The countries that could solve Britain's health crisis, according to a professor

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2 days ago

When Devi Sridhar was a child, her father, an oncologist, would show her pictures of cancer patients' blackened hearts, livers and lungs as a warning not to smoke. The slides, projected on the walls of her family home in Miami, were enough to put Sridhar and her four siblings off the habit for good. But their father was diagnosed with lymphoma when Sridhar was 12 years old, despite living a healthy life. She got used to a 'crossroads' of good or bad news at every blood test or screening. When he died, at just 49, Sridhar didn't eat for months.
Sridhar left school early, graduated from the University of Miami with a medical degree at 18, and went on to be awarded a Rhodes scholarship to Oxford for a PhD in anthropology. She became Prof Sridhar in 2014, when she joined the University of Edinburgh and set up its global health governance programme. Prof Sridhar was one of the first experts to warn that Covid was coming to Britain – in January 2020 – and later advised the Scottish government on its Covid strategy, while she went to fitness boot camps in a local park every day and qualified as a personal trainer. And then, one morning, she got a phone call as she rode the bus to work. A routine smear test had come back showing signs of high-risk HPV, and changes to her cervix. It was 'possibly cancer'.
At home in Miami, Prof Sridhar would have been staring down the barrel of huge hospital fees and debt. In Britain, extensive NHS waiting lists meant that the changes to her cervix might not be treated quickly enough to prevent their development. In India, where her parents were born, and where there were no routine cervical cancer screenings, perhaps it never would have been caught 'until it was in an advanced stage,' says Prof Sridhar, two years on.
There was no date given for a follow-up consultation, so Prof Sridhar phoned local clinics to ask whether there were any cancelled appointments she could attend. Two months later she secured a slot. Her abnormal cells were frozen, she was given an HPV vaccine to boost her immune response, and now she's cancer-free. It turned a fact that she had always known – that our health is always influenced more by the countries we live in than it is by our lifestyles – into a concrete reality.
'You can bubble yourself off individually,' with a good diet, exercise, air purifiers and water filters, 'but at the end of the day, you're all in it together,' Prof Sridhar says. That's the theme of her latest book, How Not to Die (Too Soon): The Lies We've Been Sold and the Policies That Can Save Us. From her perspective as a global health expert, trying to live for longer is less about changing our own habits and more about realising that 'if I moved to a blue zone, I would probably be doing all the same that people there already do, and I wouldn't be thinking about it,' she explains.
Britain 'leads the world in reducing gun violence' and in bringing down smoking rates, but there remains much that we could learn from how things are done elsewhere in the world, says Prof Sridhar. Here is what she knows.
The Netherlands is famous for the bike networks that span its cities. It would be easy to think that the Dutch love to cycle as a part of their culture, but bike lanes originally came about in the 1970s. In 1971, a Dutch girl called Simone Langenhoff was killed as she cycled to school, one of 450 children who died in road traffic accidents that year alone. Her father led a campaign to widen access to safe cycle routes. Now, there are 22,000 miles of cycle paths across the country, and by 2015, a quarter of all trips in the country were made by bike.
As a result, getting exercise while you travel to work or to see friends is the default. Almost all Dutch people cycle, and 'only 4 per cent of people don't get the recommended daily amount of exercise,' says Prof Sridhar. This makes it the most fit country in the world, in terms of the amount of exercise people get per week on average.
We pale in comparison here in Britain, where one in three men and 40 per cent of women are physically inactive. We have cycle lanes in our cities too, but making people want to use them is another issue. 'If you make walking or cycling safe, people will generally choose it, but people don't feel safe if they're too close to vehicles,' says Prof Sridhar. 'For women, it's often about whether a road is well-lit. We need to think through the barriers and how to tackle them, instead of telling people that their concerns aren't valid.'
Prof Sridhar points to Paris as a city where Dutch-style changes are well underway. 'When they created physically separate lanes for cycling, not just a little painted path, the number of women cycling went up radically,' she says.
Prof Sridhar would like to see the same in Britain, but first we need an attitude shift, she says. All of us around the world are inherently lazy – if we don't have to exercise, then we often won't. She wishes that the messaging from the government was that 'something is better than nothing,' she says. 'Even as a personal trainer, I struggle to get to the gym for an hour some days, but if I can manage a twenty minute walk, I'll do it, because that's much better than nothing at all.'
British adults get more than half of their daily calorie intake each day from ultra-processed foods (UPFs), a situation that has been tied to increased rates of obesity, cardiovascular disease and colorectal cancer. 'But Britain isn't fatter than people in countries like Japan because we're more stupid, or because we're lazy, or because we don't buy enough diet books,' says Prof Sridhar. It's all about the availability of healthy food – and the habits we learn as we grow up.
Prof Sridhar has adapted her own diet to be more similar to what people traditionally eat in Okinawa, a subtropical region of Japan where people are twice as likely to live to 100 as they are in the rest of the country. 'The main carb in the Okinawan diet is sweet potato,' Prof Sridhar says, which is packed with fibre and micronutrients. Then there's the practice of 'only eating until you're 80 per cent full,' as opposed to the culture of 'finishing everything on your plate' that Prof Sridhar (and most of us) grew up with.
But even if all of us in Britain knew about its benefits, that wouldn't be enough to keep us healthy. 'If I had a magic wand and could do one thing, it would be to change school meals in Britain, so that at least all kids are getting one really great nutritious meal a day,' Prof Sridhar says. Adolescents in Britain get closer to two thirds of their calorie intake from UPFs, as they're cheaper to mass produce and serve. It's a situation that sets us up to eat badly for life – and shows us how obesity is a nationwide problem, not the fault of individual people.
'We know that eating fruits and vegetables with healthier proteins is more expensive, so there are arguments against subsidising them to be cheaper or changing school meals. But you'll pay either way,' says Prof Sridhar. 'If someone gets Type 2 diabetes at age 19, they'll need support from the NHS for the rest of their life. In the end, they're the same budgets, because it's all taxpayer-funded and supported.'
In Britain, life expectancy has been in decline since 2011. In Finland, however, life expectancy has risen by around two years since then for both sexes, and things are only set to get better: by 2070, the average Finnish man should expect to live to 89. Mortality from treatable conditions is lower than the EU average, too. This is a sure sign that Finland has got it right when it comes to healthcare, Prof Sridhar says, as is the fact that cancer survival rates are among the best in Europe.
'When you're diagnosed with cancer, the faster you get access to treatment, the more likely you are to survive. Part of the reason Britain struggles with this is that we can't get treatment within the 60 days, or 30 days, whatever the crucial window is for the particular cancer that you have,' she explains.
The big difference is that Finland's health system is built around prevention, says Prof Sridhar. 'With the NHS, we often wait for someone to have a heart attack before we wonder how to save them. Instead, we should look at whether that person knew they were at risk of heart attack. Did they know their blood pressure? Did they know their adiposity levels around their abdomen? It would help if we shifted our thinking and implemented screenings earlier on.'
The way to do that is through tax, Prof Sridhar says. 'In Finland, they've done very well to reduce inequality. Capitalism exists, and it's accepted that some people will have nicer lives than others, but there comes a point where you're deemed to have enough. In Britain, there are billionaires and multi-millionaires that pay less tax than an NHS nurse, because of how the system works. We could tax those people properly, and have a healthier society where everyone does better, without putting the onus on normal working people.'
Zurich, in Switzerland, is the least polluted city in the world. It wasn't always that way. In 2010, the city's air was badly polluted, a result of traffic as well as wood-burning for heat in the winter. The city committed to lowering its emissions, which meant reducing the amount of journeys people took by car.
Here, as in many countries with cleaner air, 'the message has been about connecting diesel and the danger from air pollution to your health and the health of your loved ones, rather than the environment,' says Prof Sridhar. 'Changing your car is really expensive. Helping people to realise that children who breathe polluted air are more likely to have asthma, and will have changes in their brain, makes it easier for them to take action.'
Switzerland also has some of the cleanest tap water in the world, along with Germany. In England, we've 'become worse at separating sewage from the water supply,' says Prof Sridhar. When it comes to fixing that, however, we needn't look so far for answers.
'Scotland has some of the cleanest and best-tasting water in the world, while in England, water quality has declined,' says Prof Sridhar. 'The difference is that in Scotland, our water is publicly owned. When things go wrong, we're able to hold water companies accountable, because the shareholders are people who live here. In England, where water is private and the companies are owned by people overseas, that's much harder to do.'
Prof Sridhar's Nani, her maternal grandmother, lives in Chennai, a big city in the east of India. At 92, she stays active, eats a simple plant-based diet, and has a good social life. She lives independently and can still get about well. 'She hasn't fought ageing, or tried to look younger,' Prof Sridhar says.
Prof Sridhar's grandmother has inspired her to pursue 'functional health' rather than attempting to look a certain way. Doing squats and staying flexible is important 'because one day, those are the things that will help you to go to the bathroom on your own,' she says. 'My grandmother would never in a million years say that she's sporty, and it would be helpful to move away from those categories in Britain too,' says Prof Sridhar. It's another change that could start in schools, where at the moment, 'people can feel that they're un-sporty, so can't participate'.
India has its own challenges with getting its population to move more – 'people have often had to work hard and move all of their lives just to get food and water, so why would they move in their leisure time?', Prof Sridhar points out – 'but there are fewer care homes in India as well as in Japan, so someone like my grandmother is able to stay living independently for longer, because you can stay in your community for longer'.
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