June 13, 2025 • 40 mins
Whilst life expectancy is declining in the UK and America and other high-income countries, some tech billionaires have become obsessed with life longevity - but which factors really impact how long we live and when we die?
Public health expert Devi Sridhar speaks to Krishnan Guru-Murthy on Ways to Change the World about the launch of her new book 'How not to die (Too Soon).
She explains how changing our public health policy could improve life expectancy, what the UK can learn from other countries when it comes to health, and what her own cancer diagnosis taught her about the state of the NHS’ waiting list times.
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Episode Transcript
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(00:00):
Yeah. So the lie being that you're
individually responsible for your health and if you are
disciplined enough or have enough willpower, then you can,
you know it's your job to do it.What do you think we as a
country should do to make our diet more health?
1st, we need to start with children.
We're feeding them cheap empty calories, largely ultra
processed. It's a massive problem that we
(00:20):
basically have in NHS, but it's not really a health service,
it's a disease service. You're sick and you go in and
you say can you? Can you help?
I mean, on vaccines, you know, America is massively pushing
back. What does that mean for American
health? America's health is going
backwards. I mean, they're having measles
outbreaks, like children are dying of measles, which is
preventable. It's a vaccine preventable
(00:40):
disease. We are going to see a resurgence
of things that were eliminated or gone.
Hello and welcome to Ways to Change the World, the podcast
where we talk to the thinkers, innovators, the radicals with
the big ideas on how to change the world for the better.
My guest today is the public health expert Debbie Shridhar,
whose insights and arguments came to the fore during the
(01:03):
COVID crisis, but who has been researching public health
interventions since she was a teenager in Florida with a
father dying from cancer. She had her own brush with the
disease 2 years ago, just as shebegan writing her latest book,
How Not to Die Too Soon. Fortunately, she managed to do
just that and joins us now. We'll get to that collision with
your own mortality in a moment. But first of all, if you could
(01:26):
change the world in any way, howwould you change it?
I think would be to prioritize health and well-being in our
everyday lives and have healthy long ageing in a vibrant way.
But your your book is all about really how we've been sold a
lie. Yeah.
So the lie being that you're individually responsible for
your health and if you are disciplined enough or have
(01:46):
enough willpower, then you can, you know, it's your job to do it
instead of actually looking at the fact that we are social
beings who are within a community and are receptive to
those forces. Because I mean, there are so
many industries now around health, diets, you know, how we
should live, what we should drive, all those sorts of
things. And what you're really saying is
(02:08):
it's much more than individual responsibility.
Governments have got to make biginterventions.
Completely. So it comes from looking at
places, you might call them bluezones or places where people
live long healthy lives. If you look at the individuals
within them, it's not because they're individually in a sense
everyday thinking about it. It's if they're just living
their life in the way community has been constructed and the
(02:28):
government has created policies.And so my take away was not that
we should be looking and thinking, oh, I need to sleep
like someone in a Blue Zone or Ineed to eat like someone there.
It's actually saying how do we create more places and have
policies that let us just live our lives, but through living
our lives we actually end up in a healthier way.
So what is a Blue Zone in publichealth?
So a Blue Zone are places where people tend to live close to
(02:50):
100, have low rates of chronic disease, low rates of
hospitalizations. So examples would be, you know,
Okinawa and Japan, they've looked at Sardinia and Italy,
they've looked at, you know, different communities across the
world. And they're thinking, why do
people there live longer, healthier lives?
And a lot of the research has pulled out individual habits
instead of actually looking at the community itself, which is
(03:10):
why we. Get hung up on Mediterranean
diets. And that kind of thing.
Exactly. Yeah.
And the Mediterranean diet is great.
It actually has been shown to have massive health benefits.
But it's easier if everywhere you go serving Mediterranean
diet food and you go to school and kids are eating that and you
look in the local supermarkets and that's what you can get, get
the fresh produce and it's affordable and it's delicious.
And I think the problem is trying to import that without
(03:32):
actually changing the food culture that we're all part of,
or what you can actually do in your daily life.
So what? What are the big lessons from
those those places where people are living long and healthy
lives? Well, the lessons, and they
won't be any surprise, are diet,physical activity, low levels of
violence, strong levels of community, good access to
healthcare, you know, clean water, clean air, not much Rd.
(03:53):
traffic, accidents or chance of dying, you know, in your
everyday life on a cycle or walking.
And so actually things that people would be like, Oh yeah,
that makes sense. But the difference being that
those are ingrained in policy. It's not because individually
you're doing anything about it. It's actually how they're
constructed. So this is about big government
and governments looking at this wrong.
Well, I think it's too easy for governments to say, well,
(04:15):
actually, why should we care about that issue?
It's an individual thing. And actually if you're well
powered enough, you can make sure you get your exercise.
Part of me is like, if you look at the populations that get the
greatest level of physical activity, it's built into their
daily life because cities are built around walking or cycling
or public transport, their options, alternatives to just
being in a car, being sedentary.So the idea being that just
(04:36):
running fitness campaigns, YouTube campaigns, Dubai has
tried a free month of fitness, don't actually get the
population as a whole moving. It's actually the invisible
drivers of how do people get around a city?
How do kids get to school? How do people get to work?
And how do you make it that actually there are more kind of
we call active travel options, but it has to come from, let's
say, design of how you actually design A city rather than
(04:57):
individually saying to people, go run your 5K or go, you know,
some people will do it. But again, you're almost
reaching a fit who just want to get a bit fitter.
You're not reaching the bulk of people who are sedentary who are
just like I do shifts, I've got to care for my parents or my
children, I don't have time. So you have to make it inbuilt
into the city and into their lives so it's invisible,
accessible and then it's people can do it.
(05:18):
Now you you begin the book with your own brush with cancer.
Just just explain what happened.Well, it's just me living my
life. I think of myself as quite
healthy, young, you know, doing all the things I'm supposed to
be doing and going. You're a fitness obsessive.
Really. Aren't you, well, a bit too
much? Yeah, probably, probably you're
on too much. And my idea being like, I just
went for a screening and that's part of the NHS.
(05:40):
We all go for regular screenings.
You get your letter. And I went in and they came back
and they said, well, actually wefound high risk HPV and we found
abnormal cells. It looks like there's a
likelihood of cancer. You need to come in for an
appointment. And then my struggle to get an
appointment because the NHS in Scotland, I guess similar in
England, has major backlogs. And this was just after the
pandemic. So actually they had all these
women who just been pushed forward and forward, you know,
(06:01):
not having the screening programs running.
And I was like, my lab results have already taken a couple
months, which means this is looking almost in the past.
So who knows what's happened since then.
And then trying to get an appointment when you know it'll
be 6 to 9 months. And knowing from being American
that in the States, you get yourresults within a couple days and
you get your treatment within a week.
So actually you're like, how is this So?
(06:22):
But I guess the point of bringing it up was to say, one,
we're so relying on the healthcare system we're in.
I couldn't treat myself. I couldn't fitness my way out of
this or eat, you know, my Mediterranean diet.
I was relying on the healthcare offering.
But also the idea that, you know, there are things where we
actually do need society to stepup.
And me having access to a program, a screening program,
(06:42):
getting the treatment, which I did living longer had to do with
having an NHS which was able to be provided, which is accessible
and free at the point of care, which is one of the points I
wanted to raise. That in the States you'd have
that, but you're paying 10s of thousands of dollars.
So in a sentence, your choice isdo I just risk it might go away
or end up paying $30,000 for it.So idea being that actually
(07:04):
before we start saying the NHS doesn't work, it has problems,
it does that actually there are barriers to care in a lot of
other countries. And it may not be a wait list,
it might be a high bill, or it might be not having doctors.
And so also to bring some comparative reflection and to
where the NHS is compared to other systems.
OK, well, well, so well, let's talk about the NHS for a little
bit then, because obviously that's the government's massive
focus. They're piling more money into
(07:26):
it. And as every government I can
remember, they are going to talkmuch more about prevention being
the key. But you know, the truth is they
don't really get there today. Yeah, it's a massive problem
that we basically have in NHS, but it's not really a health
service, it's a disease service.You're sick and you go in and
you say can you, can you help? And I think they're the real
(07:48):
thing is it's really hard to invest in prevention because the
focus is on A and E wait times and ambulance wait times and the
person dying of the heart attack.
How do you actually go backwardsto say how do we reduce the
likelihood of that person havinga heart attack?
So for there, the things that I thought about like why don't we
have a yearly annual checkup where people get their blood
pressure, which would tell you very clearly a sign of are you
at risk of a stroke or heart attack?
(08:10):
Where you have support, You know, in the sense of this is
what you need to do in terms of a plan to get your health on
order. And so actually having to make
those decisions to shift away from hospitals to actually
community care and doing in a concrete way.
So looking at what are the five things people going into A&E for
or taking up the hospital budget, how do we work back to
the community level to start trying to unpick it?
It'll take years. And I think that's the problem
(08:31):
for governments. They don't happen overnight,
happens over years. But I think that's the only way
because we will never treat our way out of this crisis with the
NHS, an aging population, chronic disease, more and more
people living longer but dependent on social care.
The only way is to rethink it and think, how do we make aging
in a healthy way, an independentway where you're not relying on
a healthcare system where you actually can touch base with in
(08:54):
a preventive way, but not wait until you're actually very
severely I'll before you're going in.
But aren't aren't we in a catch 22 when it comes to the NHS,
which is that it is so busy treating the sick?
Yeah, it doesn't have the resources to do all the
preventative work and the and the annual checks.
You know, if you if you booked everybody into an annual check,
you wouldn't be able to get AGP appointment anymore.
(09:15):
True and you're. Sick.
Completely and I think that's the catch 22 we're in we're
almost having to have to work itback right because there are
people who need care for diabetes and chronic conditions
and hypertension but actually how do you work backwards and I
think there we do have to be honest about the past 15 years
investment in the NHS. The investment in the NHS hasn't
kept up with other countries, France, Germany, they do spend
(09:37):
more per capita on providing healthcare.
So one thing is saying we are coming out of a pit where
actually we have a long wait list.
We have to invest in it, but invest in a smarter way.
The everyone is talking about itand I think that's great.
But the question is, will that actually deliver and will they
actually be able to do that and create the bandwidth for that?
I mean, politically we've got ourselves into a situation now
(09:57):
where it is very common for people to say the NHS is a money
piss and you can pile more and more money into it but it won't
really change outcomes, you know, How has that been allowed
to become the norm? Well, I think there there's also
like this idea that like somehowother places are better or have
it all figured out. And that's why I wanted to bring
up the examples of the States oreven India where it's out of
(10:19):
pocket care. You literally go to a doctor and
70% of people are paying for their care out of pocket, which
has its problems. But I think they're the only way
to say it's not piling it into the NHS.
It's saying this is what we're going to put the money in for
these priorities. It's going to go towards
prevention. And this is the service which
we're trying to keep for the benefit of everybody.
But I think where we will go down the black hole is if we
(10:40):
don't invest in primary. Primary prevention is things
like diet, physical activity, smoking, alcohol, you know, the
drivers. Secondary prevention is like
things like diabetes screening programs, blood screen, you
know, basically saying to peoplethese are early indicators of
disease, let's get on it early. We don't invest in those two.
There is no way you can keep up with an elderly population and
health services. No country can.
(11:00):
So you have to rethink it and think, OK, how are other
countries managing to have agingpopulations which are healthy?
And that's why in the book I talk about Japan, because Japan
has like whole football teams ofpeople over 100, like they're
still playing on a football team.
And I was just looking, thinkingwhat a fascinating place where
actually aging independently in a healthy way has been
normalized. And how do we actually think of
(11:21):
that and think, are we thinking about aging idea?
You get older, you get sick, youdie.
Why is that normalize instead ofyou get older, how do you remain
independent? How do you remain healthy and
actually save some of that budget where we're spending a
lot on, you know, the last 20 or30 years of someone's life?
OK, so how do they have 100 yearolds on football teams?
Well, their diet, huge ones. They have very low rates of
obesity, chronic disease, going back to children, what they
(11:44):
offer their kids in school meals, they get 9 fruits and
vegetables here we're trying to meet five, there, it's nine.
They manage to kind of support people.
Effective healthcare system focused on prevention and so
they're you know they've struggled with smoking rates but
they've brought in legislation to get smoke free brought them
down very low rates of you know respiratory diseases because
(12:06):
they've had clean air initiatives and net 0 focus.
But I do want to put like a little asterisk because they do
struggle with suicides and mental health.
So Japan in some way is you think, great and all these
different areas, an exemplar. And then you go to mental
health. And they are actually probably
the country where more people died of suicides by October 2020
than of COVID-19. And it wasn't because of
(12:28):
lockdowns. That was a trend continuing.
But they are the outlier. And so in a sense, if you can
maintain someone physically, butactually they do struggle with
mental health. And so just to not paint them as
the actual perfect population, they have struggles too.
So so take diet because you know, diet is the ultimate
personal responsibility in our society and there is endless
(12:48):
industry around you know, books,websites, you know, fads.
What do you think we as a country should do to make our
diet more healthy? Well, I think first we need to
start with children. And I think there everyone would
agree that children are not responsible for their own diet.
They're gently fed what their parents feed them at home,
what's in their home and what's at school.
(13:09):
And if you look at what's in school meals or around schools,
it's basically junk food. We're feeding them cheap empty
calories, largely ultra processed because it's cheap, it
lasts forever. And there's a big lobby because
it's a big market. And so there I'd say the first
thing to look at is we, I think we're saving money on school
meals by saying like actually we're only going to spend $0.50
a meal or $0.45 a meal, pence, sorry, not sentence.
(13:32):
But then you go and you look at what you're spending on a child
who develops diabetes by age 19,type 2 diabetes, that's care for
the rest of their life. And so I think there there's
this false economy of trying to save money on something.
So school meals would be 1. So you look at the places
reversing childhood obesity rates going up, South Korea,
Japan, Denmark, those places have focused on children and the
school environment, meaning not just, you know, high schoolers
(13:55):
might like or senior schoolers might want to go outside of the
school. So what is the environment?
I think another one is affordable options.
Like we know since Brexit that fruit and vegetable prices have
gone up quite radically, like cucumbers up to 100%.
So when someone goes in to buy abasket of goods which would say
are more nutritious, is much more expensive than to buy them
that are cheap. And I think that understanding
(14:15):
that actually we have to figure out how to make healthier
options cheaper and more affordable and accessible.
Because it shouldn't have to be that that actually to feed your
children properly or feed yourself properly, you're going
to have to actually pay so much more.
And a lot of people just can't. I mean through subsidy or
changing agriculture or I mean all of these things.
Yeah. And I think there's innovative
(14:36):
solutions I bring up, you know, in the book.
I really try to give practical examples because otherwise
sounds like fairy tales, right? And one is around Wales, which
started actually what they call a courgette trial, zucchini
trial. And what they said was that they
were going to, with schools, go to whole, you know, food
manufacturers and then the middle men and say we are going
to guarantee you a market. We're going to guarantee you all
school meals. We guarantee you that and you
(14:57):
guarantee quality. Can you provide that at this
price? And because they were guaranteed
this market for a certain amountof time, they were able to bring
down the price and they integrated into school meals.
So actually, there you go, a vegetable affordable in a school
meal and they're trying to trialthis with other vegetables in
the sense that if you create a market, you can guarantee it.
Can you actually get producers to meet the prices that you
(15:19):
need? Because a lot of it comes down
to price. So I think they're they're
innovative trials of actually trying to see how can we shift
things. Denmark is another one.
They started a system of what they call kind of keyhole
labeling, where they label products to help identify for
people when they go into a shop,what are healthier options.
It seemed to work well until thebarrier of cost came up.
People said it's more expensive.They looked at subsidies for
(15:40):
those. I was saying you can't just have
sin taxes and tax unhealthy thing.
You have to make it more affordable.
So I think there it's kind of slowly shifting it through these
levers of kind of cost, affordability, education, but
schools as well as a great placeto start with children.
And about shifting the spend away from what it costs to fix
people or treat people. Exactly.
And to what it what it costs to prevent.
(16:00):
The problem is it's two separatebudgets, right?
So one line is NHS and one line is education and where school
meals are coming from. And so you're think you're
saving money because you're pulling it from school meals,
but you're spending it because people are getting sick.
So having that joined up, thinking of actually how do we
join it up to say we might spenda bit more there, but the
savings will come. They might not come for five
years or 10 years, but how do you have that longer term
(16:20):
thinking? But but how do you get ordinary
families who are struggling withtheir weekly supermarket shop?
Even if you subsidise the the courgette and the cucumber to
buy those things, you know when the fact is that ultra processed
foods is tasty, cheap, easy, canbe stuck in the microwave,
(16:41):
doesn't require all that cookingefforts and knowledge that we
don't have as a society. Completely.
And there I think there's policylevers.
So if you look back, I mean it'sa bit different but somewhat
similar as you take smoking, something that you would have
said 30-40 years ago is addictive.
People like to buy their cigarettes.
Smoking was ubiquitous and pubs and cultures, you would have
thought how are you ever going to do this shift to a world
(17:02):
where actually people aren't going to have that and they
managed to through policies. That's one of Britain's success
stories, right, of actually using different policy levers
that now smoking rates have declined rapidly in other
countries. Like how did Britain do it?
Well, it was through a mix of creating different zones where
you can't smoke, right, smoke free places, make it taxation,
targeted education, making it easier to quit.
(17:23):
So you go to pharmacies, you getsupport.
And so I feel like we almost need a similar kind of strategy
for diet. We're thinking through how do we
use the policy levers We have tostart shifting it away with
recognition. It's not an individual choice
that actually in the end people are making choices based on how
much money they have, how much time they have, how much
knowledge they have have. And that there is a reason
there's a socio economic gradient for obesity, right?
(17:45):
It's and also that it's easier to stay within a healthier
weight in Japan than it is here.That means there's something
about the food culture. It can't just be individuals
being less, having less willpower or anything like that.
So. There there is a basic bias
against the nanny state in Western democracies.
So how do you persuade people that regulation is good?
(18:07):
You just look around us and how much of our life.
So why have we not had a mass shooting in a school in Britain?
It's because of Dunblane in Scotland, where there was a
shooting and parents came together and said no more guns.
And then it progressed through various, you know, both
Conservative and Labor governments to the point where
you can't easily find a gun. Recently in Edinburgh, they did
have a student who was arrested with massive plans based on
(18:30):
Columbine for a school shooting.Even where they would stand,
what they would do couldn't get a gun.
That was the difference. Otherwise that would have had
basically planned it in great detail.
The one piece missing. So when people look around and
say, oh, nanny state, I'm like, is that a nanny state that
actually you can't easily buy a gun, take another one.
Clean air. We know increasingly the damage
that air pollution does. If you're in some place like
(18:52):
India, it's the equivalent of smoking 50 cigarettes a day.
Half of kids in Delhi have damage to their lungs.
And then you take Delhi and you say, OK, that could be London.
That could be any of the big cities that have large
populations, cars, diesel manufacturing industry.
Why doesn't London and have air as bad as Delhi?
Because of all the measures brought in both by both
conservative and labor mayors saying, actually we want to try
(19:14):
to keep London's air as clean aspossible with the balance of
obviously we need some cars, we need some things.
But do you want to live in a world where, you know, you have
lockdowns like they do in Delhi because the air is so bad?
People are staying inside because they can't breathe
outside. That's regulation, That's nanny
state. And then go through roads if we
had no walk. You know, there's so many ways.
(19:35):
NHS, that's a regulation. So much of our lives that we
take for granted is policy measures that keep us safer and
give us freedoms. We have the freedom here to send
your kids to school without being shot.
I mean, the, the, the government's just announced, you
know, over £100 billion of infrastructure investment.
There isn't any part of that conversation that is about
(19:55):
making sure that infrastructure that makes us walk more or cycle
more or anything like that. I mean, why?
And you know, you've worked closely with governments in
Scotland. Why is it so hard to make this
part of the conversation? I think it's hard because
there's a focus on immediate returns.
(20:15):
They want to know like tomorrow.And I think there's a real
problem now with constant pressure to focus on other
things. And I contact later in the book,
like why? Who wants to be a politician?
Because you get constantly hammered by things.
So if you're trying to raise infrastructure, then there's the
issue of like you're trying to take away cars, Why are you
trying to take away cars? And you're saying we're not
taking away cars, we're offeringyou options.
(20:37):
I think the nicest thing in Edinburgh and they've tried to
do this, 15 minute cities, you can walk, you can psych, you can
take a bus or you can take your car.
Taking car might be a bit more expensive, but those are the
options. It's more freedom.
And I think the problem though is when you try to say it, you
just get car, but you're trying to take away cars.
You know, the green, you know, the green agenda is the woke
agenda, blah, blah, blah. And I feel like it becomes hard
to be clear through it. So I do feel for politicians
(21:00):
because I feel like they're being boxed in sometimes by
being hit by kind of half truthsand trying to defend that.
So can't progress like the healthier agenda.
And I feel it here as well. I mean, hearing the debate when
Labor came in, there was great promise about prevention, about
healthier meals, about these kind of things.
And I know they're trying to do it.
But it feels like, you know, when the Prime Minister comes
(21:20):
out here, Starmer, he's talking about immigration.
I'm like, why are we talking about immigration?
We should be talking about making life better for people.
What do like immigrants have to do with that?
It's a different conversation, but it sometimes feels like he's
been forced into that instead ofkeeping to the agenda of
actually what makes life better for people living here.
And I can tell you, I don't think it's immigrants who are
(21:40):
the reason that everything is not working.
And it's an easy out. But that's one of the things
that gets me is like the distraction.
So politicians get dragged down that debate instead of focusing
on like, the key one, which is how do we make life better for
people, healthier, easier to live?
And actually that requires investment in public services
and in infrastructure, but in ways where you think about
active travel, walking and affordability.
(22:01):
So how, how hard is this as a government advisor to get them
to, to, to realize that these sorts of interventions could
actually change lives? You know, there's a sense in
which when somebody like you comes along and says these
things, it's like, well, yes, I know in an, in an ideal world
that we could spend all of that money.
But the, in the real world, we can't do all of that.
So, you know, we're going to geton with this.
(22:25):
Yeah, and I guess that's partly why I wrote the book.
I give examples, I give concreteexamples for every single issue.
Mental health, They say here we can't provide enough therapists
or GP appointments for everyone who needs mental health care.
Weightless. They're like 2 years long.
I'm like, OK, how is India dealing with this?
So India has started to do experiments, looking at lay
therapists, people you train fora month who go into communities
(22:46):
and actually they found depression rates go down
massively. Just having someone train for a
month who can sit with you in the community and then say,
actually, I need to escalate youbecause is you need to go see a
doctor. We've created, we've had GPS
doing that, right? GPS are basically that service
GPS are overloaded because they're dealing with mental
health on top of everything else.
So my thing is, well, why wouldn't we learn from India?
(23:06):
If they're able to do lay therapists, why can't we do it
here? And I think that's what I've
been trying to do with government, you know,
politicians and ministers and just saying, you say it's too
hard, why can they do it? You say it's too difficult, why
are they doing it? And I feel that way about the
states now. I mean, coming back to being
American and living abroad, likeyou go to the States and you
say, imagine not having mass shootings and they say that's a
(23:29):
pipe dream. Never happened.
I'm like, no one else has this. But because they're in their
bubble, they can't see beyond it.
They're like, we love our freedom.
I'm like Brits would say they love their freedom.
Australians love their freedom. Well, we have a history of it.
Serbia has the history of it. Colombia has a history of it, so
many places. And so I think taking away the
exceptionalism of being like, you're not exceptional because
you're American. Look at the rest of the world.
(23:51):
They just have on policy in a different way and I think that's
what I try to bring it to ministers, international
examples. On vaccines, you know, America
is massively pushing back. They've announced this review of
all vaccines. They're looking at MMR again, as
if there's anything to look into.
We know for a fact there's nothing to look into in terms of
the link between MMR and autism,but they're looking into it
(24:11):
again. They've announced that they're
going to take away the giving ofCOVID vaccines to children.
Now we've done all that in Britain already, but in America
they for cost. Reasons here though, So we do it
here for cost, not for safety anything.
So there's a difference. Right.
So I mean so So what does that mean for American health?
Well, America's health's going backwards.
(24:32):
I mean, they're having measles outbreaks, like children are
dying of measles, which is preventable.
It's a vaccine preventable disease.
We are going to see a resurgenceof things that we considered
like that were eliminated or gone.
But the but the Trump administration and the MAGA
crowd would believe or argue that you're part of some sort of
corrupt, giant sort of farmer driven cabal that is trying to
(24:58):
sort of pull the wool over the population's eyes for for the
pharma companies to make money. Completely.
And that's what you're painted at.
And it really frustrates me. And that's why I, like I do
mention in the book why I went into public health.
I had an offer. I could have gone to Harvard
Law, I could be in, you know, Wall Street.
I had other options. And most people in public health
are like me. And we've chosen a career where
we want to actually look at the best data, analyse it, talk to
(25:21):
other experts and help all of us, including ourselves, live
longer, healthier lives through public health policy.
People in public health generally don't go into it for,
you know, to become incredibly rich or famous.
It's a very kind of Cinderella science.
And so I think there, it's really frustrating because
you're like the people advocating for vaccines
generally are people who have seen these diseases, don't want
(25:43):
them coming back and want to prevent children suffering from
them. I mean.
Do do you have any sense of why it is that in relatively
educated societies like the United States you have this
almost deliberate stupidity? I think.
It there is anti science and anti established truth.
But it's I wouldn't even, I don't, I think it's almost that
(26:04):
people think they're more clever.
They figured something out that you haven't figured out.
They're like, oh, you don't realize I've done my research.
And it is worrying because like there's a nature study recently
that they said people like a statement and said, is this true
or is it not true? And the longer they spent on the
Internet, the more they went down the conspiracy rabbit hole.
So like, the more research you do, the more educated you try to
become, almost the way the web is set up, the more you start
(26:28):
believing this kind of stuff. And then it's hard to come back
to reality and say, actually, that's not true.
This is, you know, this. Let's go back to facts.
Let's go back to analysis. But I think there, there's not
really any fact checking happening on the Internet.
If you look in the past, people got their news from mainstream
outlets, they got it from newspapers and there was fact
checking. Like if I write something for
the Guardian, it goes through fact checking.
(26:48):
I'm accountable for those. And we have to look at the
sources. And I guess same for being on a
news program and it doesn't haveany fact checking.
You can say whatever you want. And so how is someone supposed
to know the difference between apolished YouTube video of
someone saying something and showing graphs and someone
who's, you know, it's very hard.So I I also sympathize in the
sense of people don't know what to believe anymore.
And when will we see the fruits of these policies in America?
(27:13):
You know, when will we see the, the, the, the, the declines in
life expectancy and the increasein disease?
Well, we're already seeing the decline in life expectancy that
started before the pandemic. Although that's not because of
Trump. That's kind of.
Long term. Exactly.
That's there. I think now we're already seeing
the rise of measles outbreaks. I think that we'll continue to
see as vaccine rates come down. But I think we're looking at the
(27:34):
next, you know, 5 to 10 years, especially if you take away
health healthcare, which is the other big one, right?
Starting to pull back and roll back.
You know, some of the AffordableCare Act, which expanded
healthcare for people. You don't have healthcare, you
can't pay in the American systemto get help for cancer or even
any kind of screening. It's extortionate.
And so I think you'll see some immediate impacts in terms of if
(27:55):
healthcare has rolled back. But I think, you know, the
longer term, 5 to 8 years of vaccines being pulled back and
then outbreaks starting to happen will be see mumps
outbreaks, rubella outbreaks, people dying of things that you
thought this would never happen in America, America.
So I mean, your vision is about us living long and healthy
lives. Along the way.
You're you're going to have lotsof people who, who don't live
(28:18):
long and healthy. They might live long, but
they're living with disease, with dementia, you know, with
diabetes, all of these sorts of things.
Are you sure you want us all to live longer lives?
Given that you know you can't get rid of all of we can't all
live long and healthy, can we? Yeah.
So I think there, that's why I chose 100.
(28:40):
That's kind of the number in thebook.
I say to live to 100 long and healthy with full capacity.
And that's from looking at places like Japan and Greece and
Italy where you do see people making it to 100 and pretty good
health. So I'm like it's not 120 or 150.
I'm saying 100 is attainable from other places, but actually
if you look at end of life care,most people say they want to
live longer. Like you and me might now say
we're ready for death when it comes.
(29:01):
We're ready. But when it actually comes, most
people do everything they can inthe last week of life, including
for their loved ones to save them.
Very few people. And let's just look at the
medical spending. You can see it goes there.
They say we can maybe extend it two more days, but it's going to
cost this much. Most people say try, try, try.
So I do think it's quite funny that people are like, oh, I'll
just smoke today and I'll be fine.
(29:22):
And then in 30 years they get lung cancer and they're just
like, what? I want to live longer.
Why did I do that? But our demographics are not set
up for us to support long life, are they as the truth?
I mean, you know, we there aren't enough children being
born to to work and generate wealth to pay for all of these
old people who are not going to be working are going to be
economically inactive and require huge health bills.
(29:44):
Well, I guess that's why. But The thing is we're going to
have an ageing population, as ismost of Western Europe and the
state. That's just the fact of it.
And we can talk about like the replacement fertility, but no
place has seems to have figured out how to to get people to have
more kids. I mean, I think South Korea was
offering you a free pet if you had a child and and Hungary,
they'll give you like thousands of euros in dollars.
And so I feel like we haven't yet figured out that problem,
(30:06):
but. You, you buy into the fact that
that that is a problem is you because a lot, a lot of I've
got, you know, kids who are 18 and 20.
A lot of, a lot of kids that agelive in a world in which they
think we have a population crisis and that there are too
many people. And I spend a lot of time going,
no, no, no, we don't have enough.
You know we need more of you to pay for people like me.
Yeah. But I guess there the tricky
(30:27):
thing is that we are hearing over overpopulated.
We have too many people coming in, there's too many immigrants.
But actually if you look at it that we do need the immigration
because if we don't have the immigration, we aren't going to
have the younger population to be able to support people in
their elder age. So I think it's both there.
It's both recognizing we need healthier aging.
So at the age of 50 or 60, people aren't dependent on the
health care system for 40 years.But on the other side, I think
(30:49):
looking at the, the, the, the youth is saying, yeah, we are
going to have we're we're sub replacement fertility right now.
What about dementia? I mean, is there any evidence
that if you live a healthier life that you reduce your
likelihood of getting dementia? Yes, so actually one of the
positive stories has been that we have managed well.
We always hear about this dementia tsunami of more people
(31:10):
having dementia. Actually at each age you're less
likely to have it. So a six year old today is less
likely to have dementia than 110years ago.
Or when we turn 80 or 90, we're less likely to have it than our
parents. So actually there are progress
made and they say it has to do with, you know, now knowing the
importance of diet, staying mentally active, you know, also
(31:31):
early screening, better medications, better awareness.
So actually there have been progress made in dementia in the
sense that we are learning more and more how to delay it.
It's not inevitable we're going to die of something.
But actually there are, there isprogress in that.
In contrast to something like cancer where we're seeing the
opposite, actually, we're seeingpeople getting cancer at a
younger and younger age. That's when I say the, the, the,
(31:51):
the flip sides. We're not doing as well on that.
And that's because of diet. Well, that's hypothesis, not
firm, but basically that cancersthat are that it's called early
onset cancer. If you get cancer in your 30s or
40s or 50s and the bulk of thoseare actually related to the
digestive system. So that ties into ultra
processed food and changing of the gut microbiome.
So people like Chris van Tulekenwho wrote ultra processed people
would say that actually it is linked.
(32:13):
And I think Harvard researchers are actually trying to prove
this link. But there is a puzzle of why
like we have younger and youngerpeople getting something when
our awareness and our ability tolike, let's say, treat diseases
should be getting like we shouldbe delaying cancer.
Instead, we're having the opposite.
You, you do end with a sort of manifesto of what government
should do. So let's just go through it.
What's? What's the list?
(32:35):
So the list was just five thingsbecause of course, if I had a
time with the government say what do you want to do?
And the first is we need to figure out how to increase
fruits and vegetable intake in in Britain and make it more
affordable. I think the numbers have been
declining in terms of our awareness is up.
Again, if you ask most people, they know it, they just don't
implement it. So that gap.
The second one is around active travel, so thinking about
(32:58):
alternatives to cars and then there thinking actually how do
we get this? And I do call for more like
public ownership of things because public ownership of rail
to make it more affordable. There's no reason that flying
from Edinburgh to London should be cheaper than the train.
So that's another one around pricing.
Third one's around allay therapist that actually can we
(33:18):
think of mental health provisionin the sense of getting it out
to communities and not just keeping it with GPS who are
overloaded. So actually can we figure out a
way we have a layer of triage that goes outside the core
medical system? There's another another one
around the NHS. We talked about prevention and
actually what would prevention look like?
And I know you say that, you know, getting an annual MOT or
(33:40):
check up for every person will be expensive or couldn't be
possible. It'd save a lot of money in the
end. If people knew they had
hypertension, like high blood pressure, they might actually be
able to do something about it. Take medication, which we know
is effective, or actually changesome of their lifestyle habits.
Look at their, their, their overall work with AGP to work
through their plan. And then the last one is around,
(34:02):
actually, I talked about water and public ownership of water,
which I know is a big debate here.
Why? Because I feel that water I, I,
I talk about in the book like the history of clean water,
which goes back to Jon Snow and the cholera epidemic.
And the idea that actually you have to keep your water systems
separate to sewage. And what has happened in the
(34:22):
past five years in England, including in Scotland, but more
in England of kind of sewage is being pumped out to beaches,
rivers, lakes, destroying not only kind of the ecosystem
that's there, but actually harming people's health in the
process. And that actually water bills
have gotten higher and higher. And yet the provision of what
you'd need to be doing was separating water from sewage
just seems to have gone out the window.
(34:43):
Like untreated sewage should notbe on beaches and lakes.
It's very dangerous to human health.
And it's not just me. Chris Whitty, Chief Medical
Officer, has written a report onthis.
And, and I just say, well actually if you look at water,
it's a human right. It's a system that we need for
our health and it should be publicly owned so that it's
accountable to people. And it is owned publicly in
Scotland because I know here it's a big debate.
(35:03):
We have Scottish Water, it's accountable to Scottish
Parliament. You have a real push for
accountability. They still have sewage linkages,
there's still problems, but they're dragged in front of
Parliament because the shareholders are the Scottish
public. They're not foreign owned
companies. So I basically go through kind
of five things where people might say, oh, that's a ideal,
you know, fairy tale wish. And I say, but no, it's being
(35:26):
done this way in another place. It's quite funny to watch the
water debate here being in Scotland when you're like, it
works well in Scotland. So why wouldn't you just have
that system here if it works well there?
And I know there's all kinds of historical issues of why that is
and what it means. But when people say what
publicly on water, I'm like, it's happening in Scotland and
most people seem pretty happy with the provision and what you
pay for it. And more money has gone into
(35:48):
infrastructure or bills are lower and the pay in terms of
the profits all gets reinvested because it goes back to the
shareholder. So it's just saying some of
these ideas you think are crazy.Oh, publicly owned rail,
publicly owned water or thinkingsomething seems crazy in one
place, but it's happening in another.
To say that about guns in America, you've spent time in
America. If you say to them, Can you
(36:09):
imagine not having easy access to guns?
People say, oh, it's crazy. I'm like, that's other places in
the world and it's accepted here, right?
And so I think that's part of the the challenge is saying to
politicians and to the public, it's not crazy if you believe
it, it can happen. And this is how it can happen.
There's a plan and another placehas done it.
Learn from it. I just also wanted to talk to
(36:30):
you about we think about public health purely as a domestic
policy question. What role would you like to see
public health considerations play in our foreign policy as a
country? You know, the way we look at the
relationships we have, the impacts of things like the war
in Gaza, poverty in Sudan alongside the war there, all of
(36:54):
those sorts of things, How if you put a public health lens on
our foreign policy, what would happen?
Well, I think they're the easiest way to convey to people
because people say, is it in ournational interest or why should
we do it? So it's obviously aid that you
just want to help people. But there I'd say infectious
diseases and why we have to be careful.
Like our biggest vulnerability from, and I've said this in the
(37:16):
past for global health security is something emerging at a
Guinea or Malawi or South Africa, maybe now the United
States because of bird flu and coming here and then spreading.
So actually thinking about foreign policy in the sense of
how do we keep other places alsohaving well functioning
healthcare systems which can detect?
Because the way something new will be detected is someone
walks into a clinic, it's unusual, a nurse sees it, doctor
(37:39):
sees it, swabs it, it goes for sequence saying they say, uh oh,
it's unusual, we shouldn't see this and then it gets flagged.
But if those systems don't existin other places, we wouldn't
even know until it spread. So I think they're starting to
think about foreign policy because I know now there's a
real lens of what does it do forus, What does it do for the
British people saying actually that's protection for us because
if it emerges anywhere, we're atrisk.
(37:59):
So the undermining of the UN andThe Who, these are really big
problems. Massively, massively.
I mean, coming back to the states, we've talked about kind
of the vaccine agenda. But the other thing worrying
around avian flu is right now avian flu is spreading among
dairy cows in America and we're seeing for the first time cow to
cow transmission. That's mammal to mammal.
(38:19):
We always saw this as a bird, like an avian flu.
It's in mammals. It's now one mutation away from
spreading human to human. We've seen cow to human.
We've not yet seen human to human.
The US under the Biden administration was doing regular
briefings. I was able to attend them with
the CDC saying where are the herds that are infected are
countermeasures. These are the vaccines we're
thinking of. This is our planning.
(38:41):
These are, you know, this is thescreening.
It's all gone now. It's all gone.
There's no communication and scientists within the CDC and
within FDA and they've been fired or been told you can't
speak. So we have a black hole there
right now. So actually one of the biggest
worries being here is if something emerges when we even
know because we worry about the Guineas and the Malawi's and
other places. But it could be the United
(39:02):
States because of the policy of,you know, just saying we don't
want to know or they do know andthey don't want to say it.
But you know, right now if they're anti vaccine, you're
almost anti germ theory. So we're going backwards in that
so. Just finally, I mean, the whole
argument, the thrust that you'vemade is that we need to
understand that these are big systemic governmental problems,
(39:25):
but it's not just about the individual, but what should the
individual try and do? Yeah, I think we'll vote.
So I think one of the biggest things I've seen is
disengagement with politics because they're all the same.
Doesn't matter to me, I'm just going to live my life.
So one thing is actually be engaged and vote because it
makes a massive difference in terms of the policies that are
implemented. And then the other thing I'd say
(39:47):
is if you can move every day, like right now, we've been
sitting a while, but just move every 30 minutes, hour.
Any kind of movement you can addto your life will add years to
your life. I think it's the number one
proven thing. Exercise in terms of having
happy 'cause it leads to like hope molecules that makes you
happy. It gets you moving and makes you
(40:08):
have less risk of getting any kind of diseases and things like
that. It's the evidence.
We don't need more studies on the benefits of exercise.
There's so many. So just move a bit more.
If you can, probably not me, butI guess other people looking at
their lives. So yeah.
Debbie Sreedhar, thank you very much.
Perfect. Thanks.
That's it for this episode of Ways to Change the World.
Until next time, bye bye.
Yeah. So the lie being that you're
individually responsible for your health and if you are
disciplined enough or have enough willpower, then you can,
you know it's your job to do it.What do you think we as a
country should do to make our diet more health?
1st, we need to start with children.
We're feeding them cheap empty calories, largely ultra
processed. It's a massive problem that we
(00:20):
basically have in NHS, but it's not really a health service,
it's a disease service. You're sick and you go in and
you say can you? Can you help?
I mean, on vaccines, you know, America is massively pushing
back. What does that mean for American
health? America's health is going
backwards. I mean, they're having measles
outbreaks, like children are dying of measles, which is
preventable. It's a vaccine preventable
(00:40):
disease. We are going to see a resurgence
of things that were eliminated or gone.
Hello and welcome to Ways to Change the World, the podcast
where we talk to the thinkers, innovators, the radicals with
the big ideas on how to change the world for the better.
My guest today is the public health expert Debbie Shridhar,
whose insights and arguments came to the fore during the
(01:03):
COVID crisis, but who has been researching public health
interventions since she was a teenager in Florida with a
father dying from cancer. She had her own brush with the
disease 2 years ago, just as shebegan writing her latest book,
How Not to Die Too Soon. Fortunately, she managed to do
just that and joins us now. We'll get to that collision with
your own mortality in a moment. But first of all, if you could
(01:26):
change the world in any way, howwould you change it?
I think would be to prioritize health and well-being in our
everyday lives and have healthy long ageing in a vibrant way.
But your your book is all about really how we've been sold a
lie. Yeah.
So the lie being that you're individually responsible for
your health and if you are disciplined enough or have
(01:46):
enough willpower, then you can, you know, it's your job to do it
instead of actually looking at the fact that we are social
beings who are within a community and are receptive to
those forces. Because I mean, there are so
many industries now around health, diets, you know, how we
should live, what we should drive, all those sorts of
things. And what you're really saying is
(02:08):
it's much more than individual responsibility.
Governments have got to make biginterventions.
Completely. So it comes from looking at
places, you might call them bluezones or places where people
live long healthy lives. If you look at the individuals
within them, it's not because they're individually in a sense
everyday thinking about it. It's if they're just living
their life in the way community has been constructed and the
(02:28):
government has created policies.And so my take away was not that
we should be looking and thinking, oh, I need to sleep
like someone in a Blue Zone or Ineed to eat like someone there.
It's actually saying how do we create more places and have
policies that let us just live our lives, but through living
our lives we actually end up in a healthier way.
So what is a Blue Zone in publichealth?
So a Blue Zone are places where people tend to live close to
(02:50):
100, have low rates of chronic disease, low rates of
hospitalizations. So examples would be, you know,
Okinawa and Japan, they've looked at Sardinia and Italy,
they've looked at, you know, different communities across the
world. And they're thinking, why do
people there live longer, healthier lives?
And a lot of the research has pulled out individual habits
instead of actually looking at the community itself, which is
(03:10):
why we. Get hung up on Mediterranean
diets. And that kind of thing.
Exactly. Yeah.
And the Mediterranean diet is great.
It actually has been shown to have massive health benefits.
But it's easier if everywhere you go serving Mediterranean
diet food and you go to school and kids are eating that and you
look in the local supermarkets and that's what you can get, get
the fresh produce and it's affordable and it's delicious.
And I think the problem is trying to import that without
(03:32):
actually changing the food culture that we're all part of,
or what you can actually do in your daily life.
So what? What are the big lessons from
those those places where people are living long and healthy
lives? Well, the lessons, and they
won't be any surprise, are diet,physical activity, low levels of
violence, strong levels of community, good access to
healthcare, you know, clean water, clean air, not much Rd.
(03:53):
traffic, accidents or chance of dying, you know, in your
everyday life on a cycle or walking.
And so actually things that people would be like, Oh yeah,
that makes sense. But the difference being that
those are ingrained in policy. It's not because individually
you're doing anything about it. It's actually how they're
constructed. So this is about big government
and governments looking at this wrong.
Well, I think it's too easy for governments to say, well,
(04:15):
actually, why should we care about that issue?
It's an individual thing. And actually if you're well
powered enough, you can make sure you get your exercise.
Part of me is like, if you look at the populations that get the
greatest level of physical activity, it's built into their
daily life because cities are built around walking or cycling
or public transport, their options, alternatives to just
being in a car, being sedentary.So the idea being that just
(04:36):
running fitness campaigns, YouTube campaigns, Dubai has
tried a free month of fitness, don't actually get the
population as a whole moving. It's actually the invisible
drivers of how do people get around a city?
How do kids get to school? How do people get to work?
And how do you make it that actually there are more kind of
we call active travel options, but it has to come from, let's
say, design of how you actually design A city rather than
(04:57):
individually saying to people, go run your 5K or go, you know,
some people will do it. But again, you're almost
reaching a fit who just want to get a bit fitter.
You're not reaching the bulk of people who are sedentary who are
just like I do shifts, I've got to care for my parents or my
children, I don't have time. So you have to make it inbuilt
into the city and into their lives so it's invisible,
accessible and then it's people can do it.
(05:18):
Now you you begin the book with your own brush with cancer.
Just just explain what happened.Well, it's just me living my
life. I think of myself as quite
healthy, young, you know, doing all the things I'm supposed to
be doing and going. You're a fitness obsessive.
Really. Aren't you, well, a bit too
much? Yeah, probably, probably you're
on too much. And my idea being like, I just
went for a screening and that's part of the NHS.
(05:40):
We all go for regular screenings.
You get your letter. And I went in and they came back
and they said, well, actually wefound high risk HPV and we found
abnormal cells. It looks like there's a
likelihood of cancer. You need to come in for an
appointment. And then my struggle to get an
appointment because the NHS in Scotland, I guess similar in
England, has major backlogs. And this was just after the
pandemic. So actually they had all these
women who just been pushed forward and forward, you know,
(06:01):
not having the screening programs running.
And I was like, my lab results have already taken a couple
months, which means this is looking almost in the past.
So who knows what's happened since then.
And then trying to get an appointment when you know it'll
be 6 to 9 months. And knowing from being American
that in the States, you get yourresults within a couple days and
you get your treatment within a week.
So actually you're like, how is this So?
(06:22):
But I guess the point of bringing it up was to say, one,
we're so relying on the healthcare system we're in.
I couldn't treat myself. I couldn't fitness my way out of
this or eat, you know, my Mediterranean diet.
I was relying on the healthcare offering.
But also the idea that, you know, there are things where we
actually do need society to stepup.
And me having access to a program, a screening program,
(06:42):
getting the treatment, which I did living longer had to do with
having an NHS which was able to be provided, which is accessible
and free at the point of care, which is one of the points I
wanted to raise. That in the States you'd have
that, but you're paying 10s of thousands of dollars.
So in a sentence, your choice isdo I just risk it might go away
or end up paying $30,000 for it.So idea being that actually
(07:04):
before we start saying the NHS doesn't work, it has problems,
it does that actually there are barriers to care in a lot of
other countries. And it may not be a wait list,
it might be a high bill, or it might be not having doctors.
And so also to bring some comparative reflection and to
where the NHS is compared to other systems.
OK, well, well, so well, let's talk about the NHS for a little
bit then, because obviously that's the government's massive
focus. They're piling more money into
(07:26):
it. And as every government I can
remember, they are going to talkmuch more about prevention being
the key. But you know, the truth is they
don't really get there today. Yeah, it's a massive problem
that we basically have in NHS, but it's not really a health
service, it's a disease service.You're sick and you go in and
you say can you, can you help? And I think they're the real
(07:48):
thing is it's really hard to invest in prevention because the
focus is on A and E wait times and ambulance wait times and the
person dying of the heart attack.
How do you actually go backwardsto say how do we reduce the
likelihood of that person havinga heart attack?
So for there, the things that I thought about like why don't we
have a yearly annual checkup where people get their blood
pressure, which would tell you very clearly a sign of are you
at risk of a stroke or heart attack?
(08:10):
Where you have support, You know, in the sense of this is
what you need to do in terms of a plan to get your health on
order. And so actually having to make
those decisions to shift away from hospitals to actually
community care and doing in a concrete way.
So looking at what are the five things people going into A&E for
or taking up the hospital budget, how do we work back to
the community level to start trying to unpick it?
It'll take years. And I think that's the problem
(08:31):
for governments. They don't happen overnight,
happens over years. But I think that's the only way
because we will never treat our way out of this crisis with the
NHS, an aging population, chronic disease, more and more
people living longer but dependent on social care.
The only way is to rethink it and think, how do we make aging
in a healthy way, an independentway where you're not relying on
a healthcare system where you actually can touch base with in
(08:54):
a preventive way, but not wait until you're actually very
severely I'll before you're going in.
But aren't aren't we in a catch 22 when it comes to the NHS,
which is that it is so busy treating the sick?
Yeah, it doesn't have the resources to do all the
preventative work and the and the annual checks.
You know, if you if you booked everybody into an annual check,
you wouldn't be able to get AGP appointment anymore.
(09:15):
True and you're. Sick.
Completely and I think that's the catch 22 we're in we're
almost having to have to work itback right because there are
people who need care for diabetes and chronic conditions
and hypertension but actually how do you work backwards and I
think there we do have to be honest about the past 15 years
investment in the NHS. The investment in the NHS hasn't
kept up with other countries, France, Germany, they do spend
(09:37):
more per capita on providing healthcare.
So one thing is saying we are coming out of a pit where
actually we have a long wait list.
We have to invest in it, but invest in a smarter way.
The everyone is talking about itand I think that's great.
But the question is, will that actually deliver and will they
actually be able to do that and create the bandwidth for that?
I mean, politically we've got ourselves into a situation now
(09:57):
where it is very common for people to say the NHS is a money
piss and you can pile more and more money into it but it won't
really change outcomes, you know, How has that been allowed
to become the norm? Well, I think there there's also
like this idea that like somehowother places are better or have
it all figured out. And that's why I wanted to bring
up the examples of the States oreven India where it's out of
(10:19):
pocket care. You literally go to a doctor and
70% of people are paying for their care out of pocket, which
has its problems. But I think they're the only way
to say it's not piling it into the NHS.
It's saying this is what we're going to put the money in for
these priorities. It's going to go towards
prevention. And this is the service which
we're trying to keep for the benefit of everybody.
But I think where we will go down the black hole is if we
(10:40):
don't invest in primary. Primary prevention is things
like diet, physical activity, smoking, alcohol, you know, the
drivers. Secondary prevention is like
things like diabetes screening programs, blood screen, you
know, basically saying to peoplethese are early indicators of
disease, let's get on it early. We don't invest in those two.
There is no way you can keep up with an elderly population and
health services. No country can.
(11:00):
So you have to rethink it and think, OK, how are other
countries managing to have agingpopulations which are healthy?
And that's why in the book I talk about Japan, because Japan
has like whole football teams ofpeople over 100, like they're
still playing on a football team.
And I was just looking, thinkingwhat a fascinating place where
actually aging independently in a healthy way has been
normalized. And how do we actually think of
(11:21):
that and think, are we thinking about aging idea?
You get older, you get sick, youdie.
Why is that normalize instead ofyou get older, how do you remain
independent? How do you remain healthy and
actually save some of that budget where we're spending a
lot on, you know, the last 20 or30 years of someone's life?
OK, so how do they have 100 yearolds on football teams?
Well, their diet, huge ones. They have very low rates of
obesity, chronic disease, going back to children, what they
(11:44):
offer their kids in school meals, they get 9 fruits and
vegetables here we're trying to meet five, there, it's nine.
They manage to kind of support people.
Effective healthcare system focused on prevention and so
they're you know they've struggled with smoking rates but
they've brought in legislation to get smoke free brought them
down very low rates of you know respiratory diseases because
(12:06):
they've had clean air initiatives and net 0 focus.
But I do want to put like a little asterisk because they do
struggle with suicides and mental health.
So Japan in some way is you think, great and all these
different areas, an exemplar. And then you go to mental
health. And they are actually probably
the country where more people died of suicides by October 2020
than of COVID-19. And it wasn't because of
(12:28):
lockdowns. That was a trend continuing.
But they are the outlier. And so in a sense, if you can
maintain someone physically, butactually they do struggle with
mental health. And so just to not paint them as
the actual perfect population, they have struggles too.
So so take diet because you know, diet is the ultimate
personal responsibility in our society and there is endless
(12:48):
industry around you know, books,websites, you know, fads.
What do you think we as a country should do to make our
diet more healthy? Well, I think first we need to
start with children. And I think there everyone would
agree that children are not responsible for their own diet.
They're gently fed what their parents feed them at home,
what's in their home and what's at school.
(13:09):
And if you look at what's in school meals or around schools,
it's basically junk food. We're feeding them cheap empty
calories, largely ultra processed because it's cheap, it
lasts forever. And there's a big lobby because
it's a big market. And so there I'd say the first
thing to look at is we, I think we're saving money on school
meals by saying like actually we're only going to spend $0.50
a meal or $0.45 a meal, pence, sorry, not sentence.
(13:32):
But then you go and you look at what you're spending on a child
who develops diabetes by age 19,type 2 diabetes, that's care for
the rest of their life. And so I think there there's
this false economy of trying to save money on something.
So school meals would be 1. So you look at the places
reversing childhood obesity rates going up, South Korea,
Japan, Denmark, those places have focused on children and the
school environment, meaning not just, you know, high schoolers
(13:55):
might like or senior schoolers might want to go outside of the
school. So what is the environment?
I think another one is affordable options.
Like we know since Brexit that fruit and vegetable prices have
gone up quite radically, like cucumbers up to 100%.
So when someone goes in to buy abasket of goods which would say
are more nutritious, is much more expensive than to buy them
that are cheap. And I think that understanding
(14:15):
that actually we have to figure out how to make healthier
options cheaper and more affordable and accessible.
Because it shouldn't have to be that that actually to feed your
children properly or feed yourself properly, you're going
to have to actually pay so much more.
And a lot of people just can't. I mean through subsidy or
changing agriculture or I mean all of these things.
Yeah. And I think there's innovative
(14:36):
solutions I bring up, you know, in the book.
I really try to give practical examples because otherwise
sounds like fairy tales, right? And one is around Wales, which
started actually what they call a courgette trial, zucchini
trial. And what they said was that they
were going to, with schools, go to whole, you know, food
manufacturers and then the middle men and say we are going
to guarantee you a market. We're going to guarantee you all
school meals. We guarantee you that and you
(14:57):
guarantee quality. Can you provide that at this
price? And because they were guaranteed
this market for a certain amountof time, they were able to bring
down the price and they integrated into school meals.
So actually, there you go, a vegetable affordable in a school
meal and they're trying to trialthis with other vegetables in
the sense that if you create a market, you can guarantee it.
Can you actually get producers to meet the prices that you
(15:19):
need? Because a lot of it comes down
to price. So I think they're they're
innovative trials of actually trying to see how can we shift
things. Denmark is another one.
They started a system of what they call kind of keyhole
labeling, where they label products to help identify for
people when they go into a shop,what are healthier options.
It seemed to work well until thebarrier of cost came up.
People said it's more expensive.They looked at subsidies for
(15:40):
those. I was saying you can't just have
sin taxes and tax unhealthy thing.
You have to make it more affordable.
So I think there it's kind of slowly shifting it through these
levers of kind of cost, affordability, education, but
schools as well as a great placeto start with children.
And about shifting the spend away from what it costs to fix
people or treat people. Exactly.
And to what it what it costs to prevent.
(16:00):
The problem is it's two separatebudgets, right?
So one line is NHS and one line is education and where school
meals are coming from. And so you're think you're
saving money because you're pulling it from school meals,
but you're spending it because people are getting sick.
So having that joined up, thinking of actually how do we
join it up to say we might spenda bit more there, but the
savings will come. They might not come for five
years or 10 years, but how do you have that longer term
(16:20):
thinking? But but how do you get ordinary
families who are struggling withtheir weekly supermarket shop?
Even if you subsidise the the courgette and the cucumber to
buy those things, you know when the fact is that ultra processed
foods is tasty, cheap, easy, canbe stuck in the microwave,
(16:41):
doesn't require all that cookingefforts and knowledge that we
don't have as a society. Completely.
And there I think there's policylevers.
So if you look back, I mean it'sa bit different but somewhat
similar as you take smoking, something that you would have
said 30-40 years ago is addictive.
People like to buy their cigarettes.
Smoking was ubiquitous and pubs and cultures, you would have
thought how are you ever going to do this shift to a world
(17:02):
where actually people aren't going to have that and they
managed to through policies. That's one of Britain's success
stories, right, of actually using different policy levers
that now smoking rates have declined rapidly in other
countries. Like how did Britain do it?
Well, it was through a mix of creating different zones where
you can't smoke, right, smoke free places, make it taxation,
targeted education, making it easier to quit.
(17:23):
So you go to pharmacies, you getsupport.
And so I feel like we almost need a similar kind of strategy
for diet. We're thinking through how do we
use the policy levers We have tostart shifting it away with
recognition. It's not an individual choice
that actually in the end people are making choices based on how
much money they have, how much time they have, how much
knowledge they have have. And that there is a reason
there's a socio economic gradient for obesity, right?
(17:45):
It's and also that it's easier to stay within a healthier
weight in Japan than it is here.That means there's something
about the food culture. It can't just be individuals
being less, having less willpower or anything like that.
So. There there is a basic bias
against the nanny state in Western democracies.
So how do you persuade people that regulation is good?
(18:07):
You just look around us and how much of our life.
So why have we not had a mass shooting in a school in Britain?
It's because of Dunblane in Scotland, where there was a
shooting and parents came together and said no more guns.
And then it progressed through various, you know, both
Conservative and Labor governments to the point where
you can't easily find a gun. Recently in Edinburgh, they did
have a student who was arrested with massive plans based on
(18:30):
Columbine for a school shooting.Even where they would stand,
what they would do couldn't get a gun.
That was the difference. Otherwise that would have had
basically planned it in great detail.
The one piece missing. So when people look around and
say, oh, nanny state, I'm like, is that a nanny state that
actually you can't easily buy a gun, take another one.
Clean air. We know increasingly the damage
that air pollution does. If you're in some place like
(18:52):
India, it's the equivalent of smoking 50 cigarettes a day.
Half of kids in Delhi have damage to their lungs.
And then you take Delhi and you say, OK, that could be London.
That could be any of the big cities that have large
populations, cars, diesel manufacturing industry.
Why doesn't London and have air as bad as Delhi?
Because of all the measures brought in both by both
conservative and labor mayors saying, actually we want to try
(19:14):
to keep London's air as clean aspossible with the balance of
obviously we need some cars, we need some things.
But do you want to live in a world where, you know, you have
lockdowns like they do in Delhi because the air is so bad?
People are staying inside because they can't breathe
outside. That's regulation, That's nanny
state. And then go through roads if we
had no walk. You know, there's so many ways.
(19:35):
NHS, that's a regulation. So much of our lives that we
take for granted is policy measures that keep us safer and
give us freedoms. We have the freedom here to send
your kids to school without being shot.
I mean, the, the, the government's just announced, you
know, over £100 billion of infrastructure investment.
There isn't any part of that conversation that is about
(19:55):
making sure that infrastructure that makes us walk more or cycle
more or anything like that. I mean, why?
And you know, you've worked closely with governments in
Scotland. Why is it so hard to make this
part of the conversation? I think it's hard because
there's a focus on immediate returns.
(20:15):
They want to know like tomorrow.And I think there's a real
problem now with constant pressure to focus on other
things. And I contact later in the book,
like why? Who wants to be a politician?
Because you get constantly hammered by things.
So if you're trying to raise infrastructure, then there's the
issue of like you're trying to take away cars, Why are you
trying to take away cars? And you're saying we're not
taking away cars, we're offeringyou options.
(20:37):
I think the nicest thing in Edinburgh and they've tried to
do this, 15 minute cities, you can walk, you can psych, you can
take a bus or you can take your car.
Taking car might be a bit more expensive, but those are the
options. It's more freedom.
And I think the problem though is when you try to say it, you
just get car, but you're trying to take away cars.
You know, the green, you know, the green agenda is the woke
agenda, blah, blah, blah. And I feel like it becomes hard
to be clear through it. So I do feel for politicians
(21:00):
because I feel like they're being boxed in sometimes by
being hit by kind of half truthsand trying to defend that.
So can't progress like the healthier agenda.
And I feel it here as well. I mean, hearing the debate when
Labor came in, there was great promise about prevention, about
healthier meals, about these kind of things.
And I know they're trying to do it.
But it feels like, you know, when the Prime Minister comes
(21:20):
out here, Starmer, he's talking about immigration.
I'm like, why are we talking about immigration?
We should be talking about making life better for people.
What do like immigrants have to do with that?
It's a different conversation, but it sometimes feels like he's
been forced into that instead ofkeeping to the agenda of
actually what makes life better for people living here.
And I can tell you, I don't think it's immigrants who are
(21:40):
the reason that everything is not working.
And it's an easy out. But that's one of the things
that gets me is like the distraction.
So politicians get dragged down that debate instead of focusing
on like, the key one, which is how do we make life better for
people, healthier, easier to live?
And actually that requires investment in public services
and in infrastructure, but in ways where you think about
active travel, walking and affordability.
(22:01):
So how, how hard is this as a government advisor to get them
to, to, to realize that these sorts of interventions could
actually change lives? You know, there's a sense in
which when somebody like you comes along and says these
things, it's like, well, yes, I know in an, in an ideal world
that we could spend all of that money.
But the, in the real world, we can't do all of that.
So, you know, we're going to geton with this.
(22:25):
Yeah, and I guess that's partly why I wrote the book.
I give examples, I give concreteexamples for every single issue.
Mental health, They say here we can't provide enough therapists
or GP appointments for everyone who needs mental health care.
Weightless. They're like 2 years long.
I'm like, OK, how is India dealing with this?
So India has started to do experiments, looking at lay
therapists, people you train fora month who go into communities
(22:46):
and actually they found depression rates go down
massively. Just having someone train for a
month who can sit with you in the community and then say,
actually, I need to escalate youbecause is you need to go see a
doctor. We've created, we've had GPS
doing that, right? GPS are basically that service
GPS are overloaded because they're dealing with mental
health on top of everything else.
So my thing is, well, why wouldn't we learn from India?
(23:06):
If they're able to do lay therapists, why can't we do it
here? And I think that's what I've
been trying to do with government, you know,
politicians and ministers and just saying, you say it's too
hard, why can they do it? You say it's too difficult, why
are they doing it? And I feel that way about the
states now. I mean, coming back to being
American and living abroad, likeyou go to the States and you
say, imagine not having mass shootings and they say that's a
(23:29):
pipe dream. Never happened.
I'm like, no one else has this. But because they're in their
bubble, they can't see beyond it.
They're like, we love our freedom.
I'm like Brits would say they love their freedom.
Australians love their freedom. Well, we have a history of it.
Serbia has the history of it. Colombia has a history of it, so
many places. And so I think taking away the
exceptionalism of being like, you're not exceptional because
you're American. Look at the rest of the world.
(23:51):
They just have on policy in a different way and I think that's
what I try to bring it to ministers, international
examples. On vaccines, you know, America
is massively pushing back. They've announced this review of
all vaccines. They're looking at MMR again, as
if there's anything to look into.
We know for a fact there's nothing to look into in terms of
the link between MMR and autism,but they're looking into it
(24:11):
again. They've announced that they're
going to take away the giving ofCOVID vaccines to children.
Now we've done all that in Britain already, but in America
they for cost. Reasons here though, So we do it
here for cost, not for safety anything.
So there's a difference. Right.
So I mean so So what does that mean for American health?
Well, America's health's going backwards.
(24:32):
I mean, they're having measles outbreaks, like children are
dying of measles, which is preventable.
It's a vaccine preventable disease.
We are going to see a resurgenceof things that we considered
like that were eliminated or gone.
But the but the Trump administration and the MAGA
crowd would believe or argue that you're part of some sort of
corrupt, giant sort of farmer driven cabal that is trying to
(24:58):
sort of pull the wool over the population's eyes for for the
pharma companies to make money. Completely.
And that's what you're painted at.
And it really frustrates me. And that's why I, like I do
mention in the book why I went into public health.
I had an offer. I could have gone to Harvard
Law, I could be in, you know, Wall Street.
I had other options. And most people in public health
are like me. And we've chosen a career where
we want to actually look at the best data, analyse it, talk to
(25:21):
other experts and help all of us, including ourselves, live
longer, healthier lives through public health policy.
People in public health generally don't go into it for,
you know, to become incredibly rich or famous.
It's a very kind of Cinderella science.
And so I think there, it's really frustrating because
you're like the people advocating for vaccines
generally are people who have seen these diseases, don't want
(25:43):
them coming back and want to prevent children suffering from
them. I mean.
Do do you have any sense of why it is that in relatively
educated societies like the United States you have this
almost deliberate stupidity? I think.
It there is anti science and anti established truth.
But it's I wouldn't even, I don't, I think it's almost that
(26:04):
people think they're more clever.
They figured something out that you haven't figured out.
They're like, oh, you don't realize I've done my research.
And it is worrying because like there's a nature study recently
that they said people like a statement and said, is this true
or is it not true? And the longer they spent on the
Internet, the more they went down the conspiracy rabbit hole.
So like, the more research you do, the more educated you try to
become, almost the way the web is set up, the more you start
(26:28):
believing this kind of stuff. And then it's hard to come back
to reality and say, actually, that's not true.
This is, you know, this. Let's go back to facts.
Let's go back to analysis. But I think there, there's not
really any fact checking happening on the Internet.
If you look in the past, people got their news from mainstream
outlets, they got it from newspapers and there was fact
checking. Like if I write something for
the Guardian, it goes through fact checking.
(26:48):
I'm accountable for those. And we have to look at the
sources. And I guess same for being on a
news program and it doesn't haveany fact checking.
You can say whatever you want. And so how is someone supposed
to know the difference between apolished YouTube video of
someone saying something and showing graphs and someone
who's, you know, it's very hard.So I I also sympathize in the
sense of people don't know what to believe anymore.
And when will we see the fruits of these policies in America?
(27:13):
You know, when will we see the, the, the, the, the declines in
life expectancy and the increasein disease?
Well, we're already seeing the decline in life expectancy that
started before the pandemic. Although that's not because of
Trump. That's kind of.
Long term. Exactly.
That's there. I think now we're already seeing
the rise of measles outbreaks. I think that we'll continue to
see as vaccine rates come down. But I think we're looking at the
(27:34):
next, you know, 5 to 10 years, especially if you take away
health healthcare, which is the other big one, right?
Starting to pull back and roll back.
You know, some of the AffordableCare Act, which expanded
healthcare for people. You don't have healthcare, you
can't pay in the American systemto get help for cancer or even
any kind of screening. It's extortionate.
And so I think you'll see some immediate impacts in terms of if
(27:55):
healthcare has rolled back. But I think, you know, the
longer term, 5 to 8 years of vaccines being pulled back and
then outbreaks starting to happen will be see mumps
outbreaks, rubella outbreaks, people dying of things that you
thought this would never happen in America, America.
So I mean, your vision is about us living long and healthy
lives. Along the way.
You're you're going to have lotsof people who, who don't live
(28:18):
long and healthy. They might live long, but
they're living with disease, with dementia, you know, with
diabetes, all of these sorts of things.
Are you sure you want us all to live longer lives?
Given that you know you can't get rid of all of we can't all
live long and healthy, can we? Yeah.
So I think there, that's why I chose 100.
(28:40):
That's kind of the number in thebook.
I say to live to 100 long and healthy with full capacity.
And that's from looking at places like Japan and Greece and
Italy where you do see people making it to 100 and pretty good
health. So I'm like it's not 120 or 150.
I'm saying 100 is attainable from other places, but actually
if you look at end of life care,most people say they want to
live longer. Like you and me might now say
we're ready for death when it comes.
(29:01):
We're ready. But when it actually comes, most
people do everything they can inthe last week of life, including
for their loved ones to save them.
Very few people. And let's just look at the
medical spending. You can see it goes there.
They say we can maybe extend it two more days, but it's going to
cost this much. Most people say try, try, try.
So I do think it's quite funny that people are like, oh, I'll
just smoke today and I'll be fine.
(29:22):
And then in 30 years they get lung cancer and they're just
like, what? I want to live longer.
Why did I do that? But our demographics are not set
up for us to support long life, are they as the truth?
I mean, you know, we there aren't enough children being
born to to work and generate wealth to pay for all of these
old people who are not going to be working are going to be
economically inactive and require huge health bills.
(29:44):
Well, I guess that's why. But The thing is we're going to
have an ageing population, as ismost of Western Europe and the
state. That's just the fact of it.
And we can talk about like the replacement fertility, but no
place has seems to have figured out how to to get people to have
more kids. I mean, I think South Korea was
offering you a free pet if you had a child and and Hungary,
they'll give you like thousands of euros in dollars.
And so I feel like we haven't yet figured out that problem,
(30:06):
but. You, you buy into the fact that
that that is a problem is you because a lot, a lot of I've
got, you know, kids who are 18 and 20.
A lot of, a lot of kids that agelive in a world in which they
think we have a population crisis and that there are too
many people. And I spend a lot of time going,
no, no, no, we don't have enough.
You know we need more of you to pay for people like me.
Yeah. But I guess there the tricky
(30:27):
thing is that we are hearing over overpopulated.
We have too many people coming in, there's too many immigrants.
But actually if you look at it that we do need the immigration
because if we don't have the immigration, we aren't going to
have the younger population to be able to support people in
their elder age. So I think it's both there.
It's both recognizing we need healthier aging.
So at the age of 50 or 60, people aren't dependent on the
health care system for 40 years.But on the other side, I think
(30:49):
looking at the, the, the, the youth is saying, yeah, we are
going to have we're we're sub replacement fertility right now.
What about dementia? I mean, is there any evidence
that if you live a healthier life that you reduce your
likelihood of getting dementia? Yes, so actually one of the
positive stories has been that we have managed well.
We always hear about this dementia tsunami of more people
(31:10):
having dementia. Actually at each age you're less
likely to have it. So a six year old today is less
likely to have dementia than 110years ago.
Or when we turn 80 or 90, we're less likely to have it than our
parents. So actually there are progress
made and they say it has to do with, you know, now knowing the
importance of diet, staying mentally active, you know, also
(31:31):
early screening, better medications, better awareness.
So actually there have been progress made in dementia in the
sense that we are learning more and more how to delay it.
It's not inevitable we're going to die of something.
But actually there are, there isprogress in that.
In contrast to something like cancer where we're seeing the
opposite, actually, we're seeingpeople getting cancer at a
younger and younger age. That's when I say the, the, the,
(31:51):
the flip sides. We're not doing as well on that.
And that's because of diet. Well, that's hypothesis, not
firm, but basically that cancersthat are that it's called early
onset cancer. If you get cancer in your 30s or
40s or 50s and the bulk of thoseare actually related to the
digestive system. So that ties into ultra
processed food and changing of the gut microbiome.
So people like Chris van Tulekenwho wrote ultra processed people
would say that actually it is linked.
(32:13):
And I think Harvard researchers are actually trying to prove
this link. But there is a puzzle of why
like we have younger and youngerpeople getting something when
our awareness and our ability tolike, let's say, treat diseases
should be getting like we shouldbe delaying cancer.
Instead, we're having the opposite.
You, you do end with a sort of manifesto of what government
should do. So let's just go through it.
What's? What's the list?
(32:35):
So the list was just five thingsbecause of course, if I had a
time with the government say what do you want to do?
And the first is we need to figure out how to increase
fruits and vegetable intake in in Britain and make it more
affordable. I think the numbers have been
declining in terms of our awareness is up.
Again, if you ask most people, they know it, they just don't
implement it. So that gap.
The second one is around active travel, so thinking about
(32:58):
alternatives to cars and then there thinking actually how do
we get this? And I do call for more like
public ownership of things because public ownership of rail
to make it more affordable. There's no reason that flying
from Edinburgh to London should be cheaper than the train.
So that's another one around pricing.
Third one's around allay therapist that actually can we
(33:18):
think of mental health provisionin the sense of getting it out
to communities and not just keeping it with GPS who are
overloaded. So actually can we figure out a
way we have a layer of triage that goes outside the core
medical system? There's another another one
around the NHS. We talked about prevention and
actually what would prevention look like?
And I know you say that, you know, getting an annual MOT or
(33:40):
check up for every person will be expensive or couldn't be
possible. It'd save a lot of money in the
end. If people knew they had
hypertension, like high blood pressure, they might actually be
able to do something about it. Take medication, which we know
is effective, or actually changesome of their lifestyle habits.
Look at their, their, their overall work with AGP to work
through their plan. And then the last one is around,
(34:02):
actually, I talked about water and public ownership of water,
which I know is a big debate here.
Why? Because I feel that water I, I,
I talk about in the book like the history of clean water,
which goes back to Jon Snow and the cholera epidemic.
And the idea that actually you have to keep your water systems
separate to sewage. And what has happened in the
(34:22):
past five years in England, including in Scotland, but more
in England of kind of sewage is being pumped out to beaches,
rivers, lakes, destroying not only kind of the ecosystem
that's there, but actually harming people's health in the
process. And that actually water bills
have gotten higher and higher. And yet the provision of what
you'd need to be doing was separating water from sewage
just seems to have gone out the window.
(34:43):
Like untreated sewage should notbe on beaches and lakes.
It's very dangerous to human health.
And it's not just me. Chris Whitty, Chief Medical
Officer, has written a report onthis.
And, and I just say, well actually if you look at water,
it's a human right. It's a system that we need for
our health and it should be publicly owned so that it's
accountable to people. And it is owned publicly in
Scotland because I know here it's a big debate.
(35:03):
We have Scottish Water, it's accountable to Scottish
Parliament. You have a real push for
accountability. They still have sewage linkages,
there's still problems, but they're dragged in front of
Parliament because the shareholders are the Scottish
public. They're not foreign owned
companies. So I basically go through kind
of five things where people might say, oh, that's a ideal,
you know, fairy tale wish. And I say, but no, it's being
(35:26):
done this way in another place. It's quite funny to watch the
water debate here being in Scotland when you're like, it
works well in Scotland. So why wouldn't you just have
that system here if it works well there?
And I know there's all kinds of historical issues of why that is
and what it means. But when people say what
publicly on water, I'm like, it's happening in Scotland and
most people seem pretty happy with the provision and what you
pay for it. And more money has gone into
(35:48):
infrastructure or bills are lower and the pay in terms of
the profits all gets reinvested because it goes back to the
shareholder. So it's just saying some of
these ideas you think are crazy.Oh, publicly owned rail,
publicly owned water or thinkingsomething seems crazy in one
place, but it's happening in another.
To say that about guns in America, you've spent time in
America. If you say to them, Can you
(36:09):
imagine not having easy access to guns?
People say, oh, it's crazy. I'm like, that's other places in
the world and it's accepted here, right?
And so I think that's part of the the challenge is saying to
politicians and to the public, it's not crazy if you believe
it, it can happen. And this is how it can happen.
There's a plan and another placehas done it.
Learn from it. I just also wanted to talk to
(36:30):
you about we think about public health purely as a domestic
policy question. What role would you like to see
public health considerations play in our foreign policy as a
country? You know, the way we look at the
relationships we have, the impacts of things like the war
in Gaza, poverty in Sudan alongside the war there, all of
(36:54):
those sorts of things, How if you put a public health lens on
our foreign policy, what would happen?
Well, I think they're the easiest way to convey to people
because people say, is it in ournational interest or why should
we do it? So it's obviously aid that you
just want to help people. But there I'd say infectious
diseases and why we have to be careful.
Like our biggest vulnerability from, and I've said this in the
(37:16):
past for global health security is something emerging at a
Guinea or Malawi or South Africa, maybe now the United
States because of bird flu and coming here and then spreading.
So actually thinking about foreign policy in the sense of
how do we keep other places alsohaving well functioning
healthcare systems which can detect?
Because the way something new will be detected is someone
walks into a clinic, it's unusual, a nurse sees it, doctor
(37:39):
sees it, swabs it, it goes for sequence saying they say, uh oh,
it's unusual, we shouldn't see this and then it gets flagged.
But if those systems don't existin other places, we wouldn't
even know until it spread. So I think they're starting to
think about foreign policy because I know now there's a
real lens of what does it do forus, What does it do for the
British people saying actually that's protection for us because
if it emerges anywhere, we're atrisk.
(37:59):
So the undermining of the UN andThe Who, these are really big
problems. Massively, massively.
I mean, coming back to the states, we've talked about kind
of the vaccine agenda. But the other thing worrying
around avian flu is right now avian flu is spreading among
dairy cows in America and we're seeing for the first time cow to
cow transmission. That's mammal to mammal.
(38:19):
We always saw this as a bird, like an avian flu.
It's in mammals. It's now one mutation away from
spreading human to human. We've seen cow to human.
We've not yet seen human to human.
The US under the Biden administration was doing regular
briefings. I was able to attend them with
the CDC saying where are the herds that are infected are
countermeasures. These are the vaccines we're
thinking of. This is our planning.
(38:41):
These are, you know, this is thescreening.
It's all gone now. It's all gone.
There's no communication and scientists within the CDC and
within FDA and they've been fired or been told you can't
speak. So we have a black hole there
right now. So actually one of the biggest
worries being here is if something emerges when we even
know because we worry about the Guineas and the Malawi's and
other places. But it could be the United
(39:02):
States because of the policy of,you know, just saying we don't
want to know or they do know andthey don't want to say it.
But you know, right now if they're anti vaccine, you're
almost anti germ theory. So we're going backwards in that
so. Just finally, I mean, the whole
argument, the thrust that you'vemade is that we need to
understand that these are big systemic governmental problems,
(39:25):
but it's not just about the individual, but what should the
individual try and do? Yeah, I think we'll vote.
So I think one of the biggest things I've seen is
disengagement with politics because they're all the same.
Doesn't matter to me, I'm just going to live my life.
So one thing is actually be engaged and vote because it
makes a massive difference in terms of the policies that are
implemented. And then the other thing I'd say
(39:47):
is if you can move every day, like right now, we've been
sitting a while, but just move every 30 minutes, hour.
Any kind of movement you can addto your life will add years to
your life. I think it's the number one
proven thing. Exercise in terms of having
happy 'cause it leads to like hope molecules that makes you
happy. It gets you moving and makes you
(40:08):
have less risk of getting any kind of diseases and things like
that. It's the evidence.
We don't need more studies on the benefits of exercise.
There's so many. So just move a bit more.
If you can, probably not me, butI guess other people looking at
their lives. So yeah.
Debbie Sreedhar, thank you very much.
Perfect. Thanks.
That's it for this episode of Ways to Change the World.
Until next time, bye bye.
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