Review: How Not to Die (Too Soon). The Lies We've Been Sold and the Policies That Could Save Us, by Devi Sridhar

One could probably construct an entire yoga studio out of books claiming to help people live longer and healthier lives. Recent members of this subspecies of the self-help industry include: Hack Yourself Healthy; Eat Yourself Healthy; Every Body Should Know This; The Longevity Super Agers Cookbook; Anti-Inflammatory Reset; Stronger: 10 Exercises for a Longer, Healthier Life; Unbreakable: A Woman's Guide to Ageing with Power, and so on, and on, and on. ‘Going on’ could be described as the main obsession of these books, if they did not also insist that living longer is not enough: you must also be healthy to boot. Of course, should the relentless instruction to remain healthy and stay alive cause you any worry, there is guidance out there to help you manage that too, such as: Overcoming Health Anxiety; Help Me I'm a Hypochondriac!; The Complete Guide to Overcoming Health Anxiety: How to Live Life to the Fullest… Because You're Not Dead (Yet); Help! I'm Dying Again, and so on, ad nauseam.

One of the oldest fantasies is to live forever, not least because it satisfies the unbounded egoism of the human animal, for whom ‘the sense of death is most in apprehension’, as Shakespeare wrote. Once, people crowded into church pews to hear their fellow mammals—with no more insight into an afterlife than a lettuce leaf—lecture them on divine providence; about a supernatural authoritarian who would grant them immortality. Now people listen to podcasts hosted by health gurus, read health and fitness columns and crowd into yoga studios, health food shops and gymnasiums. Hopes of immortality now rest on that obstreperous and failure-prone organism that betrays ‘the indelible stamp of our lowly origins’, as Darwin wrote. The Enlightenment physician Julien Offray de La Mettrie observed that the body is ‘a machine which winds itself up’, and it is to the functioning of this evolved machine that people now feverishly look, as the expectation that one can purchase and invest one's way to a state of equilibrium called ‘health’ takes hold. Having thoroughly pathologised ageing, the decrepit consequences of advancing time are to be pre-emptively treated with our technocratic culture's customary managerialism. The result is a contagious collective anxiety about the prospect of death, fuelled by preening social media influencers and befuddled billionaires who think they can buy immortality.

In fact, due to digital communications technology, perhaps at no previous point in human history has the idea of longevity so permeated consciousness. With the Financial Times reporting that ‘the global longevity economy is projected to be worth $33tn by 2026’, this ‘new age of anti-ageing’ is exemplified in a new series, ‘The Longevity Project’, which includes one writer embarking on a ‘year-long quest to live forever’—a year of obvious futility that comes at the expense of what Montaigne aptly called ‘jollity and feasting’, which ‘tends to death’. More and more products are claimed to be needed in one's heroic battle against decay, from magical supplements to wearable technology that tracks and measures one's bodily functions to ensure optimal performance. After all, if every other aspect of life can be repackaged for corporate profit through the introduction of new pseudo-needs, why should this not extend to the body itself, the epicentre of various neuroses? Exercise is now reverentially marketed as an ‘insurance policy’ against ageing: in expensive gyms with state-of-the-art equipment, one's body can be contorted and fuelled into a superior kind of being. As I can personally attest, there is no joy or spontaneity in a gymnasium; there is only a strained, deadly serious atmosphere of attainment. At all times, you are being told, subliminally, that this is what it takes.

In this informative book on public health policy, which blends personal and political commentary with advice on how to live a healthier life, Devi Sridhar rails against the ‘rampant individualism’ mentioned above, which places responsibility for health outcomes squarely on the personal choices one makes. She points out that ‘physical activity, diet, smoking, mental health, gun violence, safe roads and transport, clean water, clean air and access to quality health care’—in other words, the essentials that make a healthy, lengthy life possible—are all intimately bound up with the political choices of governments. It is strange to think that this sort of message—that it is policy that matters more than individual willpower—should be necessary, but the human brain seems geared to think in terms of simplistic relationships of cause and effect that inadequately grasp the complexity of real-world arrangements. The misconception that human beings are the autonomous authors of their own lives overlooks the extent to which we are biophysically conditioned by our sociocultural environment.

Health turns out, then, to be a complex matter of political, social, and legal infrastructure. Many people live, for instance, in a ‘food desert’ in which a preponderance of aggressively marketed pseudo-foods, laden with chemicals and saturated fats, predominate. Typically, such areas are impoverished, which means that residents can hardly move to more expensive areas where life expectancy is higher—the link between healthy lifespan and wealth being well established. People live lives constrained by opportunity, time, money and location, and at the prevailing whim of what their rulers decide to provide them. In many countries, there simply is not a baked-in set of presuppositions about what the duties of government are; often, political responsibility is abdicated. Being ‘governed’ means being left to navigate whatever social and economic environment corporate power has decided to set up for you; whatever market conditions so happen to dictate your behaviour. Law—the precondition for a just society in which both individuals and large conglomerations of financial and political power are held accountable—is in many places corruptly enforced, indifferently or unevenly applied or simply non-existent.

Given that we seem to be going backwards when it comes to the health of children (it recently emerged that high blood pressure rates have doubled in a mere twenty years), these are urgent matters of public policy that require political intervention. While longer lifespans in part explain the rise in certain health conditions, the coincidence of easily obtainable processed foods, sedentary lifestyles and exposure to pollutants means that people are suffering earlier from diseases that were simply not as prevalent previously. In this sense, we are all being subjected to the results of political choices made earlier in history, such as the shift to sedentary labour, the decision to make polluting vehicles the dominant mode of transportation, the privatisation of vital public services, or allowing conscienceless corporations to flood the market with cheap imitations of food.

In Thailand, 33 per cent of all deaths are related to traffic accidents; the United States is the only high-income country in which civilian-owned guns outnumber actual people; 90 per cent of English water companies are owned by profit-seeking corporations: several of many statistics Sridhar provides that point to the role socioeconomic conditions have in determining how long you might live—the message being that health is about more than attaining a pristine body where nothing processed passes one's lips. ‘Clean’ eating and gym-going will not stop you from getting flattened by a vehicle, being arbitrarily or deliberately shot, sickened by the water supply or exposed to life-threateningly polluted air, nor will they remedy the unavailability of affordable healthcare or housing. What makes Sridhar's contribution valuable is its insistence on acknowledging political reality, and that huge numbers of premature deaths are preventable. For all that we live in a market economy shaped, in theory, by the preferences of consumers, the truth is that the political power to shape reality is with those to whom it has been delegated, and that the political regulation of corporate greed and its indifference to human harm is quite literally a matter of life and death.

With their knowledge of death haunting them, humans are nature's greatest invalids, forced to accept what they nevertheless despise—their own, fateful end. Except that many people still cannot accept it. The desire to deny death once found its dominant expression in the mystifications of theism; now it emerges in the condescending obfuscations of the health industry, and in the adolescent burblings of Silicon Valley venture capitalists. Certainly, Sridhar's book effectively counters a delusory vision that conceives of human beings as atomised economic units, autonomous biological machines. But it is no less valuable for striking the right balance between accepting that death is perfectly explicable and natural, and emphasising that it would also be good if fewer people died needlessly from preventable causes that can to a large extent be politically remedied: that being shot dead or unable to access mental health services is not, after all, a mere matter of bad luck.

How Not to Die (Too Soon): The Lies We've Been Sold and the Policies That Could Save Us, by Devi Sridhar. Viking Press. 336 pp. £22