When it comes to leading a healthy lifestyle, too often the odds are stacked against us, observes Dame Sally Davies. People often eat more calories than they need. Walking around town or cycling to work often means sharing the roads with distracted drivers, placing physical safety at risk and adding mental stress to the day.
Davies has devoted much of her career to studying these and other drivers of health and devising ways to improve health in the United Kingdom at the individual, community, and country levels. She is the master of Trinity College Cambridge and UK Special Envoy on Antimicrobial Resistance, and she spent nine years as England’s chief medical officer and the United Kingdom’s chief medical adviser.
In a conversation with Lars Hartenstein, coleader of the McKinsey Health Institute (MHI), Davies shared her definition of health, how the pandemic has changed our perceptions of health, and actions governments and employers can take to improve population health. The following is an edited version of their conversation.
Lars Hartenstein: Let’s start with the fundamentals. How do you define health?
Dame Sally Davies: In Britain, people often equate health with the National Health Service. They think of health in terms of treating illness, but it’s much broader than that. In our book, Whose Health Is It, Anyway?, my colleague Johnny Pearson-Stuttard and I talk about total health, by which we mean physical health, mental health, and social health [including spiritual health]. All three are necessary for good health. Moreover, a person can be disabled and still have good physical, mental, and social health.1 Healthy doesn’t mean free of illness or disease—it means managing to live well.
Lars Hartenstein: How do you distinguish between prevention and health promotion?
Dame Sally Davies: Promotion of health is almost an old-fashioned concept. I prefer to focus on helping people live the best lives they can. That includes not only tending to physical, mental, and social health but also taking actions as a society to make the healthy choice the easy choice. If we make it easier for people to keep healthy, we help them avoid developing diabetes, high blood pressure, heart disease, or other chronic conditions.
Lars Hartenstein: Do you see differences in our understanding of health as a result of the pandemic?
Dame Sally Davies: We’ve seen that those who started with chronic ill health have had poorer outcomes in the pandemic than those who started with good health. Also, people who suffer inequalities and are among the most deprived in our communities were at much higher risk of catching COVID-19—because they live in more crowded circumstances and take public transport to work—and of dying from it. The pandemic has highlighted the importance of starting with good health.
Lars Hartenstein: Would you agree that social determinants of health have moved to the forefront through COVID-19 and that a more comprehensive perspective on health2 is emerging?
Dame Sally Davies: Absolutely, although I prefer the term “social drivers of health” because “determinants” sounds very passive. Drivers, by contrast, are much more active, and we can modify them. There are biological drivers, for example, and social drivers and, importantly, commercial drivers of health.3
Lars Hartenstein: Health involves the healthcare system, government, the private sector, the education system, and more. How do we embrace this broader perspective?
Dame Sally Davies: Yes, health is everything, including even green spaces, active travel, and the like. There’s no magic bullet to shift our thinking away from health as sickness services to health as a whole. But we need to make sure that we resolve climate change, provide active travel options, and work with employers to support the health of their workforces.
In the city of London, there’s a wonderful network working on mental health. Members work together to learn how to support and improve the mental health of their employees. Meanwhile, governments can take actions like imposing a sugar tax on soft drinks, as was done in the United Kingdom.4 As a result of that action, after two years, companies were selling 10 percent more drinks, but the amount of sugar and calories saved to our population was massive.
Of course, we have to provide a national sickness service. People expect that. But we can do so much more. We need to move away from framing health as a political issue that’s tied to an electoral cycle. We need to think about the return on investment [ROI] to people in ten and 20 years’ time, not just three to five years.
We need to move away from framing health as a political issue ... we need to think about the return on investment to people in ten and 20 years’ time.Dame Sally Davies
Lars Hartenstein: As we think about health at the confluence of government, the economy, and education, what is one thing that you would like leaders around the world to consider doing differently?
Dame Sally Davies: Leaders need to understand what health really is and why it matters. COVID-19 has helped reveal how chronic ill health resulting from inequities affects outcomes. But then they need to take action and measure the impact, because things that get measured get acted on. I persuaded the UK government to set up a national health index, which is run by the Office for National Statistics. It’s currently in its second beta form, but it analyzes data to do with healthy lives, healthy people, and healthy places. You can look at the data by area and over time to see what is changing. That allows local or national leaders to say, “What if I change this? Will it improve the metrics of the national health index?” I hope over time that the government will start to use that and actually put it beside GDP as it reports to the public.
Lars Hartenstein: You’ve worked in government for a long time. What are the kinds of things that government leaders might do differently using a national health index alongside GDP?
Dame Sally Davies: A national health index gets governments to think longer term about an ROI on health. They can consider setting up a national public health fund that’s focused on long-term ROI. Governments also can work with industry and impose regulations if companies fail to make the healthy choice the easy choice. In addition to things like our sugar tax, governments can look to promote the shift to electric cars to help reduce air and sound pollution and can support active travel by giving pedestrians and cyclists more rights, among other actions.
Lars Hartenstein: How can commercial drivers be harnessed to improve health?
Dame Sally Davies: Certainly, there is a lot that we as individuals can do to improve our health, but much more can be done at the societal level—and not just by the government. Companies also have an essential role to play. They can contribute directly through their products—for example, auto manufacturers can lessen pollution and restaurants can reduce portion sizes—but if they aren’t prepared to do that and they are earning a big profit, maybe they should be taxed so the money can be used to promote public health in different ways.
How companies treat their employees is also a commercial driver. Are they making it easy to cycle to work and then have a shower? Are they supporting their mental health? Are they giving them education in nutrition? Are they providing housing? We know that if employees’ health needs are met, they’ll be more productive. So there are countless ways they can contribute, but many of them are doing nothing at this moment. They’re just taking the profit.
Companies learned through the pandemic how a health crisis damaged their economic performance and may now see how it’s in their interests to support the health of their workforces and local communities, even if not for society as a whole.