How to build a healthier, longer-living society

Hello and welcome to Incident Genius, a biceis masterclass in podcast form. Every Monday and Friday we're joined by some of the world's leading scientists and experts to talk about some of the most fascinating ideas in science and technology today. I'm Jason Gujja, commissioning editor of BBC Science Focus. The most commonly held narrative states that we're all ultimately responsible for our own health and wellbeing. While there's undoubtedly truth in this idea, the bigger picture shows that the societies we live in and the policies shaped by our governments also play a huge role in our quality of life and longevity. In this episode we're joined by Devi Shridhar, professor of global public health based at the University of Edinburgh, to talk about her latest book, How Not To Die Too Soon, the lies we've been solved and the policies that can save us. She tells us how the key to longevity starts with education, speaks about the lessons we can learn from some of the longest lived populations in the world, and details the positive societal changes governments can make to help us all live longer, healthier lives. So welcome to the podcast, thanks so much for joining us. Thank you for having me. So today we're talking about your new book, How Not To Die Too Soon, the lies we've been told and the policies that can save us. So let's start with the big question, what are the lies we've been sold? I think the lie that we've been sold is that we are fully responsible for our health, that we can biohack our way to longevity, there's a booming wellness industry and health industry, and so what my book pushes back on that saying that actually many of the factors that determine our health and how long we live are actually about where we live, what community we're part of and kind of the circumstances within we were born with and live within. So in the book you talk about something that's known as a blue zone. So for those who don't know, what is that and where are they? So blue zones were a concept that became quite fashionable about a decade ago, which are places in the world where people tend to live very long in good health. So there think of islands like Okinawa off of Japan, off of Italy, Sardinia, Greek islands, so basically places where you're like, wow, that's a really good quality of life and people there live a long time. And these blue zones part of what came out of that was looking at what do people in those blue zones do? So what are the seven or eight things? So they looked at things like how much do they sleep at night? What do they eat? Are they part of the community? Their stress levels, their activity levels, and come up with a checklist where anywhere in the world you can get your eight things to be like someone in a blue zone. And my book pushes back from that and I'm more interested in actually the blue zones policy and social and cultural environment. Quite simply, if any of us move to a blue zone, would we need to check off eight different things on a list? Or if you're just living our life, would we live longer? And vice versa, people in those blue zones move to Glasgow or London or, I don't know, in the States, somewhere in Texas. Would they still live as long in such a healthy way? So I kind of want to take the concept and turn it around saying, let's not be like the people in blue zones. How do we make more places look like blue zones to live within? And so that's kind of where blue zones come into it. So one big thing you talk about is diet. And so people will have heard of, like you mentioned that Okinawa, they have a very sort of a unique diet, really. And people talk about the Mediterranean diet. And personally, I grew up in England, the middle of England in the 1980s, which is like peak frozen oven-ready food era. It was, you know, everything looked radioactive. It was what the journalist Michael Pollan calls edible food-like substances. But that was sort of baked into our culture, for want of a better phrase. But the Mediterranean diet, that's in, as far as I can see, nothing to do with policy. It's literally part of the culture. So how can we change that? So I would push back on that in the sense that we respond to the cues around us. I'm a classic example. I grew up in the States, similarly in the 80s, and I was fed on a diet of fruit loops and Lucky Charms and breakfast cereals. And actually, my dad was really excited by these coming from India, because he was like, they have cartoons, they're colorful, how wonderful I can give my kids a slice of America. This is what America is about. And to be fair at the time for both of us, there wasn't much research on the health consequences of eating these things, right? So a lot of parents could be like, what's the difference between a frozen lasagna and a fresh lasagna? Or what's the difference between, you know, squishy supermarket bread and baking? You know, this is great. We have progress, right? But I think now we have enough information to know that actually, diet's incredibly important in terms of your health and chronic disease. And many of these products are implicated in health issues. So then that becomes, as you're saying, how do you change it? Right? Isn't this just the way it is? And I think what's interesting there is to say, well, actually, we eat what's around us. We eat what's offered in supermarkets, what's affordable, what's accessible. School meals are the classic thing to look at, because no one could say a child is responsible for what they're eating at school. They get, at least here in Scotland, like two options, a meat and a veggie, you choose it, that's what you eat. And unfortunately, that is building a culture. And even if children don't want to eat it, they have to eat it, they're at school, of eating very unhealthy, processed, frozen-like products, edible-like foods, as you say. And if you look at other countries that are reversing the tide on child obesity, Denmark, South Korea, Netherlands, they are looking at what they're feeding children and changing it. Because actually, that's a market where you can say, actually, children have to eat what they're given. And so you must, you should be giving them a nutritious diet, at least in schools, and then moving out from there. But actually, when they do talk to people about what they eat, of course, people will say, I like to have chips sometimes, or I want a burger, or I want to eat what I want. That's all right. We're not looking at 100% clean eating. It can actually be orthorexium, quite dangerous to mental health to be that obsessive. It's like, where's 80% of what you're eating coming from? And I think that is where we need to shift the message towards, we're not saying, take away anything that people might say, I like it, or it's part of our culture. You're just shifting it. And then I think also healthier substitutes. So if you like a Sunday roast or a fried breakfast or a lasagna, is there a healthier and more nutritious way to have it? And generally it means moving away from processed foods made in factories, which don't really resemble anything you could make yourself. Yeah, so let's stick with school meals. I think this is a really important thing. In the book, we've mentioned Okinawa earlier, but funny enough, I spent several years living in Japan. And I know they have absolutely wonderful school lunches. I'd love to eat that every day, personally. But also, a few years back, Jamie Oliver in the UK made this campaign for healthier school meals, which is right on. But a lot of people resisted it. Parents were coming to the school gates and throwing over pies and kebabs for their kids. So is it really just a case of if you build it, they'll come? I think it is, because if you take any of those kids and move them to Japan, I'm curious, your experience having lived there, I think many of them would eat with Japanese kids are eating at school. I mean, that's what kids are like. They want to eat what everybody else is eating. And that's kind of socialization, right? They want to be fit in. That's such a big part of being a kid and a teenager. So I think there, of course, if you're the one child who has the sushi at lunch and everyone else is having chips and sausages, you might be like, "Why am I the weird one?" But if everybody's eating sushi, you're like, "Actually, that's quite normalized." And I think with Jamie Oliver, I mean, the two things I'd reflect on is one, maybe his celebrity was both great in bringing attention, but also detrimental because it became a cause celebrity, right? Like, instead of just being something quietly done that kids just go and do and parents are just like, "I think a lot of parents wouldn't even know what their kids are eating at school most days," right? And then the other thing I would say is I think the way budgeting is done in government can be very siloed. So education budgets is where school meals come out of. It's part of the education kind of system. And there you're making choices over, should we really be spending on school meals instead of teachers or instead of learning or we're having cuts? Where you're paying for that cuts in spending so little and that's what Jamie Oliver focused on, right? How do I do it for a pound or for 50p a meal? We're paying for it in our NHS and health system. So actually, because of the silos, in some ways, I almost feel like school meals should come out of the NHS budget because then you could show prevention is actually leading to savings in the system. If you just do it through education, there's no saving. You're like, "Well, we're just feeding kids. What does it matter if it's a pound or three pounds?" Right? There's no cost-benefit ratio, which is how government decides what to invest in. We're from a health perspective, if you're like, actually, that one pound, if you raise it to a pound 50 and we reduce the number of children being admitted with type 2 diabetes when they're 20 or who will need lifelong care because of chronic disease, all of a sudden, guess what? The cost-benefit ratio goes and we should be spending five pounds per meal because it saves us 10 pounds per person and that's the logic we have to get to. But unfortunately, it's been siloed. School meals aren't seen as a health issue. They're seen as social welfare. They're seen as part of the education, but they're not seen as actually improving children's health, which should be, I think, the central message now to many governments. Yeah, so let's shift gears a little bit. We'll come back to diet again in a minute. When I grew up, we'd do several hours of PE a week. It's in the syllabus and you think, well, surely, maybe naively, you'd think that that would develop a lifelong habit of exercise, but it doesn't. It's quite the opposite. I think a lot of kids do PE and develop a lifelong hatred of exercise because it can be seen as punitive, dictatorial, bullying happening. If you're not the most sporty, you identify as being like, I'm not sporty. I'm not athletic. I don't like that. So I actually think we need to be introducing it into schools in a way that feels fun, that feels like actually you're part of a community. And in some ways, it goes against sports days and things, but making it less competitive. It doesn't matter in life when you're 40, if you run 5K, how fast you are. Some people will care, others really don't. You can choose swimming. You can choose going to a dance class. You can choose, I don't know, just going for a walk with your dog. Life, you can move in all kinds of ways. And unfortunately, I think sometimes in schools, it's made to feel like, who's the fastest? Who's the best? Oh, you're not, you're not sporty. And I think taking away these labels of sporty, athletic, good at something and just being like, how do we all do it and enjoy it in the way you find it enjoyable? So I feel like there, yeah, it's, it's funny. You say, you know, we've tried to bring in this into schools, but actually I think it can turn off a lot of kids from feeling excluded from what they see as the exercise community, which should actually include everybody. Yeah. So not everyone wants to go to the gym. Not everyone wants to go for a jog or whatever. But, you know, you talk in the book about the Dutch and how they're healthy due to different ways in which they approach this. And it's kind of an everyday thing, which again, is just part of the culture that we don't have over here in the UK. You know, I personally speaking, I'm, you know, not old, but I went to university in the mid 90s in London. And just really purely out of habit in economics, I'd cycle to my lectures. And everyone, whenever I told them, I said, you crazy, that's, that's so dangerous. But since the London Olympics and the success of team GB in cycling, the cycling levels went up. So if you go to London now, you'll see hundreds of hundreds, if not thousands of commuters. And I find this interesting because it's not necessarily a direct government policy, but investment in the athletics team ended up making the population slightly healthier. I find that fascinating. Completely. And it comes back to the point, if you build it, they will come. London Belt, a great cycle network. Every time I go, there's more separate cycle lanes or, you know, cycle networks. And guess what? More people cycle. And again, I don't think it's people who would say, I'm a cyclist, because we all think of a cyclist as someone who's out doing mountains or tour de France or, you know, training. They're just people who want to get around like you did and think a cycle is pretty quick. It's better than walking. I don't want to have a car. And so I think they're looking at, you know, cycle routes. But even in Edinburgh and Scotland, and I know this is being debated in England now, there's free public transport, free bus travel if you're under 26. You get what's called a Young Scots card and you can get on buses for free from the age of like, you know, three. So you're free and then you get the card and then you can go on buses and you just tap it. And I think this is really smart because it's not just a mobility scheme. It's a public health scheme, because you're getting actually children and then teenagers and then youth, young people in universities, using the buses, getting around. And that means you have to walk to the bus stop, walk back. We have to think about pedestrian, you know, pathways and that city planning. And again, I think, wow, you're setting up people for lifelong, realizing there's more life in a car. You might need a car. And of course, cars are important for the elderly. If you're disabled, distances, I use a car, I cycle, I walk, I use the buses. And I think, can we see people in that kind of holistic way, but say actually, if they're used to the bus system, or they understand the cycle lanes, guess what? They're more likely to use them. But that is city planning, investment and needing actually someone to think about it in a logic. We can't just leave it to happen. There has to be some kind of planning behind it. Let's stick with city planning then. So another personal thing for me, I live in Bristol. And a few years ago, they introduced the ultra low emission zone, which is right outside my house. So that ended up with me having to buy a new car. Fortunately, I was in a position where I could do that. But lots of people aren't, say like, somebody's working as a nurse or something, and they need their car to get to work. People aren't going to like policies like this. Agree completely. But I think there we need two strands. One is you have to subsidize the better option for the environment and for health. So if you look at places like Japan, where you lived and they've had many cars and environmental issues, they subsidize healthier choices. For example, a hybrid car or an electric car, or one that's even coming back to it, not diesel. Again, I feel like there we need to not just expect, like you can't just take away cars and not offer cycle lanes or public transport. You have to first build the cycling and public transport, and then hopefully people move away from cars. And similarly with these zones, you can't just say to people, you can't drive that car without first prepping. Here are options. We'll buy back your vehicle if it's heavily polluting. We'll help you get a new one. And there I think, yeah, also the second part I would say is education around actually the health harms of your health is better because you have a less zone right outside. Like you're benefiting from cleaner air. But actually the people most damaging their health and their children's health and their loved ones going in that vehicle are those in a diesel vehicle. So you're not giving up your diesel vehicle because the government says it's you should do it for climate change or it's some eco warrior. You're doing it because you don't want to have respiratory issues or those around you to have it. And I don't think we enough educate that actually sitting in a stalling car with the fumes is not like you're doing it for the community. Don't do it for yourself. You shouldn't be breathing those fumes and neither those in the car and around you. And I think that message maybe isn't strong enough in terms of the individual aspects of why lesons are good for you. And then government's kind of helping to make it possible for those who as you say may not be able to afford switching out their vehicle without government subsidies or help. So sort of sticking with city planning, then you hear a lot in recent years about something that they call a food desert where people in sort of economically deprived parts of the town or city don't have access to healthy food. You know, they'll go to school, they'll have a few pounds and they'll go to the chicken shop every day or something. So that seems to me like there's some sort of policy that could be implemented to change this. Yes. I mean, I think again, the easiest way to start is with children and schools. So again, Japan, other places have implemented what they call green zones, which is around a school or around where you have many youth going out that actually only certain products can be sold. So regulating things like sodas where teenagers might go for those right away and making sure it's the other side, they're healthier options there. Again, it's a tricky one because you really see it's driven by the market. So to give you an example, if you go to certain parts of Edinburgh, you will find grocery stores are full of nutritious vegetables, fruits, you know, whatever you want to have grains, meats, fish counters, incredibly expensive. You go to other parts of Edinburgh and you find Iceland, which I guess is a frozen food, and you find, I mean, I guess now we're getting places like Aldi and Lidl, which offer both, which I think is a really great step forward. But I'll tell you a funny story. I was at a like a benefactor event. I often get invited to these to speak to kind of people who have very, very wealthy to try to talk about, you know, health issues, social justice, community investment, where you can put your, you know, your, your charity too. And I mentioned, yeah, it's astonishing in Iceland, everything is frozen. And she looked really puzzled. And I just said, yeah, it's astonishing, like to have, you know, only things that you can get, like you can't get fresh vegetables, you don't get fresh fruit. And she said, but I've been to Iceland, they have wonderful fresh fish. I said, I met Iceland, the shop. And she said, Iceland's a shop. I was like, there are many Iceland's, it's a chain, but it just shows the bubble you're in, right? That she didn't know, she thought I was talking, she had been on our latest holiday to Iceland, I was talking about how great their food was. And I was like, we just didn't connect. But coming back to it, it's really hard because how much can government regulate where shops build? And they generally build where they think there'll be demand. And I guess they're, it's starting with affordability, city planning, can someone get within 15 or 20 minutes to a shop to be able to buy what they, what they want to eat and have? We're talking about public health and government policies. So the sort of the big thing that a lot of people will think of is, is healthcare systems and how they function. So it over here, we have the NHS. But it's, it's getting stretched to its limits really at the moment. And I think I've heard you say that it treats disease, doesn't prevent diseases. So what do you mean by that? Well, I'll give you the example of football, American soccer, but here it's football, which is imagine health is a football pitch and that's your team. I would see an healthcare system and a doctor or nurse as the goalie. They're the last line of defense before the goal goes in. Your defenders or what I would call secondary prevention are you screening people for hypertension? Do you have early signs of cancer? Can we pick up things earlier? So actually they never get near the healthcare system. We can treat you out in the community in GP practices, for example. And then I'd say you go out a level further and that's prevention, that's things like diet, air quality, your movement levels, do you smoke? How much do you drink? All those kinds of things that come together. And so unfortunately with the NHS, we have too many goals being shot at this goalie. We then say the goalie is not working and is being a rubbish goalie. And actually, then we just criticize the whole system, think we need to privatize it or go a different model. I think the model fundamentally works. Where I think the issue is that you want to have a goalie who's bored, who's like, this game's going great because I'm just staring at the sky and everything's on the other side of the pitch because my whole team is working. And I think that's kind of how I think we need to see the NHS is actually how do we get everything else working so that when someone does arrive in A&E with a heart attack, we have a system that can deliver for them. And how do we make sure we have fewer people in that position? It's a real difficult one for politicians because you have actually a toxic loop of how do you get out of it, right? Prevention takes time. And I, but I think there that's kind of the analogy I use to kind of understand where we are right now and why it's not the fault of A&E's failing or healthcare staff. It's because too big a load is put on them and the rest of the system is not invest. And the NHS does spend less on prevention than other comparable countries and much more on acute care. So basically we're not helping children manage their asthma at home. What's happening is those kids are arriving with an asthma attack in hospital and then having to stay four or five nights. That's costing the healthcare system so much more than if they were actually having a community nurse coming to their house, making sure they have their inhalers, monitoring the air quality to make sure they never had to be in that position. But it requires re-jigging how we think of health and the healthcare system. Yeah, so we're talking the sort of overarching theme of our conversation is how to live longer and healthier. So one thing that I find really fascinating is the support people are given after they retire. So they're kind of, I don't know what the retirement age is now. 66, 67, I think, isn't it? After that, a lot of people just don't know what to do. And sort of going back to Japan, you'll get a lot of like grannies, they call them bar chans. And they're just set up like little small businesses and things. I'm not entirely sure how that works, but lots of them do it. And you just don't see it over here. Yeah. And the other thing interesting about Japan is they have like over 70, over 60 football teams. Like you're over the age of 70 and you play on a football team or you're over the age of 80. And that's going up. I think I recently saw like an over 90 football squad. The idea that people are active. I think they're one thing we have to recognize is we're not aging in a healthy way in Britain currently. The Japanese are astonishing for how well they maintain their physical and mental health into later life. This is why I pick 100 in the book as I think is a realistic way to achieve it by looking at populations like the Japanese and South Koreans as well as the royalty. How long they all seem to get to 100 or close to it. And so I think there it's saying how do we actually not only look at life expectancy, but healthy life expectancy so people could set up stalls or could be part of choirs or singing groups or football clubs or whatever they might enjoy. But I think they're, you know, the challenge is, you know, here in Scotland, we recently got the national records released what they call healthy life expectancy. So not just how long you live, but how long do people say they've lived in good health? They're happy with their bodies and their minds. It's going down. For men, it's 59. 59, can you imagine? And for women, it's 60. That disguises obviously inequality. There'll be areas which are much higher. There are areas that are much lower. Glasgow, I know where you've lived, has exactly that huge, you know, differences. But the idea that we were saying that at 60, after that, you're not going to be in good health. To me, that's astonishing because that's so low. You should be able to, with a health care system, support and good luck, lead, you know, living like the Japanese, quite active socially and physically into your, you know, 80s and 90s, ideally. So we've talked about an awful lot of interesting stuff there. So sort of by way of summary, you have kind of a list of key points that you think policies that should be implemented. Can you just run us through those as a kind of final word? Yeah. So at the end of the book, I look at five asks, because people might come away and think, well, this isn't a self-help book. I've not been told, which, you know, I do talk about exercise and diet, but maybe not in the same self-helpy way that some people might think they might need. And the five things I focus on are, you're going to challenge my memory here. The first is, you know, fruits and vegetables. They've become more expensive since Brexit. How do we actually get nutritious diets more affordable? There should be a working group in the government working on this, especially in regards to school meals and how we start with children, but move up the age ranges. The second thing is around the NHS and prevention as we discussed. How do we actually reorient the system and start seeing, you know, health and well-being as the main focus instead of as, you know, the NHS is the last resort where people have to go when they're on well. The third we haven't touched on it is mental health. We know mental health issues are increasing. And so actually looking at new kind of roles in other countries, they've tried lay therapists. So people in the community who maybe aren't trained in psychology or don't have, you know, medical degrees, but for a month or so are given basic training so they can engage in the community to increase mental health provision for those who suffer mild to moderate depression. So we're not talking about serious depression, but kind of a triage service that you can go there first and make an assess if they can help. Adding in, this is a bit controversial, but I talk about public transport and investing more in public transport and infrastructure. For example, publicly owned rail. I don't understand why we've made it in Japan's example of people taking public transport, right, to get around why we don't invest in it. And the fifth one, if I'm correct, relates to water. And that's an issue that I feel quite strongly about, which is, I don't know if people know that in Scotland, water is publicly provided. It's saved in public ownership. And we have, I have my water bottle here, free tap water provided at different stations. And it's seen as a basic, you know, service of government that you provide, water to your citizens and it's clean and sanitation systems keep it separate. And any, you know, we do pay for it through council tax, but any profit this company makes is a public company gets reinvested. And it's accountable to people who live here and to the parliament. And I don't understand in England why that model is not being used, because there are major issues, as we know with water in this, in England, and people talk about public ownership like it's radical. And I'm like, it's not radical, it's happening here. It's literally across, just drive across the artificial border and you'll see it. So I think those are things that I talk about in terms of how this engages people's minds to think more, more widely about their communities and where they're living. Thank you for listening to this episode of Instant Genius, brought to you from the team behind BBC Science Focus. That was Professor Devi Shridhar. To discover more about the topics we've just discussed, check out her book, How Not To Die Too Soon. 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