The Miracle Pill

by Peter Walker

  There it is: the phrase so disliked by Peska – the fear of a government being seen as too interfering in telling individuals how to protect their welfare. And yet, when I speak to Hunt, his own party is weeks away from openly ordering an entire nation what to do to avert a health crisis. You could argue that coronavirus is different in that the threat can be transmitted, so it is a matter of communal rather than individual responsibility. However, as we’ve seen across this book, personal choice also tends to be a moot concept when it comes to physical activity. Being unable to cycle to work because of speeding motor traffic is not the same as absorbing viral droplets from another passenger coughing on a packed train. But both are firmly outside the individual’s control.

  To get another perspective, I talk to Sarah Wollaston, a family doctor who became a Conservative MP, before then defecting to the Liberal Democrats. Now out of parliament, when we speak she has just finalised re-joining the medical register to help with coronavirus efforts. As an MP Wollaston chaired the health committee now led by Hunt, which under her leadership produced a report into the inactivity crisis, which called for considerably more official action on the issue.

  Wollaston’s opinion is that none of the health ministers she tackled on the issue, Hunt included, seemed to really get it. ‘It’s just lip service,’ she tells me. ‘They say they take it seriously. But it’s one thing to say, “Yes, yes, we know all this is terribly important,” but it’s another thing to put in place the policy that makes it a reality. It doesn’t just happen by telling people to go out and exercise more. Promotion is all very well, but as with any public health programme, it’s people who are already active and well informed who pick up on the advice, and you just end up with widening health inequalities.’

  This is particularly the case, she says, over walking and cycling: ‘The power is all in the car lobby. It’s not with the cycling lobby. Until we shift that and you have ministers prepared to be bold and to ring-fence a sufficient amount of the transport budget to active travel, it’s never going to happen.’5

  For a final point of view I seek out someone who has dealt with the subject in two ways. Andy Burnham was, like Hunt, the Health Secretary, holding the role in the Labour government of Gordon Brown. He is now mayor of Greater Manchester, where he employs Chris Boardman to transform the city for cyclists and walkers, as we saw in Chapter 5. Burnham has a perhaps more Finnish opinion on the nanny state. ‘You know the quote about the nanny state, don’t you?’ he tells me mischievously. ‘People who complain about the nanny state are usually people who had nannies when they were children.’

  Burnham argues that one of the difficulties in central government pushing cohesively for more physical activity is that it is, as he puts it, ‘an orphan policy’, which falls between the remits of several departments. ‘It’s not quite the Department for Culture, Media and Sport, because they’re more sport,’ he explains. ‘With Communities and Local Government, it’s not really top of their list. And with Health, they think of hospitals before they think of parks and active living. So it kind of falls between the cracks, and therefore it’s never been properly championed from a national perspective. And yet, it is the answer to so many things, and not just health.’

  Could this change with coronavirus? Burnham believes it might, not least because of the need to transform the way people move around cities, with continued social distancing meaning a drastic reduction in public transport capacity. A couple of days before speaking to me, Burnham had been on a conference call with Johnson and the mayors of other English cities, including London, to discuss ways to prevent gridlock if many thousands of extra people try to drive to work. Burnham recounts what the prime minister told them: ‘We were given what sounded like very active instructions to prioritise cycling and walking infrastructure.’6

  This opens up the possibility of a tipping point for activity, not just in the UK but in numerous other places. It could arguably be seen as an accidental victory, almost a by-product, given that the main impetus in reshaping urban transport priorities would be to avoid crowds on trains and buses, and then in turn to prevent roads seizing up from a rush to car travel. To an extent, this is immaterial: just as your body doesn’t care whether its activity comes through formal exercise or routine exertion, the health benefits from more people using new bike lanes or widened pavements are exactly the same, no matter why they were constructed.

  That said, there are other public health issues at play, and signs that some in government are aware of them. As mentioned earlier, a series of initial studies have noted the way coronavirus appears particularly deadly not just in older people but in those who are obese or have conditions such as high blood pressure, type 2 diabetes and cardiovascular disease, all of which are closely linked to inactivity. But one research paper from a US professor of exercise science, David Nieman, so recent that it was published only six days before I type these words, makes a more explicit link between the two areas. Coronavirus, Nieman argues, is ‘a wake-up call’ over the globe’s increasingly poor long-term health. All similar viruses, he notes, have notably higher mortality rates in people who are physically inactive, meaning the promotion of movement should be among the ‘primary prevention strategies against respiratory illnesses’.7 Has this message resonated? It’s hard to tell, and, at least in the UK, you could imagine some politicians viewing it as a move into nanny state territory. But certainly some people I have talked to inside Downing Street appear to understand the point.

  The other side of the equation is whether people, having been through the coronavirus restrictions, will become more accepting of subsequent interventionist government policies, particularly if they might improve outcomes in future outbreaks. Burnham, for one, thinks this is possible: ‘There is such an opportunity here, and I did sort of hear in Boris Johnson’s voice that he might get that. Time will tell. But it’s an opportunity I don’t think we’ll ever get again in quite this form. There is a public appetite to not go back to business as usual – people want this to be a moment of positive change, in many ways.’

  Burnham says he has been thinking about the political transformation after voters removed Winston Churchill from office in 1945, despite him leading the nation through the war, with the Labour government bequeathing the UK its National Health Service and social security system. ‘I feel like I understand that a bit more now, with coronavirus,’ Burnham explains. ‘You look at the world through a new lens when you have a moment like this. I think the public do have a more public-spirited sentiment.’

  The double narrative

  The parallel with the post-war period is one several people are making. A few days after talking to Burnham I speak to a former colleague of his, Ed Miliband, not officially in connection with this book, but for my day job. Miliband, the ex-Labour leader, is now responsible for industrial policy with the party, and is explaining his hopes that economic recovery efforts after the coronavirus lockdown will be centred on green issues, which would include more active travel.

  ‘It’s a contemporary equivalent of what happened after 1945,’ Miliband tells me. ‘It’s never too early to start thinking about the future, to think about what kind of world we want to build as we emerge from this crisis. I do think that there’s a public mood about this. I think we owe it to have a sort of reassessment of what really matters in our society, and how do we build something better for the future.’8

  On the same day I speak to Miliband, in fact at more or less the same time, a spokesman for Boris Johnson tells journalists, including one of my colleagues, that the prime minister is devising plans for a new approach to the nation’s health in the wake of his own near-fatal encounter with coronavirus. He is, we are told, extremely serious about this.9 No more than an hour after that, some other news emerges: my own city, London, is to close off large sections of the centre to all vehicles apart from buses, bicycles and pedestrians, at a stroke creating one of the biggest traffic-free areas in the world.10 It’s the kind of pla
n that even a few months earlier would have seemed an impossible dream, something that would need years of consultation. Now, the work is scheduled to be completed within six weeks.

  This is suddenly moving from the unlikely into the downright strange. There are two narratives unfolding with this book. The first is the one I have outlined over the preceding chapters: a centuries-old story about the gradual eradication of everyday physical movement from so many lives, and a reluctance on the part of ministers and officials to engage properly with the repercussions. In parallel, and as I write those same chapters, the discourse on public health in the outside world is changing at an unprecedented pace. It is no longer just that governments are taking concerted action on the different public health crisis of coronavirus. Many of them are now responding to the challenge by introducing some of the most radical measures ever seen which could reintroduce large-scale physical activity.

  It is thus the fate of this book to end on something of a cliff-hanger, one where the reader will have the inevitable benefit of several more months of knowledge. It’s impossible to tell where all this will go. It is entirely feasible that emergency cycle lanes and expanded pavements in Paris, Milan, New York, London, Manchester, Liverpool and countless other cities stay in place, bringing with them an upsurge in the number of people walking or cycling their way to the thirty minutes a day of health-enhancing activity, and beyond. Urban populations used to cleaner air could decide they don’t want cars clogging their neighbourhoods again. The reborn, post-coronavirus economy and society could prompt a permanent, even if semi-accidental, shift towards more movement.

  But it could all turn out very differently. In the coming weeks and months it might become clear that as people return to work but are banished from public transport, many decide they only feel safe driving. Spooked by gridlock, cities could instead remove bike lanes, make parking cheaper, express hopeful platitudes about an eventual shift towards electric cars as pollution levels soar again.

  Right now, the former seems more likely, but the history of efforts to combat inactivity is littered with false dawns, for example the cycling boom that swept the US and several other countries following the 1973 oil price crisis, only to fizzle out. While I joke with friends and colleagues that the pace of change is now so rapid my book could end up being irrelevant before it is even published, the truth is that things are never so easy. As the Dutch and Danes showed, it takes decades to build an environment in which cycling becomes truly everyday and mainstream. And active travel is only one part of the picture. Jan Gehl has spent even longer trying to persuade people to reshape cities so human-scale movement becomes the norm, the obvious thing to do.

  To extend the parallel made by others, like the Second World War, the coronavirus pandemic is so unutterably tragic and awful that it can feel anomalous to try to imagine benefits coming in its wake. But it is nonetheless vital to try to picture what might follow, and to hope it will be something better, something fairer. After decades of governments failing to take action over mass inactivity despite the overwhelming and direct evidence of the health crisis it creates, it would be curious if the eventual catalyst for change was something both different and unforeseen. But, as history has taught us again and again, when a revolution does arrive, it is not necessarily the one you were expecting.

  The joy of tech

  As you will have gathered by now, I’ve spent a long time thinking about physical activity, as well as talking to many people who think about it even more. And so, much as I have stressed several times that this is not a book of advice, it seems fair to use this final chapter to set out what I’ve learned along the way in these months as researcher, writer and occasional experimental subject/guinea pig.

  One personal lesson is that despite an initial scepticism about the use of high-tech gadgets in monitoring and scrutinising activity levels, I in fact found they can be surprisingly useful to help you maintain a movement regime – or at least they can if you find the right device. Phone-based apps have played little part for me, mainly because I seemingly don’t tend to carry my phone around with me enough to make them worthwhile. I downloaded Public Health England’s Active Ten app, which has the excellent premise of trying to get people to record at least ten minutes of brisk walking a day. But, at least in lockdown, the app has recorded so little walking for me it is presumably just a matter of time before it remotely alerts my doctor, or sounds a noisy alarm.

  Much more effective has been the wrist-worn fitness watch, with its built-in step counter and heart rate monitor. From a purely book-research point of view, the heart rate function was enormously useful in helping me work out how much activity I amassed during my usual, non-lockdown cycle commute, and at what intensity, as shown in Chapter 5. Such information, and particularly its ability to track bike rides and runs via GPS, veers significantly into the arena of exercise, and the watch is clearly aimed more at the recreational athlete than someone who just wants to build towards their 150 minutes a week of routine exertion, not least given it costs about £130. But for those, like Tom Watson, who prefer to observe their route to better health progress through charts and tables, this can still be very useful. The watch connects to a dedicated phone app, which over time amasses something of a personal health biography of heart rates, exertion levels and steps. It also tries to urge you into greater efforts by handing out slightly patronising virtual awards, for example a shiny, on-screen badge for reaching 15,000 steps in one day. Significantly more ludicrous was one portentously titled I Am the Night, which was awarded after I did nothing more notable than ride a bike after 10pm.

  Most useful has been the watch’s in-built step counter. As I detailed earlier in the book, as a target, 10,000 steps a day is largely arbitrary, and even clever, wrist-worn fitness devices are not always completely accurate. But they are a good general guide. There have been long days writing this book where I have looked up at 5pm to see I’d walked fewer than 2,000 steps, a very obvious reminder that I needed to do better the next day. The watch, a Garmin Forerunner 45, was lent to me by Wiggle, a UK-based online bike retailer who have an interest in active workplaces. Officially, it is mine to keep, but under UK journalism rules I can’t accept gifts costing more than £50. My plan had been to give the device as a prize for my newspaper’s annual charity auction. However, I might instead make a suitable donation myself and keep it. That’s something of a testament to how habituated I have become to its daily stream of activity information, and how useful I now find this.

  Sadly, the other item of technology I attached to myself for testing purposes was simultaneously the most enlightening and fascinating, but also the one device that people reading this book cannot just go out and buy for themselves. The tiny, thigh-attached plastic fob, weighing little more than a sheet of A4 paper, is very much a research-grade activity tracker, and while Sens, the Danish company who invented it, were able to indulge me with my one-off purchase, they don’t usually take individual orders. In some ways this is a shame. If everyone was able to see a week of colour-coded movement charts showing how inactive they had been and how long they had sat down, it might shock at least a few into action.

  The sensor’s totals for how long I sit down every day, particularly at work, definitely provided the biggest personal wake-up call in writing this book. I was already generally aware I sat down excessively, and often without a break. But to see it translated into a daily total of nine or so hours, and to look at the chart with its long, afternoon sessions of continuous grey, had a real impact. I already sit less than I did, although the real test will happen when lockdown ends and I return to normal office life. I’m not quite at the stage of the inactivity professionals and their active applause, but I definitely get twitchy if I sit down for too long. That’s some sort of progress.

  Two other areas of activity research have been particularly eye-opening. One is the emphasis on strength or muscle training, which is so often neglected amid the focus on the 150 minutes a week of cardio
vascular activity, and which I had certainly not thought much about. The other is reading so many research papers about the importance of at least some form of movement in helping process fats and sugars after a meal – a time when so many of us, me included, tend to slump on a sofa. In a newfound habit that very much strays from the mantra of everyday, integrated activity, but which I excuse as compensation for the long hours writing this book, in recent weeks I have found myself occasionally leaping up from in front of the TV to squat up and down while holding a barbell weight. It’s definitely exercise. It’s not especially elegant. But it is curiously satisfying.

  If I were to try to convey some sort of more general lessons, I suppose the very condensed version would be to seek the more straightforward activity gains in whatever circumstances you face. So, if you have a garden and don’t already tend it, that’s guaranteed exertion. If you live in a flat, or work in an office block, take the stairs if you can. And if your job, like mine, involves sitting down, do whatever you can to get up more often.

  But in terms of pure activity, the most effective way that most people can integrate and maintain more physicality in their lives is to walk around a bit more, or, if possible, use a bike. Walking has the advantage of being hugely straightforward, and flexible. So, for example, if you get a bus to work you can always get off a stop or two early some days. Even if you drive somewhere, seek out a distant corner of the car park, or a stopping point a few streets from your destination, picking up 1,000 or so steps every time. They all count, and they all add up, as do the health dividends.