I recently read Devi Sridhar’s book How Not to Die (Too Soon) and haven’t stopped telling people about it – here’s why.
How Not to Die (Too Soon) – a public health guide
I wish I’d known what public health was as a field of study when I was 18. Although, my 18-year old self as was probably still wouldn’t have been interested. I’d had a couple of dealings with medicine as a patient – though some of the fairly standard orthodontic variety – by then but, like most teenagers in the Western world, I didn’t think my health or the health of the population in general was something I needed to worry about.
I’d had access to lots of things that felt very normal, and I knew many things were taken care of. In public health terms, I’d lived a life of pretty extreme privilege – to me, difficulty in accessing safe drinking water was something that happened on other continents, for example, and even in the presence of police officers, I’d very rarely seen a gun.
As I’ve got older, and learned more about our lifespan’s evolution of health in general, plus discovered what public health is, I’ve become far more interested in it. Public health also links closely to preventive medicine, something else I strongly believe in (lots of people I know have heard my rant about “falls prevention” clinics and how they’re poorly named and would be almost obsolete if everyone moved more confidently in the first place). I’ve reached the point where I want to better understand why we are where we are, and how to change things, and that’s where books like this come in.
Topics covered by How Not to Die (Too Soon)
The premise of the book is to dismantle the belief that our health is our individual responsibility. In the modern era of wellbeing, privilege, and middle class pastimes, things like fitness are seen less as a pleasant hobby and more like a full lifestyle. It’s no exaggeration to say that, for some people, being their version of healthy and “optimising” themselves has become an obsession.
But, actually, the things that cause our demise aren’t a failure of our bodies, and therefore aren’t something that we have a significant impact on. And, scarily, a lot of these deaths are quite easily preventable.
Sridhar covers topics such as road safety, gun control, food quality, smoking, air pollution, and water access, as well as exercise. I found each chapter interesting to read – some of the topics broadened a basic knowledge I already had (read Caroline Criado-Perez’s Invisible Women for further information on why women are disproportionately impacted by lack of public transportation options), and some presented much newer information (due to my privileges, I hadn’t considered air and water quality previously).
Each issue is presented in terms of areas of the world primarily impacted, and those places which have either solved the problem effectively or are on the way there. I found some of these inspiring, but my pessimistic nature struggled with others. For instance, it’s lovely to hear about countries that have fantastic public transportation, but on so many levels, the UK is so broken here. We run an antiquated and privatized national system; I live in a village myself which, although not far from other towns, is horribly served by public transport and has been since railway cuts in the 1960s; and most big towns and cities in the UK are poor for cross-town public transport – Brighton is also near to me, and whilst I love the city, the existing bus network is not a solution that suits everyone.
Where Devi and I disagree
Something that the author and I have in common is that she’s a PT too, and we both qualified in our thirties. I wasn’t particularly surprised to learn that Devi takes the approach of measuring her PT clients. She references making use of body mass indexing (BMI), body fat percentage, waist circumference, and blood pressure. She then discusses various physical assessments of performance that she undertakes with clients, such as number of press ups they can do.
These are all things that I’ve been taught how to do, and firmly decided not to unless a client specifically requests it. In my opinion, performance assessments aren’t relevant for everyone – many of them (such as walking tests) aren’t inclusive, and I think that what is most important when considering any method of assessment is the suitability and relevance of it. Genuinely: what is the point of knowing a client’s weight, blood pressure, or walking speed?
My question there was rhetorical – there is logic behind knowing some of those things. I really will fight you on blood pressure, though: I’ve witnessed many people undergo 24-hour monitoring tests for this and results still be inconclusive (TL;DR, I think that blood pressure measurements should be left to medics, rather than PTs). One of my favourite things to say about services such as personal training is that I believe the best thing for the consumer is choice. We should all be able to choose someone who matches our wants and needs, so whilst I choose not to follow these procedures for specific reasons, I’m not here to stop anyone else doing so.
Who should read How Not to Die (Too Soon)?
A lot of people are put off non-fiction by expecting it to be complicated or technical. I think that Devi’s writing (I’ve also read her previous book, Preventable) is accessible and engaging, so I would encourage most people to give it a go.
If you are struggling to see the dangers in smoking (particularly passive smoking) and vaping, firearms, and our dependence on cars, I’d urge you to pick up this book. It also gives a great insight into how the different sides of the political spectrum can be highly effective when they agree on an issue, so for anyone who feels disillusioned by voting, or thinks that politicians don’t have their best interests at heart, please read this book and remember it the next time you step into a polling booth.
I’m grateful to have been sent a copy by Viking – it’s one that was on my wish list anyway, and I’m going to keep talking about it.
How Not to Die (Too Soon) by Devi Sridhar is published on 12th June 2025