case that emphasizes both personal endeavors and public health as keys to a long, healthy life.

In her interview with New Scientist, she tackles the illusion of personal responsibility for health, discusses how to elevate public health appeal, and shares her vision if she were in a position of authority.

Graham Lawton: Are you suggesting that focusing on our own health is futile?

Devi Sridhar: Not at all! Personal health initiatives can be highly effective if resources, time, and education are available. However, placing sole responsibility for health on individuals ignores the broader societal factors at play. The environment and circumstances you reside in profoundly impact your lifespan. Society often forgets the systemic issues tied to health, where individuals’ agency is critical. Yet, large-scale health improvements typically originate from governmental initiatives.

How did we come to believe that health is solely our responsibility?

This belief is empowering. People think, “What can I do today?” and “If I’m disciplined enough, I can succeed!” However, broader structural barriers often limit their ability to make changes. We’re inundated with self-help narratives while less attention is paid to systemic factors, which many perceive as not directly relevant to their own lives. Additionally, there’s significant skepticism about politicians, with a prevailing notion that nothing will change.

What’s the right balance between personal and public health measures?

The answer varies by the specific issue. Individual efforts can influence areas like diet and exercise, but for critical areas such as air quality and water safety, individuals are often at the mercy of governmental decisions.

Are celebrity diets and social media influencers further skewing this balance?

Absolutely. It’s all about marketing. We tend to believe that products with the right branding are more effective. Public health struggles with marketing challenges. Recent years have not helped, as public health messaging often comes across as oppressive rather than liberating.

How can we reshape perceptions of public health?

We need to shift the narrative around public health. It shouldn’t just be about societal benefits, but also about simplifying life. People want to understand, “How does this benefit me?” This may sound cynical, but it’s the reality we operate within.

Given the misinformation surrounding vaccinations, why do many people fall prey to such fallacies?

A lot of this is rooted in social media culture, where popularity seems to supersede accuracy. For example, when Joe Rogan discusses his experiences with measles on his podcast—where he asserts it was commonplace during his childhood—this message carries more weight than that of actual health experts. Despite being neither a medical professional nor a public health authority, his influence is substantial. If I claimed that the secret to longevity was gin and tonics, it would go viral, posing a significant challenge for credible health messaging.

Implementing effective public health policies seems complicated, isn’t it?

Change often meets resistance. Consider the initial pushback against smoking bans in pubs or seat belt laws. Though there’s resistance early on, over time, people adapt, and these measures become normalized.

Your book presents various instances of successful government interventions. Which one stands out to you?

As someone in Scotland, I have to mention the Dunblane gun laws enacted following a tragic school shooting in 1996. The resistance to these laws was fierce, yet they have effectively prevented mass shootings in British schools, saving countless lives and establishing a model for other nations.

In high-income countries, 20% of deaths are preventable. What insights can we draw from nations with lower preventable mortality rates?

Countries like Japan, which have high cancer survival rates and low chronic disease prevalence, serve as models for what can be achieved. In Japan, preventable mortality rates are estimated at about 10%, showcasing the potential for better outcomes.

Our objective should be to extend life expectancy, ideally reaching ages of 80, 90, or even 100. If one can age successfully and die of natural causes, that signifies a healthy approach to living.

However, longer lifespans mean an older population. How should we respond to this shift?

Aging should be perceived as a strength, not a detriment. The focus should be on encouraging healthy aging, allowing individuals to maintain independence without overwhelming healthcare systems.

How realistic is it to align preventable mortality rates with those of Japan?

It will likely take a decade or two, as changing urban design and reversing childhood obesity cannot be done overnight. Nevertheless, the return on investment can be considerable over time. A significant challenge is the current governmental tendency to prioritize short-term headlines over long-term planning.

If you were in charge of the UK National Health Service (NHS), what reforms would you prioritize?

I believe there’s a strong need for focus on preventive care. Currently, the UK invests significantly in acute care while neglecting prevention. The emphasis right now is on addressing hospital and ambulance waiting times, which will worsen as the population ages. My approach would be to prioritize preventive measures. Identify and invest in cost-efficient strategies to detect health issues early. What are the prevalent reasons behind hospital admissions, and how can we tackle them?

For instance, hypertension is known as a silent killer. Regular annual blood pressure checks could lead to early detection. Though the initial costs may be higher, savings can accumulate over the years. Regular assessments of waist circumference, abdominal fat, blood sugar, cholesterol levels, and grip strength should also be incorporated.

I interviewed you during the COVID pandemic, when you mentioned that it was an opportunity to address long-standing public health challenges. Did we capitalize on that?

No, quite the opposite. If anything, there has been a backlash against public health and government intervention. Strict lockdowns and mask mandates led to significant pushback. Rather than seizing the opportunity for systemic change, the focus has shifted back to individual responsibility.

Do you feel we’ve learned valuable lessons from the pandemic, and is the world better prepared for the future?

It depends on the perspective. In terms of public health, I would say no; we’ve regressed. The UK’s testing infrastructure has been dismantled. However, in terms of scientific advancement, yes, we’re now better equipped for vaccine development and more efficient research processes. If a bird flu strain spreads among humans, the UK government already has a vaccine ready for distribution.

A quote from your book resonates: “We don’t need to conduct any more studies.” Is that your position?

Yes. We have a wealth of knowledge already. Perhaps 90% of what we need to know to improve population health is already available. While there’s always room for further research, repeating studies that confirm what we already know can become a distraction and delay necessary actions.

Are we evolving positively on a global level regarding public health?

Overall, yes. Life expectancy is increasing, and quality of life is better than it was a century ago. Progress may not be rapid or uniform, and in some regions, there are setbacks, but the overall trend shows significant advancement.

What message do you want readers to take from your book?

Politicians have the power to effect change. Take the NHS, for example; its establishment was a deliberate decision, not a coincidence. Everything we have today is the result of policy choices made decades ago, and we are currently reaping the benefits. While the improvements from today’s decisions may not be immediate, future generations will benefit from them. My aim is to inspire hope for what is possible.

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