How Not to Die (Too Soon): The Lies We’ve been Sold and the Policies that can Save Us

by Devi Sridhar

‘This is the standout book on how to live longer’ Chris van Tulleken, author of Ultra-Processed People


'In a world rapidly taking leave of its senses, Devi Sridhar is a crucial voice of reason, mustering empirical evidence and powerful argument to make an essential case. Drop everything and read this book' George Monbiot, author of Regenesis


How Not To Die (Too Soon) is a fascinating, challenging and thought provoking read. It completely changes the perspective on human health and who bears responsibility for protecting it. In an age when talk of the next pandemic seems ever-present, it also couldn’t be more timely' Nicola Sturgeon

Have you ever questioned why, despite the avalanche of self-help books and optimization hacks, we remain embroiled in multiple global health crises? Populations worldwide are gaining life-shortening excess weight (even in poorer countries), and water contamination is rampant (even in richer countries). In such dire circumstances, a gratitude journal won’t help.

The stark reality is that we’ve been sold a monumental lie. The obsession with individual health optimization has distracted us from the real holding governments accountable for policies that can significantly extend our lifespans. How Not to Die (Too Soon) is a vital, transformative guide that shifts the focus from individual responsibility to societal accountability. It’s time to demand the changes that will save lives.

Genres: Nonfiction, Science

314 pages, Kindle Edition

First published June 12, 2025

Reviews

[Kate O'Shea · Rating 5 out of 5]

When I requested this book from Netgalley I assumed that it wasn't exactly a self-help book, but rather a book that might give overall personal health/lifestyle guidelines. On discovering it was more about changing government policy I thought, oh dear, not what I wanted and prepared to DNF.

If you think the same then don't stop reading. This book is absolutely fascinating in a "how on earth can I now make my government take notice?" way.

Devi Sridhar gives examples of how we can increase our age by living in healthier environments - statistics of policies that have been proven around the world. For instance the push by parents in The Netherlands to provide safer, cleaner routes for their children to travel to school has brought down air pollution in that country; when the Dunblane school shooting occurred, a small group of parents pushed hard for tighter gun controls which means it's much harder for people to buy a firearm (let alone an automatic weapon) in the UK. These are just two examples of how people power can change life expectancy.

I won't lie, there are some horrifying statistics in this book from across the world and no one country gets everything right but there are incredible changes that can be made, if only our governments were brave enough to make them.

I'd highly recommend this to anyone interested in the health and wellbeing of their society. After all, certain changes will benefit us all in the long run (and end up costing our health care services less).

Thankyou to Netgalley and Penguin Random House for the advance review copy. Very much appreciated.

[Helen · Rating 5 out of 5]

This is a great book. Focusing on collective health rather than what you can do as an individual to live longer. It’s a call to arms in some ways and also a scary insight into global public health. The message is of hope - some countries do things better than others and we should learn from each other. It’s also a reminder how lucky I am in many ways, but things could definitely be better. Thanks to NetGalley and Penguin for the ARC.

[Mr Brian · Rating 5 out of 5]

Professor Devi Sridhar comprehensively exposes the ‘lie’ of individualism within the global health crises and challenges us to switch to a narrative of more government accountability for the policy decisions which affect us all. She argues that where you live matters to your life expectancy and that the expected behaviours, driven by government action and inaction within that context, can shape not just your life, but the quality of that life. ‘We know from scientific studies and decades of public health research not only how to increase life expectancy but also how to maintain quality of life.’

Sridhar uses the age of 100 as the collective target for lifespan and explores reasons why this is both attainable and unattainable around the world. She comprehensively chronicles nine of the most important risk factors which impact our ability to live longer lives and challenges us to recognise the bad actors, companies and individuals, which stand in our way. ‘We have been focusing on the wrong thing: namely, we have been focusing on ourselves. This means looking at government policies that promote long lives…nine of the most important risk factors affecting healthy life expectancy in all countries: physical activity, diet, smoking, mental health, gun violence, safe roads and transport, clean water, clean air and access to quality health care.’

Why can't we all live to be 100 years old?

Again and again Sridhar makes the point that the steps needed to enact these policies for longer living are well known and that it is societal accountability that lies at the crux of the problem. ‘We know how to prevent millions of unnecessary early deaths around the world, both in developing countries and closer to home.’ If we know how to prevent millions of early deaths around the world, the implicit question becomes why have those lives been targeted as being expendable and who has made that choice that some- in most cases, the wealthiest- lives are more valuable and need more protection than others. It would have been too easy for this book to turn into a polemical rant about obstructive capitalists intent on growth over human suffering, but Sridhar side-steps this effectively and instead presents examples where countries and communities have successfully changed, adapted and evolved, to better protect all its citizens. Her goal is clear, ‘My aim with this book is to show you that we know what works in solving the major health challenges.’

‘This is a book about how to live longer’

Sridhar also makes it emphatically clear that, ‘This is not a book about how to die. This is a book about how to live longer.’ There is a strong focus on family and the power of human relationships which echoes through the book, aspects of life which can enhance our human experience. She quotes her ‘Nani’, recently celebrating her ninetieth birthday, whose mindset was ‘it’s not about how to die. It’s about how to live.’ That treasuring the accidents of our lives is important, as ‘life is special because it is finite.’ Therefore, a longer life span is possible, is attainable and should be a birthright of all. Sridhar reminds us that in the mid 19th century, a life expectancy of 40 was not seen as being ‘mid-life’ or ‘middle-aged’. She celebrates how far we have come since then and questions why an extension of a healthy life should not be the new expectation. ‘In 1841, life expectancy at birth was roughly forty years old…Back then, forty wasn’t mid-life: it was life.’

Of course, the nine risk factors which Sridhar explores in the text, were not so prevalent in the mid-nineteenth century, although avoiding cholera outbreaks through drinking unsafe water, which the UK identified through the efforts of John Snow, is still a lived experience for millions around the world today.

Transforming the health expectations

Of the many global examples which are used by Sridhar, the Netherlands is highlighted as an example where ‘it wasn’t always like this’, but rather where the cities were designed and structured to ensure that health was a priority. Therefore, if examples exist, it becomes logical to understand that they can be replicated in other cities and countries. Paris, in France, also aimed to put the health of citizens as an integral part of daily life through its creation of ‘Fifteen- Minute Cities’- whereby ‘a city should be designed so that most of people’s daily errands, work, education and life can be carried out within fifteen minutes (by foot or bicycle) from their home.’ Nothing inherently unusual or controversial there, when building a healthier future was the goal. ‘The way to shift physical activity at a population level, as shown by Amsterdam and Paris, is to build it into daily life so that it becomes practical, invisible, free (or cheap) and social.’

Unfortunately, in recent years, populists have gained traction by referring to these cities as places where you only have ‘15 minutes of freedom’ and that these health measures are ‘Stalinist-style.’ In this, Sridhar identifies some of the obstacles and challenges faced by countries which try and build long term healthier communities for their citizens; that these are delayed by political interests and vested interests, which look to protect their profits and cause division.

Early deaths globally could be prevented through effective change and adaptation to more physically active lifestyles. ‘The World Health Organization (WHO) estimates that 4 to 5 million deaths per year could be averted if the global population were more physically active.’
Sridhar makes the convincing argument that, ‘Just telling people to move doesn’t work if they can’t implement this advice within their daily life and routine.’
Government inaction rather than individual lack of discipline

Changing daily routines such as diet, as well as exercise, should be led by government policy and action, argues the author, where she acknowledges the complexities of relationships with food and the financial implications of eating healthily, but summarises how governments should behave. ‘Make it easier to eat well and harder to eat badly.’ She follows this by emphasising that markers of ill-health indicate where governments have failed. ‘Similarly, a population being overweight is a sign of government inaction, rather than an individual lack of discipline.’

Several examples are highlighted where government regulation and action have led to increased health outcomes for citizens. Sridhar evaluates the positive impacts of the UK government’s measures regarding behaviours around smoking, and how quickly attitudes and the culture around smoking changed, when the government intervened to safeguard the public. ‘First, make it harder to smoke through taxation, minimum purchase age, bans on ‘kiddy packs’, and ensuring cigarettes aren’t visible in shops. Second, reduce the ability of people to be able to smoke in social or work settings. Third, counter the marketing and advertising of tobacco companies which are selling a dangerous product that literally kills.’ With increased health outcomes, this also lessens the strain on access to health services, which is also explored fully by Sridhar, who suggests that these health issues should all be seen as intertwined and connected, rather than discrete issues in their own right. However, she also makes the repeated point that, ‘Regulation only works if it's enforced.’

Gun control and regulation

Shifting focus to America, Sridhar again highlights how the interests of a few can drive government policy, so that citizens there do not have the same chance of a healthier, longer- life span. She focuses on ‘freedom’ making the clear point that freedom of children to be safe appears to be of less national importance than the freedom of people to have firearms. ‘The gun lobby is a small minority who resist any change because it impinges on their profits.’ She compares school shootings in the USA, with the school shooting in Dunblane, Scotland and draws attention to a powerful group who can bring about change- the parents of dead children. For people to have the equal chance to enjoy longer life, gun control is a successful government measure and demonstrably works. ‘Gun control worked in Britain. As the Gun Control Network says, it ‘proved that good governments acting in the interests of the many, not the few, can overcome the rich and powerful gun lobby.’ She questions why the government does not intervene to protect its people-’If we know what works, why isn’t it being done?’ and notes bluntly that, ‘Getting shot at school is one of the most likely ways for a child to die in America.’ Cutting through the complex ideology and associated cultural identity that is linked with owning a firearm, Sridhar returns clearly to her underlying argument- ‘How Not To Die (Too Soon) in America, answered in part by strict gun control laws.

Access to equality

Sridhar then turns her focus on the inconsistency around the world where access to clean water, clean air and medical care is often problematic. She draws attention to the statistic that, ‘In 2023, the UN estimated that 2.2. billion people did not have access to safe drinking water.’ Over a quarter of the world’s population could not access safe drinking water in 2023- but this is only the beginning. ‘By 2025, the UN predicts two thirds of all people on the planet will live in water-stressed areas. There’s no ambiguity with water compared to other goods: humans, animals and plants cannot live without water. Find fresh water, or die.’

When there are concerns over the safety of drinking water, then this is when private companies swoop in with bottled water- making a profit out of the situation, rather than seeking to remedy a basic human need. When faced with statistics about access to safe drinking water, sometimes readers in Western Europe can feel that they are exempt from these concerns- but, as the recent ongoing sewage concerns and poor health of waterways in the UK demonstrates, having access to clean water affects developed countries as well. Schools have even closed in the US over water issues.

When we have a limited resource, which is necessary for life, then conflicts can begin over ownership of that resource. Sridhar again challenges us to imagine this scenario where a resource is privately owned and monopolised, as well as the extreme situation. ‘Can you imagine a world in which there is no fresh water?’

We are victims of circumstance in terms of geography and economic systems. Some of us can move to avoid the worst impacts and thus experience longer healthier life-spans, but this is not an option available to all. Although some risk factors are within our control, Sridhar turns to the most obvious one which is not in our control, whether we live in Switzerland, India, South Africa or the UK- the quality of our air and the impact of air pollution. ‘Dr Maria Neira of the WHO said, “The problem is that when you’re a citizen, you can’t choose the air you’re breathing. You breathe whatever is available.”’ The need to have clean air to help people enjoy healthier lives didn’t used to be a political football or a partisan issue. It has been viewed as a UK-wide public health issue, until recently, when populists use clean air as ‘anti-car’, once again prioritising the capitalist profits of industries over the health of the population. ‘The backlash against clean air measures is baffling: we all live longer with cleaner air, and the issues should have widespread appeal.’


Being happy with living

‘How Not To Die (Too Soon)’ outlines a blueprint then- a hopeful pathway to a healthier world. A pathway which identifies and challenges why the needs of the many don’t outweigh the needs of the few, or the one. As demonstrated time and time again in the book, countries around the world have identified the risk factors for their own people and have then enacted long-term solutions which change the attitudes and behaviours permanently for the good. Governments can be powerful instruments of good, which leave no one behind. ‘That’s the politics of hope: we must imagine a healthier world and take the public policy steps towards it.’
All that remains is to change the political will and to make health a priority, in order to improve life for all within a society. After all, ‘Life isn’t about not dying too soon. It’s about enjoying and being happy with living.’

[Cara Swain · Rating 4 out of 5]

This book is a comprehensive summary of the world’s health problems, with scientific evidence and learned opinion provided in an engaging narrative.
As a medical doctor, some of the content was familiar to me, but I learned a lot about wider public health problems and was shocked to discover issues such as the state of air pollution in India!

I enjoyed reading this book and found it very informative and easy to understand, if a little repetitive in places, especially where there was obvious crossover between topics (such as diet and exercise, smoking and air pollution). Although the I also personally found the excessive amount of sub-headings per chapter to be somewhat distracting.

The overall message from Prof Sridhar is that health is a multifactorial societal problem, over which the individual has only limited control. Starting from a discussion about potential for living longer (over 100), and a recent decrease in global life expectancy, she explains the role that governmental policy plays in determining aspects of health that are considered important. The epilogue is a call-to-arms for the public to lobby the UK government for meaningful change. I can’t help but feel there is a missed opportunity at the end of the book, to connect with the reader by going full circle and talking about life expectancy and reiterate the the individual efforts that can be made. The focus is so heavily on the influence of the policy makers, that the reader might be left feeling hopeless or apathetic to the problems laid out in the chapters.

Note: This was the first ARC I have received - thanks to Penguin for sending it to me. I made no agreement to review or share my opinions on social media.

[Tina Reynolds · Rating 4 out of 5]

I thought it was a really interesting exposition of all the things that government should do to ensure healthy populations. There could, potentially, have been a little bit more about the stuff that you can do yourself (rather than lobby for) but given the public health focus, it did make sense not to!

[CadmanReads · Rating 4 out of 5]

This book is a fascinating and information-rich exploration of what truly determines our chances of living a long, healthy life. It’s not just about personal choices. Professor Devi Sridhar takes a bold and timely stance: health is indeed a political issue. From clean air and safe water to reliable transportation and access to mental healthcare, she argues convincingly that governments, not individuals, hold the key to public well-being.

I appreciated the way she broke complex global health topics into digestible chapters, highlighting how where you’re born can often matter more than how many steps you take a day. She doesn’t just present a bleak picture. Throughout the book, Sridhar provides real-life examples of change. Japan reduced air pollution. Amsterdam promoted cycling. Kenya improved school zone safety.

Some parts are shocking, especially around gun violence in the U.S. or the lack of access to clean water in other countries. Others are hopeful. Her argument for community-level mental health support and lay therapy was especially compelling. She also reminds us that health inequality is deeply tied to race, class, and wealth, and that it's time we held policymakers accountable.

Stylistically, the book is clear and accessible, though it occasionally feels like a series of connected essays or columns. A few statistics could have been more consistent, as sometimes data is quoted per capita and sometimes not. I also would have preferred more sensitive language around topics like suicide. However, these issues did not detract from the critical and urgent message.

Sridhar ends with five policy areas we can push for. These are practical and realistic changes governments can make to help everyone live longer. I found myself pausing often to reflect and even made a small change by standing up to move every half hour, one of her simple, research-backed suggestions.

This is a compelling, sometimes unsettling, but ultimately hopeful book. Whether you're new to public health or already familiar with the field, "How Not to Die (Too Soon)" will offer fresh insights, supported by global examples and thoughtful analysis. I’d definitely recommend it to anyone interested in health beyond the headlines.

[Anne · Rating 4 out of 5]

This is a fascinating deep dive into the large aspects of public health. We're talking gun control, air quality, water provision, mental health stigma, and healthcare provision. Among many other topics. Dr Sridhar shows that we’re encouraged to lose weight, improve our fitness, join gyms etc but it’s all pointless unless your government and infrastructure are supporting you in the necessary aspects of overall health provision.

We have life shortening in India because of poor air quality, people dying in Nigeria because they’re held prisoner on a ward and left untreated if they can’t pay their health bills, many countries where no drinking water is available and people have to buy bottled.

The research is thorough and covers east and west and shows even the so called ‘developed countries’ could do more to protect their citizens.

This would be an ideal read for anyone in politics or considering it as a career, or any interested member of the populace. It’ll certainly open your eyes.

I was given a copy of this book by NetGalley

[jean · Rating 4 out of 5]

This was an interesting book setting out differences in global health policies, both good and bad, and what countries can learn from each other to support their citizens. Not taking away from the fact that individuals also have a responsibility to maintain their health, Ms Sridhar pointed out in an easy to read style how difficult this can be when basics such as air and water are polluted. Unsurprisingly it's quite a political book and I imagine not everyone will agree with her possible solutions,, but having a conversation is a start. I did feel I was already aware of much of the information in the book, but it was helpful to have it laid out in one place
Thank you to netgalley and penguin books for an advance copy of this book.

[Louise Wilson · Rating 4 out of 5]

This book takes a look at health issues. Professor Devi Sridhar what the government should be doing to make our population more healthy, some of te suggestions are highlighted. It's not just about health, in America she talks about how easy it is to have firearms and the mass killings, especially in schools. In other parts of the world, she speaks about how not everyone has access to clean water. This is an interesting and informative read.

Published 12th June 2025

I would like to thank #NetGalley #PenguinGeneralUK and the author #DeviSridhar for my ARC of #HowNotToDieTooSoon in exchange for an honest review.

[Emma Haines · Rating 4 out of 5]

i listened to a podcast of an interview with Professor Devi Sridhar so i was influenced to read her book. very cool she teaches at Edinburgh uni. lots of great statistics and anecdotes from around the world on success stories and disasters about public health. there is hope in this book and a rallying cry. she made a crucial point in the epilogue about how we don't actually need any more research, we know what we should be doing. unfortunately, it's more about the political will of states.

[Helen · Rating 4 out of 5]

What a fascinating read.
How external factors affect our life expectancy. From access to healthcare, gun control, driving, smoking, clean water and diet.
Taking examples of good and bad practices all over the world.
It's a book that will make you stop and think not just about your own choices but about policies in your home country and others around the world.

[Bookwormbadger · Rating 4 out of 5]

This is a very informative and interesting book about the various health issues facing many countries worldwide, some of which are shared by all, and some of which (gun violence, water-borne diseases and so on) are country-specific. I thought it was a fascinating and thought-provoking read.

[Carolyn]

Anyone know why this is no longer available to buy on any of the book site?

[Colin · Rating 4 out of 5]

Very well researched and informative. Let's hope the Government reads this book.

[Caro Harper · Rating 4 out of 5]

Really good but sometimes a bit repetitive.

[RecycledWords · Rating 4 out of 5]

TW: There is a chapter on suicide which I found somewhat insensitive.

An information-packed overview of some of the major factors which affect populations around the globe's likelihoods of reaching the age of 100.

Whilst there was a lot of information to take in, Sridhar carefully construed the facts in easily digestible language and explained the benefits and risk factors for each set of facts. I came away feeling very well informed on what can be done on an individual level as well as what politicians need to do at a societal level to improve the life expectancy of everyone.

A single star knocked off for some of the facts being presented in incidence counts as opposed to per capita as it doesn't really make the data comparable. I also think the language around suicide could have been more sensitive, the term "committed suicide" perpetuates stigma surrounding suicide and mental health. "Deaths from suicide" or similar seem more appropriate when discussing mental health service failings.

Thanks to NetGalley and the publisher for the ARC. All opinions are my own.