Reducing premature deaths, the limits of human longevity, and healthy cities

Gavin, Richard, and Jessamy get into the studio for another bonus episode looking at the launch of the Global Health 2050 report at the World Health Summit in Berlin, a report which shows a path to cutting premature mortality by 50% by 2050. Also up for discussion are the limits of human longevity and what well-designed cities mean for health.

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Transcript

This transcript was automatically generated using speech recognition technology and may differ from the original audio. In citing or otherwise referring to the contents of this podcast, please ensure that you are quoting the recorded audio rather than this transcript.

Gavin: Hello, welcome to the Lancet voice. I'm Gavin Cleaver. It's October 2024. I was very happy to have you here with us today for another little bonus episode. I'm joined by Richard Horton, editor in chief of the Lancet, and Jessamy Bagnell, senior executive editor at the Lancet. And today we're going to discuss the launch of the Global Health 2050 report took place at the World Health Summit in Berlin.

We're also going to talk a little bit about the limits of human longevity and urban design and how that relates to health. I hope you enjoy the conversation. If you've got any feedback, please do send us an email at podcasts at lancet. com. Thanks again. And I hope you enjoy.

Right. Welcome to the Lancet voice, everyone. And a little bonus episode where. We sit here and chat. I've got Richard Horton, Editor in Chief of The Lancet in the room, and Jessamy Bagnall, Senior Executive Editor at The Lancet. We've done quite a few of these now, so, uh, obviously we're in quite a professional groove, right, of sitting down and, uh, chatting in The Lancet's new podcast room.

Richard, I believe you wanted to talk about something that we published recently and that you went to Berlin for, am I correct? I think Global Health 2050. 

Richard: Yes, it was the World Health Summit held in Berlin, which has become quite a feature on the global health circuit now. It used to be held in the Charité Hospital and was a relatively small meeting.

But now they've teamed up with the German government and the World Health Organization is a big part of it. So at this year's meeting, they had Olaf Schultz pitch up to the Marriott Hotel in, uh, In Berlin, along with Bill Gates and Tedros came along. So it is the place to be and to be seen at. And I was very pleased that we managed to get a slot on the program to launch our Global Health 2050 report, led by the indefatigable Dean Jameson, uh, and also Larry Summers, who, uh, have been absolutely fantastic co hosts of this project, which actually began in 2013 with the, what, which, what was called then Global Health 2035.

Gavin: I see. So is there going to be an update every 15 years? 

Richard: Yeah, I think the longevity of, uh, of our leadership is going to have to be handed to the next generation. Gavin, yay me. But it was a, it was a brilliant piece of work. I mean, amid all of this sort of depression of conflict and post pandemic and climate change, um, they struck a defiantly optimistic note by saying that we could, um, by 2050, cut premature mortality by 50%.

That's mortality in people 70 years and younger. And that's a very bold and slightly brave, courageous claim to make. But they produce all the figures for it. And their messages are extremely strong. So Just a very briefly summarize 50 by 50 is the objective that we can reach. I should say that Richard Peto has been arguing that we can do this for many years.

And so Richard's work has been absolutely crucial as a foundation for this commission. Um, but I think one of the really important findings is, you know, we're never in a world where universal health coverage is the mantra for every good global health advocate. But what this commission says is that you don't have to wait for the perfect health system or for perfect universal health coverage in order to make massive gains, massive wins for health.

So that's very true. optimistic to say we can make progress without having universal health coverage. Uh, they also go on to say that we need to have a reset in the way we think about universal health coverage. It doesn't have to be fully universal and they identify 15 priority conditions divided between noncommunicable diseases and injuries and infectious disease diseases and maternal health conditions.

Um, they really emphasize that you can achieve this goal by focusing on some very specific issues. One they zoom in on with a laser like focus is tobacco. And they have this little phrase, tobacco is the new tobacco, because everybody thinks, you know, orange is the new black. Well, no, actually, tobacco is the issue.

And it's probably the single, but not probably, it is the single most important intersexual issue that could make gains to get to 50 by 50. 

Gavin: I'm starting to see how catchy phrases get developed. 

Richard: Yeah, no, absolutely. Exactly. Exactly. Exactly. No, they really they've got their comms here. Very, very good. And then pandemics, because there's they have a frightening figure in there that there's over 25 percent chance of there being a pandemic the size of COVID 19.

Um, In the next 20 years or so, which is pretty excruciatingly nerve wracking. And then they also go on to say that don't drop development assistance. You still need to have ODA But you don't need to have, be spraying all your ODA to middle income countries, you need to focus it, target it on the very, very poorest of countries, and also invest it in global public goods such as systems for pandemic prevention.

So it's a very, they have these seven key messages, um, it's a fantastic report. There are going to be national commissions set up now, there's definitely going to be one in Nepal, the United States, Nigeria. one particular province in China. We're going to launch it again. It's our Chinese Academy of Medical Sciences Lancet meeting in November in Beijing.

Um, so super exciting. 

Gavin: That is exciting. I was thinking what we, what is always said in global health is that we need to Give aid to the poorest countries to, uh, better ensure health for the rest of the world to, you know, increase health, uh, markers around the world health outcomes. So is it that this is more kind of laser targeted?

Richard: So I think what this is trying to do is, you know, when people say, well, the path to health lies through universal health coverage, it's such a, I mean, it's, it's great. Um, and, uh, meaningful in that we have the National Health Service. And we all know what that is. Um, appeals to UHC are very generalized and rather vague.

And what this commission has done is, it's actually, it's taken these 15 conditions. It's looked at cost effective interventions for these 15 conditions. And then put them together into 19, what they call modular packages. So, you could take this package of interventions for a particular problem, and those interventions are the ones you then have to cost and pay for, and find a means to implement in a particular way.

setting. They want, they don't want it to be seen as a prescription. They were really big on emphasizing that their recommendations have to be tailored to the particular local context, but they really have come up with a practical plan. I think that's the difference between this and the vague appeals to UHC.

Here is a concrete plan that you can take to a country and to a locality and implement it. And that really is a first. 

Jessamy: I think I, I, I. Totally agree. And although it's a very complex piece of work, the actual message is very simple. And I love that about it. You know, because it's saying essentially, health systems are serving lots of different goals at the moment, they want to, you know, there's an element of equity, they're trying to prevent disease, they're trying to improve quality of life, they're trying to reduce the severity of disease, all of these different things.

And when you've got so many different goals from a health system, Actually, sometimes there's a sort of absence of action and this marker of PPD, PPD and saying, let's just focus as an overarching, um, kind of goal for every health system. Let's focus on this one thing. I found that very compelling and, and I hope the governments would as well, because actually it makes things much easier.

If you can just say, this is our health system and all of our different policy actions should now be completely geared around halving 70. If you can do that, wow, everything opens up because things make sense. You can slot that in nicely. 

Richard: Absolutely. It really, I think they've really gone for a simple top line message, um, which is.

Super powerful. And I have to say, I think there's a reason why that was successful in this commission. And it wasn't thanks to the health people involved. This was a commission that was very much Half economists, half health experts. And I think the economists and Dean is an economist, Larry Summers is an economist.

I think what the economists have done is bring a kind of reality check in terms of policy making to this commission, which sometimes we don't have, you know, health people, they like to make things more complicated because we're scientists. We don't want to leave anything out. We want to explain the cause 

Jessamy: of.

Richard: Yeah, exactly. I mean, it's it's it's who we are. And that's fine. But the economists come along and say, let's sweep that out of the way. If you're it's literally if you're in the elevator with a decision maker, you've got 10 seconds to make your case. And if you're They know that I mean, Larry Summers was was Treasury Secretary.

He was chief economist at the World Bank. He's moved in these circles. You may not like every political opinion he has. But the fact is, the guy's got experience where it matters. And that was his message to us. Keep it simple, and have a very powerful message. And, and also the other point he made repeatedly was, you can't do everything.

You need to be seen to let certain things go, which is why we focused on these 15 conditions. We haven't gone for everything. We've said Focus on these conditions, you can make huge gains, gains that you can have before you get to the perfect universal health coverage. 

Jessamy: I think that's exactly right. And I think, you know, today, when there are health systems across the world, and we've spoken about them met, you know, many times over the last few weeks, that are really struggling to see a way forward in the UK.

We've suddenly got an open consultation for everybody to have a say on the NHS, where Street Team wants to give a Zen pic to poor people to get them back to working. You know, these are actions of governments who are lost in health, and they need a path forward. And I think this offers an extremely clear one.

Richard: Yes, I mean, the idea of giving everybody in the UK a smartwatch that somehow this is going to transform health is somewhat mad. Yeah. And, you know, I have great admiration for Wes Streeting. Actually, I think he's, you know, he's a powerful debater. He's got a strong vision for what it where he wants the NHS to go.

But I think these, the some of these ideas that are being proposed, they're losing the big picture. They're scattergun, 

Jessamy: aren't they? They're scattergun, you know, we've got enormous burden. enormous multi morbidity, what should we do? Let's do this, this, this and this. This is an overarching, you know, this document gives you an overarching vision.

Richard: And there's no reason why you couldn't have 50 by 50 in the UK. 

Jessamy: No reason at all. In fact, you know, this is this is meant for every single type of development level. 

Richard: Absolutely, absolutely. So there you go. We should invite West Street together and persuade him. 

Gavin: It's exactly right what you're saying, Jasmine.

The gimmick is the kind of the enemy of policy because things like that, the government's put them forward and then they're like, well, we've done something. 

Jessamy: Yeah. 

Gavin: You know, whereas actually, um, only well thought out policy documents, I say only well thought out policy documents, but you know, they're a lot more likely to succeed than giving everyone a smartwatch.

Yeah, 

Jessamy: absolutely. 

Gavin: And I 

Jessamy: think also what I find refreshing about this is. There's a combination of prevention. There's a combination of analysis of clinical diseases. And what I, what I think that I see across the world for many health systems is a very narrowly focused neoliberal technological approach to health that, that really can't think about anything else.

And you see that with the Azempic injections. I mean, that that's, we're operating in such a constrained field of what's possible in. That that is depressing, but also means that I think that the solutions that are suggested feel very disjointed and 

Richard: reactionary is interesting. You bring up the sort of neoliberal side.

If you go back before the 2013 Lancet Commission that Dean led, the actual origin of this work is in the 1993 World Development Report. And that was when Larry Summers was, uh, the Chief Economist at the bank. Dean worked for Larry, um, and Dean led all the work for that particular project. In fact, it was the World Development Report, that's the first of the Global Provenance Disease, because Chris Murray was working on it too.

Uh, So that report was used, um, as an instrument to promote this idea called the Washington Consensus, which was, of course, all about restricting the role of the state, and everything should be sold by the market and the private sector. Um, and it was interesting that, um, Dean, when he was speaking, Last week at the launch of the commission, he made reference to the fact that the Washington consensus was one of the original, um, ideas in the 1993 WDR, but he said that He thinks that that was a mistake, because if you look at this report, there's a very strong argument that a lot of the health system interventions in these modular packages needs to be publicly financed.

So the role of the state is absolutely critical here. And what this, what this report does, it doesn't, it doesn't come out. with this front and center. But it's a very subtle message that we write throughout the report, the absolutely critical importance of the state as an actor in building health, you can't do it without a strong state.

Gavin: It's often frustrating to me when governments talk about health departments in a way that is like, well, it has to work for the country. You know what I mean? In the sense that it has to be monetarily feasible, the things that we do have to sort of turn a profit eventually, actually, this is all about making money for the state in the longer run, when actually that's not, it's not really the right way of looking at this, you know, in a sense, we're making money in the long run here, because people will live longer, they'll be more economically viable for longer.

But also that argument is becoming more and more discredited, I think, as a health argument, just a pure health argument. 

Richard: I think that's right. I think also with one practical problem. Yeah, I said that the reason why the commission is a success is we've got half economists, half health people, you need that in countries too.

And all of Shoshana, who's an advisor to Sarah Ramaphosa at South Africa made the point in one of the panel discussions that public sector economists are few and far between in low middle income countries, because as soon as you have an economist trained in a country, They get sucked out, either abroad, so there's brain drain, or into the private sector in the country.

And so, the number of well trained public sector economists is tiny, tiny, tiny. And that is a real problem, because you need those economists to help design the systems to implement. that the reforms that health experts are recommending and they just simply aren't there. So we need more economists, we need economists, just as much as we need nurses, midwives and doctors.

Gavin: So that's an interesting question. How do we ensure the next generation of public health economists? 

Richard: Yeah, that's the that's that is a health question. It is not an economics question. It is a question that we should be thinking about and we never do. 

Jessamy: Can I just ask, though, do we? Do we? Because 

Richard: do we need economists?

Well, 

Jessamy: we do need economists, but I mean, I was very struck by some of those books that were written in the early stages of the pandemic, like The Economist Hour, you know, that looks at the number of economists that were in government pre COVID. Second World War and the number of economists that have been in the government since, say, 1970, 1980.

And they've gone up hugely. And they do funny things like in the environmental agency, you know, they're looking at swimming pools that could also be ponds, or, you know, they don't have Um, they don't have the same type of value based 

Richard: Well, that's why you need the two together, isn't it? 

Jessamy: That's why you need the two together, but do we need more economists, I 

Richard: suppose?

Do we really 

Jessamy: need more economists? We 

Richard: need more economists in low middle income countries. 

Jessamy: We 

Richard: may not need them more in the United States or more in European countries. How can the 

Gavin: swimming pools 

Richard: also be 

Gavin: ponds? 

Jessamy: I mean, it's an anecdote.

Richard: Anyway, read Global Health 2030. 

Jessamy: Definitely. 

Richard: It is, it's a fantastic read. And they've done a brilliant job. I really, I really think this is one of the commissions that we've published that will have longevity. 

Jessamy: I agree. 

Gavin: Longevity. Excellent word to finish that bit on. Because. Just to me, I believe you want to talk about the limits of human longevity and not just average lifespan, but actually how long humans can possibly live for, which I was very excited when you set it as a topic because it sounds incredibly blue sky and I'm ready to hear your thoughts on 

Jessamy: it.

Okay, well maybe I'll give a bit of background first of all. So there was a paper in Nature Aging that came out that looked at the implausibility of radical life extension in humans in the 21st century. And essentially what it's what it's talking about is this theory from about 30 years ago that humanity was approaching an upper limit to life expectancy, which was probably going to be around 82 for males and 86 for 88 for females.

So an average of 85 globally. We'd really made all the progress that we could make in terms of expanding life expectancy. And unless there was gonna be some kind of intervention in biological aging, that we were going to reach the limit. And on the opposite side of the argument of people saying that we can have radical life extension, uh, that every decade we will be exte expanding our life, um, life expectancy by three years.

And so that you're going to have lots of people that are going to be born in, you know, 2024, who can expect to live to a hundred years old. And this paper essentially says that when they've done lots of analysis of the eight countries with the longest life expectancy, places like Australia, South Korea, Japan, Italy, France, that when you look at the analysis over the last 30 years, that it's becoming increasingly difficult to increase life expectancy, and so there probably is a limit to how long we can live.

Gavin: So the trend is slowing, essentially. It's not that people aren't living longer, It's just that life expectancy is kind of topping out. 

Jessamy: It's topping out. Exactly. So there is, there's going to be a limit. There's not going to be radical extension in the way that some 

Richard: people So it's not three years life expectancy gain every decade.

It's 

Jessamy: not that it's much there. And I think, I mean, I think it's interesting because This is an enormous market as well. I mean, I was looking at some of the data before. So it depends what you look at. If you say anti aging, you know, the anti aging supplement and therapeutic market is worth 62. 6 billion this year.

Richard: But I was I read this paper. Yeah. And there's a very contentious opening to it because they say And it's actually relevant to what we were just talking about with the commission. Um, because Dean said this too, and I wasn't sure that I agreed with him. And that is that Public health and medicine have been, have made major contributions to extending life expectancy.

And Dean said science has made a major contribution to extending life expectancy. I'm not sure there's a shred of evidence to support that. I mean, at the margins, science and medicine, yes, they're fantastic. And, you know, if I, if I have appendicitis, then I certainly want a surgeon to whip my appendix out if it's inflamed.

And that's. That will save my life from having a burst appendix, but in terms of macro trends in life expectancy, I'm not so sure they the things that actually have extended life expectancy are a triumvirate of high income reduction in total fertility rate and education. Not science and health system.

You're going back to the economists again. So I think, well, I'm going, I'm going back to the, it's, it's, there is a secular trend in life expectancy, which is driven much more by the income levels and fertility rates and education and the population. And, and I'm not denying, of course, I'm not denying that medicine and science, have made vital contributions at key points.

What about antibiotics? 

Jessamy: I think it's cardiovascular disease. 

Richard: But if you look at the trends, if you look at where there's been a particular innovation, It's not been, it doesn't, you don't see an inflection point in mortality. So, for example, if you look at the reduction in life expectancy, we've got a very good reduction in, uh, I've seen in Mexico and China that we've published over the years.

You look at the reduction of the extension in life expectancy. It's got nothing to do with having a health system or universal health coverage. It's just got to do with the fact the country's richer, they're sending more of their kids to school, and women are able to control their fertility, and so they don't spend all their time looking after children who die.

Jessamy: I have to disagree. I think my understanding is on cardiovascular disease and smoking, and that we've seen the biggest life gains in the age of, sort of, 50 to 69 year olds, particularly in men and women and cardiovascular disease that has been our major that's where we've seen a big increase in life expectancy and decreasing smoking.

That was my understanding. Well, 

Richard: I think that's that's more true in high income settings. Yeah, if you go to a low income setting, I think It's, it's going up the curve in terms of income. That's what affects life expectancy more. So I, I think their argument is, is contentious. It might be right in some settings, but not in But this was 

Jessamy: obviously all high income countries that they were looking at, because these were the eight countries with the longest life expectancy.

Australia, France, Italy, Japan, South Korea, Spain, Sweden, and Switzerland. And then they look at Hong Kong and the United States, uh, particular sort of subsets. 

Gavin: Not to draw spurious correlations, but would you say then that the recent slowdown in increases in life expectancy is tied in some way to economic fortunes?

Richard: Oh, I said, absolutely. Yes, no question. 

Jessamy: Social and political 

Richard: determinants of health. Absolutely. That's been Michael Harmer's argument. And I think he's absolutely right. And it's not because if you look, we've got more advanced therapies in the health system now than ever before. That's not having the impact on life expectancy.

It's the social determinants that are having the impact to slow the rate of increase in life expectancy. The other thing that I thought was a bit confusing about the paper is they say that we're only 15 percent of women and 5 percent of men. are going to reach 100 years old, so that they're saying that there is this this limit, but they think they then go on to say that 2042 is going to be this magical year where we're suddenly going to see an explosion and number of people who reach 100 because the baby boomers.

That's going to be a hundred years after the post World War II baby boom starts. So then I was confused because they're saying on the one hand we're not going to have many people over 100 and then suddenly we're going to have an explosion of people over 100 because we've got the baby boomers coming through.

Gavin: That's when all the world's economies will fix themselves. 

Richard: Yeah. 

Gavin: Um, 

Richard: So I got very confused with this paper. I think it's a great paper. Oh yes, 50 by 50. 50 by 50 

Jessamy: will really start coming in then. That's when it will be. But I mean, I think that's why I've always felt that demography, it's a very darn card. I think.

It really is. 

Richard: It really is. And I, I love this idea of we've, we've, We've already won the, how did they put it, the first longevity revolution. How can we say that we've won the first longevity revolution? We've got, at the moment, The gap between healthy life expectancy and life expectancy is getting wider and wider.

And the reason for that is, yes, more people are living longer, but they're living longer with multi morbidity. 

Gavin: I mean, that's the crucial part. 

Jessamy: That's the crucial part. And actually, there wasn't that much in Global 50 50 about that either, although, but mainly because they didn't want to overcomplicate it.

Exactly. They definitely did not 

Richard: want to overcomplicate it. But, but they haven't, in this particular paper, they've not taken account of, of health. I mean, you don't just want to live forever in a terrible, terrible state with, you know, a dozen diseases. 

Jessamy: Actually, I don't think, I think 88 sounds pretty good to me.

I, I feel good about ATA. 

Richard: Yeah, but you can But a healthy, a healthy A 

Jessamy: healthy 

Richard: ATA. And they mention healthspan, but I don't think they pay enough attention to healthspan. And they, and I wonder, I wonder if their conclusion would have been exactly the same if they'd only talked about health Healthy lifespan.

Because there's no way that you could say that the first longevity, I think that's 

Jessamy: absolutely right. There's still a revolution to be had in healthy life expectancy, so you're not just living to 65 in good health and having 20 years of bad health, but you're living to 88 brilliantly and then suddenly dying.

Gavin: It's facile, isn't it, to take two people, one who has to retire due to ill health 20 years before they die, and another person that is perfectly healthy up until the day they die. If you, if they both die on the same day at the same age, you can't say that those two people Had, you know similar lifespans in that sense.

Jessamy: It's true. You need to look at the type of life they had 

Gavin: While I was, um, doing some Googling around this topic, I did come across the, uh, the billionaire, uh, biohackers. Are you familiar with this? I'm 

Jessamy: not. I'd love to hear more. 

Gavin: One, I hate the phrase biohacking. What is a biohacker? Right, let's get to that.

But, hack, hacking, generally, has become a term, a kind of catch all term for someone who is trying to, you know, Fix an issue, which is, you know Oh, 

Jessamy: like a life hack. 

Gavin: Yes. Like a life hack. Exactly. What's a 

Richard: life hack? 

Gavin: I hate that phrase. Who are 

Jessamy: you? . I don't understand any of this. 

Richard: This is a language that is completely, is this a generational divide between, this is a generational divide.

It is a generation. Okay, so come on. Can we have a few definitions? What is a bio hack? What is a life hack? 

Jessamy: A life hack is something. That someone tells you like a tip 

Gavin: it's like a tip It's a shortcut 

Jessamy: that a shortcut to do something in your life, 

Gavin: but our generation has decided this is called a life hack 

Jessamy: Yeah, we formalized it 

Gavin: Um A biohack 

Jessamy: careers are based on it 

Gavin: biohack is like a tip for living a healthier life Right, but what i'm doing is i'm biohacking my body by like eating well But, um, the billionaire, the billionaire biohackers have taken this to an unprecedented extent.

Um, I found, well, there's quite a, I've read a few articles about it versus the wellness industry, the wellness industry, but specifically a man called Brian Johnson, who is a billionaire. He sold Venmo, which is the payments company. And ever since he sold Venmo, he's been focusing on the limits of human longevity.

And he's been doing this by getting regular plasma transfusions, including from his son. And just as I was Googling him this morning, I found out that last week he completed his first total plasma exchange. There's a picture of him, which I can show you, holding up all of the plasma from his body that he has now replaced.

Jessamy: How old is that man? 

Gavin: He's 47. 

Jessamy: He's already obsessed with this. Yes, that's 47. 

Gavin: Yes. Um, 

Jessamy: this is going to dominate the next 40 years of his life. 

Gavin: It's quite something to read his Wikipedia page because a lot of it obviously is about this. It's titled life extension attempt on Wikipedia. And then it's just met with with criticism from 

Jessamy: going West Coast, the whole longevity industry and 

Richard: Yeah, they don't do this in Camden.

I'm afraid. But I will remember what a biohack and a lifehack is now. 

Gavin: That's good. I think you just haven't met the right Camden crowd, to be honest. 

Jessamy: Camden and cities. I mean, 

Gavin: Oh, you're taking my job, Jessamy. But you're doing it very well. And so Richard, talking about cities, you wanted to talk about the Academy of Medical Sciences 

Richard: Yes.

So this week, um, we had, or no, last week we had Mark Newman Huson, who is a professor at IS Global in Barcelona. Um, and he is an expert on healthy cities in the era of climate change. Uh, and that was the subject of his Academy of Medical Sciences, Lancet. annual lecture. Um, and he also was optimistic. This has been a week of optimism, um, where he was making a case that change is possible.

We can remodel, redesign our cities, uh, to be these nirvanas of green, cleaner, healthy living, renewable energy, physical activity, everybody on a bicycle. And we don't have to be living in these, in these high, Uh, intensity, high population, compact cities, uh, which are literally going to go into decline. Um, and with the, with the end result that we will have social fracture, um, civil disobedience, um, and eventual complete collapse.

So he was, there's a lot to take in, but he was painting this, this vision of, of, of utter catastrophe. But, we have the knowledge now to be able to veer off from that course, um, and save ourselves with these, with these beautiful cities. And he gave a lot of evidence, which was really quite inspiring, which I was not aware of, of cities and communities that are doing exactly this, that are 

Gavin: So which cities are a good example?

Richard: Well, they're not So, for example, there's a part of Dusseldorf, um, which has reinvented itself and instead of the car being at the center of everything, you know, beautiful canals and rivers and green spaces, um, Barcelona itself, um, which now, uh, is based on the idea of having blocks and in those blocks, um, You have a kind of environment, which is all about the pedestrian having priority over the car.

So they have been paving over streets, which usually had cars going down them, creating piazzas with trees. Can you see how many trees can you see from your from from where you live? Actually 

Gavin: loads because I live in Bermondsey and When the slums were cleared in Bermondsey in the 1900s, Ada Salter, who pretty much every part of Bermondsey is named after, you can't turn around without seeing something dedicated to Ada Salter, and rightly so, planted thousands of trees around Bermondsey.

And so my particularly Relatively on lovely stretch where I live by Mill Wall Stadium. So, you know, it's, um, sorry to any mill fan. 

Richard: No, it's fantastic. 

Gavin: But the, it's, it's a, it's a beautiful mature tree-lined kind of freeway. Freeway, you know, it's, um, 

Richard: but then you are living in, you are living in paradise already and, and just you've got trees around you.

'cause you 

Jessamy: highlighted the countryside. Exactly. 

Richard: Because there's 

Jessamy: another catch phrase coming. 

Richard: Well, there is, because you need to live in and the catch please tell us it. The catch phrase is. The catchphrase is the 3 3300 rule. And the 3 3300 rule is, is where we need to be aiming ourselves, and that means that you can see three trees from your window.

There's 30% tree cover in your community, and you only live 300 meters from the nearest part. And if we all lived in that environment, we would be happier, we'd be healthier, and we'd probably have a longer life expectancy, a healthy life expectancy at that. It turns out I'm absolutely sorted. 

Jessamy: You're fine, you're fine, don't worry about it.

Bermondsey 

Richard: is the paradise of London. 

Gavin: Yeah, I mean, I think when I say Bermondsey, people think about the kind of Bermondsey Street, London Bridge, really nice area up there, but um, the area south of Bermondsey, where I live. I love it. But I'm not sure I would describe it as a paradise. But never mind. What's what's Camden like Richard?

Richard: Well, where I live, which is a bit north of Camden, I can see trees from my windows. I am 300 meters from Hampstead Heath. So that's nice. I don't think that's 300 meters from Amsterdam. That's pretty nice. Yeah You know, I did actually well, maybe 500 

Gavin: when we say 300 meters from a park. I mean, I'm 300 meters from a very small park

Richard: If I take a particular shortcut I can definitely get there in a matter of minutes rather than hours. But the thing that was surprising about his lecture, and here's the here's the deal, I'd be interested to know what you thought about this. He was he gave a massive downer about electric vehicles.

Electric vehicles are not the solution to our problems. And I really thought that they were with all this EV talk. And he said, absolutely not. Because if you think about it, and his argument made a lot of sense when he said it, I just haven't talked about it like this. EVs. It's just still more cards. And it's not actually solving the basic problem, and the basic problem is that we need to be walking, we need to be on bicycles, we need to be using public transport, not just replacing one type of car with another type of car.

So, he, he was really, really arguing that we need to get rid of Electric vehicles as well as ordinary cars, and then we'll improve our physical activity. We'll have fewer accidents And we'll have less noise pollution, and I thought that was pretty convincing actually 

Gavin: I think I have a pretty good perspective on this because I spent six years living in Texas Where there's literally no ability to walk anywhere nor would you want to because it's always the temperature of an oven outside But that's six years where you even if you want to go to the grocery store at the end of the road you have to drive the two minutes to the end of the road And then I moved straight from Texas back to the proper center of London, where there's absolutely no point owning a car.

I think Southwark, the borough I live in, something like 82 percent of households don't own a car. It's the highest rate in, in London. So I've become vehemently anti car as a result of those two experiences, and I'm completely on board. I don't think electric vehicles are a solution whatsoever. In fact, we all have these crumbling public transport networks that we never invest any money into.

And I'm really interested in the example of countries like Estonia, who have made public transport completely free for everyone in the country. Because it turns out when you make public transport completely free, it doesn't actually cost a huge amount of money. We're already heavily subsidizing public transport networks.

Richard: I didn't know that actually, but still we have made public transport free. And have they got a policy on healthy cities then? They, I mean, perhaps the 

Gavin: I've waded in with a fact here without knowing more facts about it, which 

Jessamy: is 

Gavin: the issue. I'll read 

Jessamy: you another fact, which is that more than 10, 000 premature deaths could be prevented in 167 European cities if one in four trips were by bicycle.

It's a lot of death. 

Richard: The problem with London is there are too many hills. This is my excuse for not cycling to work. Only in North London. Come to South London. I haven't seen a hill in years. 

Jessamy: Exactly. Exactly. I think we're talking about Hampstead. 

Gavin: Alright, alright. So I need to move south. Move to South London.

We don't have the tube, but we also don't have hills, so it swings around a bit. 

Jessamy: Exactly. 

Richard: I thought he gave an absolutely fantastic lecture, actually. He painted a picture. Of, um, what success could look like for, for a city and I mean, when, when you, when you describe it, you know, the idea that you live in a carbon neutral, um, healthy city with all kinds of green buildings, renewable energy, resilient infrastructure, um, pedestrians, cyclists, green spaces, green industries, circular economies, fantastic.

And I think the thing he was emphasizing. was we need to spend more time thinking about livability. What is it like to live in a city? And I remember once it's difficult because he was arguing that we in the health community needs to need to put ourselves into the urban design community and make our case for why health is important.

I remember once we did a series on non communicable diseases and I went and gave a talk somewhere to a bunch of architects about the importance of health and they laughed me out of the room. And they laughed me out of the room because they said, we never think about health. We think about beauty. We think about utility.

We think about efficiency. And health is not one of the things we think about. And of course, the reason they don't think about health is nobody's ever gone to them to talk about the importance of health. So, 

Gavin: But you did and it didn't go right. 

Richard: No, it went actually really badly. And they thought I was just a, you know, just a special interest arguing for my special interest.

And I wasn't into the you know, the beautiful conceptual paradise that architecture was supposed to be creating. However, I think the problem does lie with us is no good us complaining about The way cities are, unless we go and make our case to local authorities, the people who design cities, and I think that's what That's what Mark's basic argument was that the change is possible.

This is what success looks like. There are some examples of it But if you really want to make this happen, you've got to go out there and get your hands dirty 

Gavin: I'm often struck when visiting especially Belgium and the Netherlands how Radically anti car and pro bike all of the cities are and how? Well integrated all of those.

Richard: Yeah, honestly Amsterdam, I mean, bikes, they're fantastic, but it's lethal. You can't cross the road without getting run over by a bike. There are so many of them. They come in these swarms of bikes coming down the street. There are hundreds and hundreds of bikes. And if you're this poor, lone pedestrian trying to cross a tramway with a hundred bikes saying that to you it's not easy, I can tell you.

Gavin: Amsterdam is a bad example, I think. There are simply too many people and bikes. 

Richard: Too many bikes! No cars, brilliant, a few trams, a few people, cars have been replaced by, by these, by this epidemic of bikes that needs to be controlled. 

Gavin: One of my favourite cities in Europe is Antwerp, which I think is a stunning city, and I like to go there and just rent a bike and you can literally access every single part of Antwerp by bike.

And, you'll like this Richard, they've eliminated the hills. By bringing in bike lifts for raised bike paths. So there are lifts specifically for bikes and you you drive straight into them Press a button it takes you up to the top and there's a bridge linking you to the top of the hill 

Richard: Oh, that's my kind of city.

Yeah old men like me. That would be absolutely fantastic coming back See I can go downhill to work, but it's just at the end of the day the idea of Going uphill all the way from where we are in the centre of London to where I live just fills me I'd rather book into a hotel for the night. 

Gavin: Just buy a new bicycle every day.

Leave it at the bottom of the hill. Or get an electric bike. I'll get an electric bike. Yes, that's probably 

Richard: it. But then that defeats the object of the bike, doesn't it? Because the whole point of the bike is the I think you still get some movement. Do you? 

Jessamy: Yeah. 

Richard: Yeah. You'd 

Jessamy: be okay with that. I think so. I 

Richard: like Antwerp.

I've never 

Gavin: been to Antwerp. Oh, you should visit. It's a wonderful city. Alright. Jessamy, Richard, thank you both so much for for joining me today. And we'll be back in a few weeks for another Another chat about health. 

Jessamy: Thank you, Gavin. Thanks. 

Gavin: Thank you.

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