How Not To Die (Too Soon) by Devi Sridhar review: 'a manifesto of sorts'

It may sound like a self-help book, but How Not To Die (Too Soon) is more concerned with state-level intervention, writes Stuart Kelly

Here’s the quick answer to the question posed in the title of this book by Devi Sridhar, Professor and Chair of Global Health at the University of Edinburgh and advisor to the Scottish and UK Governments, as well as the World Health Organisation, UNICEF and UNESCO: be the kind of person who buys hardback books and has £22 of disposable income (≈24% of the weekly Job Seeker’s Allowance). That is not supposed to be flippant, as one of the insistent points in Sridhar’s work is the connection between poverty and ill-health.

Professor Devi Sridhar

The subtitle makes clear another two aspects: “The Lies We’ve Been Sold and The Policies That Can Save Us”. Whenever there is a health problem, there are quacks, mountebanks and charlatans. It’s unsurprising that in Delhi, for example, there are expensive air-purifiers for sale. But hats off to Moritz Krähenmann, selling eight litre cans of Swiss Alpine air for £17.60 – we breathe, Sridhar notes, six litres a minute. The second part is trickier. Although there are aspects of our lives that we can control, and which have tangible health benefits, others are beyond the capability of the individual. Good luck solving carcinogenic car fumes, 100˚F summers or rivers full of excrement and chemical run-off on your own. (For the record, climate change is not one of the emergencies Sridhar covers). Politics and the bogey-man word “regulation” are, unfortunately, the answers sometimes. The title may have a slight after-tang of self-help, but the book itself is more concerned with state-level intervention.

The chapters cover what Sridhar calls a “collective endeavour” to increase life expectancy; although the caveat here is on the quality not the duration of life. The first three chapters, uncontentiously enough, cover taking regular exercise, eating a balanced diet and either not taking up or giving up smoking. Then comes a chapter broadly on mental health. This chapter is more sketchy. It limits itself to anxiety disorders – “struggling” seems as apt a word as any. There is one flash of really smart writing, when Sridhar having discussed the accusation that “Sustainable Development Goals” in mental health are “senseless, dreamy and garbled” writes the criteria were “mostly vague, largely immeasurable, somewhat attainable, and definitely relevant”. Although one section is headed “It’s hard to get depression taken seriously” it’s hard to take seriously when she quotes “even the darkest night will end and the sun will rise” – it might be Victor Hugo, but it sounds like Hallmark.

The next sections are more obviously public: gun control, road traffic accidents, water and air pollution; and an appropriate closure on untimely deaths caused by failures of health systems themselves. I was surprised – given Sridhar is based in Scotland – that neither alcohol nor narcotics were given special treatment, especially since minimum pricing and the recent experiment with safe drug consumption facilities. In the governmental rather than individual, it seems strange to omit warfare: as we see increasingly, it is not just cluster bombs and land mines that significantly reduce life expectancy in conflict zones but the deliberate use of food blockades, targeting of medical facilities and “kettling” populations.

Sometimes the book reads like various articles stitched together (there is a curious point in the nicotine chapter where she cites that the cheapest packet of cigarettes in the UK was £8.82 – in 2017. Would it have been too much trouble to put in that the average is now £16.60? It is at its best when it might have been subtitled “Things Are More Complicated Than You Think”. For example, a whole book might have been done on Thailand and Sweden: Thailand has the world’s worst road deaths, but managed to clamp down with sufficient rigour to have minimal Covid deaths. Sweden has strict “Vision Zero” road safety but was laissez-faire (or cavalier, take your pick) about liberties during the pandemic, with many more deaths.

Sridhar ends with a manifesto of sorts. Change is possible (for the better, I should add), it happens when there is consensus (see the difference between smoking bans and ultra low-emission zone), we can all learn from other countries, even when what we learn is that risks balance out, and the “private sector is valuable… while it’s sometimes the solution, its also sometimes part of the problem”, which is gold-star fence sitting. She also has five “asks” of government: make fresh food cheaper, provide alternatives to cars, privatise water companies, and invest in preventative medicine. I’d like to know quite how this gels with the private sector’s role. One other recommendation seems to me plain wrong: “provide local access to lay therapists, which takes mental health provision out of medical clinics”. Although I very much agree with Suzanne O’Sullivan on over-diagnosis, the benefits of therapy and non-material causes for genuine and painful material harms, the idea of outsourcing something so significant to unregistered amateurs seems ill-considered.

The plethora of contemporary references – Khloé Kardashian, Andy Murray, Catherine Princess of Wales, Feargal Sharkey – bolsters the sense this is in part a laudable exercise in recycling comment pieces. No doubt it will also strengthen the public engagement section for Edinburgh University in the next round of the Higher Education Research Excellence Framework.

How Not To Die (Too Soon), by Devi Sridhar, Viking, £22

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