Dame Sally Davies

Presenter0:01

BBC Sounds, Music, Radio, Podcasts.

Presenter0:05

Hello, I'm Lauren Laverne and this is the Desert Island Discs podcast. Every week I ask my guests to choose the eight tracks, book and luxury they'd want to take with them if they were cast away to a desert island. And, for rights reasons, the music is shorter than the original broadcast. I hope you enjoy listening.

Presenter0:43

My castaway this week is Dame Sally Davis. As Chief Medical Officer of England, she is the most senior adviser to the government on medicine and public health. Her day job is not for the faint-hearted. As well as persuading politicians to get behind evidence-based health policy that won't necessarily make them more popular, she's also in charge of responding to challenges as complex and varied as the obesity crisis, antimicrobial resistance, and the UK's response to epidemics like bird flu and Ebola.

Presenter1:14

Throughout her distinguished medical career, she's developed a reputation for speaking her mind and for making things happen. As a hematologist, she pioneered improvements in care for sickle cell disease patients. Later, she set up the National Institute for Health Research, reorganising the way medical research was funded in the NHS. She puts her approach down to her upbringing. To her parents, a theologian and a scientist, progress and ethical considerations were equally important. She says, My ambitions are all about making a difference. I'm more interested in influence than power. I want it all to work. Dame Sally Davis, welcome to Desert Island Discs. Hello, Lauren.

Dame Sally Davies1:53

Uh

Presenter1:54

So, as Chief Medical Officer, it's your job to use that influence to change our behaviour. What's the key to doing that?

Presenter2:02

Well, there are two ways to change behaviour. One is structural, seat belts, banning smoking in public places, taxes. And the other is nudging. We all in cafes or supermarkets reach for things that are easiest to take. So if the healthy is closest, then you're going to take that. And do you have a preference out of the two approaches? I think, sadly, that we need a combination of both. I would prefer that we did it by nudges, but we do need the structural changes as well. And if you think what we're trying to counteract, which is the commercial people who spend billions and billions on marketing on healthy foods and drinks, we've got to be clever and we will need some structural change.

Presenter2:49

And as independent adviser to the government, how receptive are the politicians to what you're telling them?

Presenter2:55

Well, they're always interested in advice that is evidence-based, but you have to remember that they may not be vote winners. So not only did it take us fifty years to understand the damage that tobacco does, it then took twenty years to move or longer actually to move to the ban on smoking. And most of this sort of thing is a free vote in Parliament because it's about societal needs and societal changes. You're also remarkable for your formidable energy levels.

Presenter3:26

How often do you get to relax and how do you do it? Um so I relax by going out jogging a couple of days a week. I have to say I find jogging extraordinarily boring, but I have to practise what I preach and I do feel better for it and I sleep well.

Presenter3:40

My family joked that I have an on switch and an off switch, so I go on holiday and I'm very good at turning off until the office contact me. And what part does music play in your life? Very important. As a child I wanted to be a violinist, and now we go to lots of operas as a way of winding down.

Presenter4:00

We like concerts, yes, I like music. Well, with that in mind, let's hear your first disc. Why have you chosen this one? So, this is a piece that I played when I was young. I played the viola in the Midland Youth Orchestra, and I particularly love this. It's Vaughan Williams, and the depth and beauty of it is wonderful.

Presenter5:23

Part of Raythaughan Williams' Fantasia on a Theme by Thomas Talis, performed by the BBC Symphony Orchestra, conducted by Sir Andrew Davis. Sally Davis, you remember playing that piece as a child? Apart from music, what did you enjoy doing? I didn't really enjoy school that much. I wasn't very good. I failed the 11 plus and was kind of middle of the class at GCSEs. But on a Saturday afternoon, I played in the Midland Youth Orchestra and I had violin lessons and I had chamber music lessons. Then on a Sunday afternoon I went sailing and my mother had a little sailing dinghy and my older sister crewed for her and I crewed in my father's little sailing dinghy and we would do one or two sailing races every Sunday afternoon, even when it was snowing or raining. I can remember singing Nobody Knows How Cold My Toes Are With It Snowing, singing it across this reservoir. Tell me a little bit more about your parents, your mother, Mary. What was she like? So she was a very strong character. She came from Bradford. Both my parents were first-generation universities. She went to Cambridge and studied natural sciences, essentially mechanical engineering, before they gave degrees to women. So she went back in the late 90s and there were, I think, about seven busloads of old bats who got their degrees given to them then. That must have been an incredible moment for her. It was. My husband Willem, who works in Cambridge, went and supported her and said that she was very emotional. Your father Gordon was a theologian, though not a frequent church goer, apparently. Why not? Well, when we were young, I think he went a certain amount, and we would always go on Christmas Day and Easter Day, but even that petered out. I mean, his view was you could believe, but you didn't have to attend church, and he wasn't going to go and listen to a lousy sermon when he could go and read a book that would be much better, either theological or a good crime novel. He didn't mind, but you know, don't go and listen to some rubbish.

Presenter7:21

You've also described your childhood as an odd one. Why odd?

Presenter7:26

Well, I don't know that I know any other children who never had a sleepover and only went to one boy-girl party while they were at school. So that was odd. We kept ourselves to ourselves quite a bit. But on the other hand, we had the most amazing holidays. We would go off for about six weeks, a week travelling somewhere, a month in a rented villa or flat that was quite cheap, and then a week coming home via our French family. And what were the discussions around the dinner table like? Would theology come up? Well, I remember within the family lots of discussions about ethics, you know.

Presenter8:04

The discussion, which no one can win, it was always because this was post-war. If one of the resistants had done something awful to the Germans and the Germans said, Give that person up or we'll kill you all, what should you do? And we never got to an answer, but we would debate these things quite furiously. And I still remember aged about six asking at some foreign bishop why he was so sure God existed, and him looking a bit aghast.

Presenter8:32

And I suppose, you know, that's about telling truth to power. I have found that compared to many I am fearless. I will say what I think needs to be said.

Presenter8:42

It's time to go to the music. This is your second disc, Dame Sally Davis. Why have you chosen it?

Presenter8:47

Ah well, I loved Bach and the Brandenberg concertos, and the Swingle singers came along, and I still love a cappella music when it's men's voices singing.

Presenter8:57

Baba dum dumma dum baba dum da badum.

Speaker 38:59

I'm a n-

Dame Sally Davies9:11

Da da da da da da da da da da da da dum bum bum.

Dame Sally Davies9:15

Ba-ba-dum-ba-da-da.

Dame Sally Davies9:18

Dumba dumba dumb dumb dumba dumba dumb double dumba dumba.

Presenter9:20

Yeah.

Dame Sally Davies9:21

Um

Speaker 39:25

Uh

Presenter9:25

Uh Yeah.

Speaker 39:26

Uh

Dame Sally Davies9:33

Uh

Speaker 39:33

Uh

Dame Sally Davies9:34

Uh Uh Uh

Dame Sally Davies9:36

Well I don't know what What a bad Uh

Speaker 39:38

What a

Speaker 39:38

Um paper um paper dump paper

Speaker 39:41

The button bag

Speaker 39:47

Oh no.

Presenter9:56

Part of the first movement of Bach's Brandenburg Concerto No. three performed by the Swingle Singers. Dame Sally Davis, after school you set off to Manchester to study medicine. Why did you choose that subject?

Presenter10:09

Well, I wasn't very good at much at school, but I was best at the sciences and fairly general, and I liked people, so

Presenter10:19

It was mother who said, oh, you better go and do medicine then, because in our family, and both parents and academics, it wasn't, will you go to university? It was, you will. What are you going to do and which one? And I clearly was told I wasn't going to get into Oxford, Cambridge or London, so off I went to Manchester. Your imagination had been captured by Jim Watson's book, The Double Helix. What do you remember about it? I think mother gave it to me when I was about 15, and I remember reading it, and it is the most beautiful design, our DNA, the double helix, and the book is great. Trying to work through what is the basis of life. And you go from the body to an organ to a cell to the nucleus, and then you find this stringy stuff inside, and it's made up of genes. And then you find they did X-ray crystallography, they built models, and they discovered this beautiful ladder that winds round itself. So I went off to my medical school interviews, and they'd say, Why do you want to do medicine? And I'd say, because the double helix is so beautiful, and DNA is so fascinating. I want to learn more. And in fact, I still do a lot working on DNA and genomics. So off you went to Manchester. How did you fit in on campus once you got there? I was quite active politically and I was a great organiser. Our family are great organisers, I think.

Presenter11:42

I sailed. I tried the university orchestra, but they were a bit snotty, so I gave that up.

Presenter11:47

And I demonstrated and against Vietnam and things like that. But I was clearly a bit noisy, sleeping in at one point about something, I don't remember what, but eventually I was called in by the executive dean of the medical school who said, You've been a bit noisy, so we've been wondering about developing an elective period for students, so we're going to try it out on you. I've got you a scholarship, you're going to Sweden for three months to do surgery, then we can have a bit of peace. So clearly I made more noise than I realised, and off I went to Sweden for three months. Letty, your next disc. It's your third. Why have you chosen this? So there was a Saturday night bop in the student union, and occasionally my friends would get me to go. I wasn't greatly into pop. We had all sorts of people, Stevie Wander, The Cream, The Rolling Stones, and I remember the Who. So this one is won't get fooled again, which could apply to then or now.

Speaker 312:46

Add to the new constitution. Take a fight for the new revolution.

Speaker 412:53

Put the team all around.

Speaker 312:55

Uh

Speaker 412:55

Pick up my guitar and play Uh

Speaker 312:59

Just like yesterday.

Speaker 313:02

Then I'll get on my knees and pray.

Presenter13:10

We don't get fooled again

Presenter13:13

The Who and We Get Healed Again. So Dame Sally Davis, let's go back to your early jobs. You started out in medicine as a house officer, a junior doctor, as we would say today. How would you describe your experience of those early years on the job?

Presenter13:29

It was very tough. I did two years in Manchester. They were incredibly long hours.

Presenter13:35

On the other hand, I think the hours now that young doctors do are equally hard because they're more intensive when they're there and they're pretty antisocial. We were well looked after by the team structure, but I found it quite brutalising because

Presenter13:51

Well, I mean for instance sitting all night with a young woman in her early twenties whose kidneys had packed up and it w we didn't have enough dialysis machines, so she drowned in the fluid in her own lungs. And I found all of this I was clearly quite sensitive really difficult to take.

Presenter14:13

You're top of the tree as chief medical officer today. What are your views on the training and support for junior doctors now?

Presenter14:21

I'm not happy about it now. I often, when I'm talking to young doctors, ask them how many of them have consultants who know their names?

Presenter14:31

and rarely does anyone put a hand up. Because of the shift system, we've made it so we've got young doctors working very heavy hours, and the pastoral support and the physical support has been taken out. So there may be well

Presenter14:49

trained, but the pastoral bit is generally in England, not as I would want it. What needs to be done to restore that sense of pastoral care, do you think?

Presenter15:00

I think we're going to have to go back to a firm structure.

Presenter15:03

And we need to help our consultants find the time to be able to do it. I mean, a silly example, but I set off for an interview and I'd just learned how to drive. And I got this little Triumph Spitfire sports car, and I set off, and I braked too hard, and I did a 360-degree skid in front of the ward. And my consultant saw me, and he came out, and I was sat there feeling a bit shaken, and he said, Were you going to that interview? I said, Yes. He said, Okay, you'll go tomorrow. I'll ring them up. He came and got me out of the car, gave me a cup of tea, rang them, and I had the interview and got the job the next day.

Presenter15:42

That doesn't happen anymore. I know we are putting so many through, you can't do it like that, but we have to find more humanity for our staff. If we want our doctors to have humanity with patients, we have to show it from the NHS, the hospitals, and general practice to them. Let's have some more music. Why have you chosen this one? Killer Queen. This actually goes back to my time in Spain. I stopped medicine after the first two years and I married a diplomat and went to live in Spain for four years. And I was kept sane by the Englishman who taught me Spanish, who was gay, and he and his partner adored Queen. So they were always, as I was trying to learn Spanish, blasting me with Queen.

Dame Sally Davies16:28

Complications She never kept the same address in conversation She spoke just like a baronet

Presenter16:34

Little man trying all time to get your button I then again incidentally me that way

Presenter16:46

Slash of the cut she couldn't get Spastic and precise She's a killer Cream.

Dame Sally Davies16:52

Uh

Dame Sally Davies16:53

Got by the teeth

Speaker 316:55

Got a bite with a

Dame Sally Davies16:56

Laser Paradise of all your mind

Presenter17:02

Queen and Reina Assesina, as it would be called in Spain. So, Dame Sally Davis, that track takes you back to Madrid. And as you said, you were a diplomat's wife. How did you take to that? I wasn't good.

Presenter17:16

I'm not good as an appendage. I'm me. I had to entertain and go to parties, you know. But I did learn how to ski, how to cook, how to speak Spanish, and I enjoyed the culture, the architecture. I travelled all over Spain. And looking back, of course, I learned about diplomacy and the civil service, which has paid off a multitude of times. I mean, it's been central to my success as CMO.

Presenter17:48

You returned to the UK then and to medicine, specialising in pediatrics, then hematology. Your first marriage ended in 1982. Later that year, you remarried, but in extremely sad circumstances. What happened? Well, Philip had leukemia. I still remember walking across a square, a windy square, I don't know where it was, and his consultant saying to me, Sally, I presume you were going to get married. You better do it quickly. And it all happened rather quickly, and it it was sad. He was lovely. You as a hematologist must have had an extensive understanding of his condition. How did you cope?

Presenter18:29

Um, by just getting on with it. You either collapse or you get on with it, and work is a wonderful place to get on with it.

Presenter18:37

What was very interesting was how bad society is about death. We don't talk about it. I went back to work and people kept me on an island of silence.

Presenter18:48

But it made me a better doctor. I saw what it was like to be on what I call the wrong side of medicine. I mean, I still remember when it was decided to stop his chemotherapy, he was still in hospital, we took him home to die.

Presenter19:01

But he said most people stopped going into his room. He was in a separate room to protect him from infection because they didn't know what to say, they couldn't cope, and the ones that went in and chatted to him stood out.

Presenter19:16

Did it change your approach to work? I mean, your focus on antimicrobial resistance is a notable feature of your career in recent years? Well, he did have infections. The interest in antimicrobial resistance actually came later when as chief medical officer I realized that it had got worse and worse and that the people who were expert at it, even though they raised the issue, weren't able to get attention on it. And I thought...

Presenter19:45

If we've got this many people dying twenty five thousand a year across Europe die of drug resistant infections then surely we have to give voice to this and do something about it.

Presenter19:56

And you would like the problem brought out into the open in death certificates, for example? I very much want it on death certificates. I want us to be able to count the patients. And we need to get everyone working together, preventing infections, that's cleanliness, vaccines, but actually looking after the antibiotics we've got, better diagnostics and new antibiotics, and that's proving really difficult. Let's have some more music. It's your fifth disc, Sally. Why have you chosen it?

Presenter20:24

Ah, the trumpets shall sound from Handel the Messiah. So my mother used to sing songs from the Messiah to us when we were small. And then when our children were young, we took them year after year to St John's Smith Square to hear the Messiah live, led and conducted by Stephen Leighton. So I wanted to use that version.

Dame Sally Davies20:46

The trumpet shall sound And the dead shall erase.

Dame Sally Davies20:57

And the entire

Dame Sally Davies21:07

The trumpet shall sound And the head shall be arrested Be arrays before our tune

Dame Sally Davies21:21

The Ada's incorporable.

Dame Sally Davies21:26

But we shall

Presenter21:36

Change, and we shall be changed.

Presenter21:50

Part of The Trumpet Shall Sound from Handel's Messiah, sung by Andrew Foster Williams, performed by The Britain Symphonia, conducted by Stephen Layton. Dame Sally Davis, you've been married to Willem for thirty years now and have two daughters. You had them late at 43 and 47. How did you manage to balance parenthood and your already demanding professional life? Well, it's hard work. And I suppose the difficulty is that you have less energy as you get older. But we had a wonderful nanny, Jane, and that made all the difference. And that gave me some freedoms. And my husband was terrifically supportive. We shared things. So those were the changes you made at home. Did you have to make any changes at work?

Presenter22:34

Well, for a period of time I only worked full-time instead of every hour God gives. A lot of women.

Presenter22:41

give up and I think it's such a pity because then they find it difficult to come back. I can still remember going in on maternity leave and having to breastfeed while I was chairing a meeting with a voluminous shirt, so I was very discreet, but I can now tell you that adrenaline goes out in the breastmilk too, because whenever I was angry or irritated, the baby would scream.

Presenter23:04

What reception did you get? Taking a baby to work. Yeah. Breastfeeding during meetings. I mean, even now there would be people who would respond to that and be shocked. Well, it w I did it very discreetly. I never bothered to look what their reception was. That was me. I was doing it. They were lucky to have me on my maternity leave, was my view.

Dame Sally Davies23:07

Breastfeeding

Presenter23:22

Um and everyone's quite used to me. Uh they they know I will say the truth as I see it. Has it ever got you in trouble? Oh, well, I expect so, but I'm very good at forgetting nasty events. You are smiling, though.

Presenter23:38

It's time for your next track, your sixth today. Why have you chosen this one? So, this one's Mozart and it's Don Giovanni, and it's a seduction song. I'm not sure that's perfect in a Me Too period, but it is just so very beautiful. And I still remember it from the Lozy film in the late 70s, where it starts in the glass blowing in Venice and then goes on to the Palladio Villa, the Rotunda. And in fact, Willem and I went to Venice for a long weekend earlier this year and went back to glass blowers and round some of these places. So, happy memories all round.

Dame Sally Davies24:19

Yeah.

Speaker 424:19

Uh

Dame Sally Davies24:24

Reaching a song

Speaker 324:29

Abu Lord be uncomfortable.

Dame Sally Davies24:50

The open was all rest, then I'm so beautiful, then I'm so beautiful, then I'm so beautiful.

Dame Sally Davies25:04

Journey, you're gonna be a little bit more.

Dame Sally Davies25:08

Oh cheetah and love.

Presenter25:18

From the soundtrack to the 1979 Losie film of Mozart's Don Giovanni, that was L'A chi d'Aram Lamano, sung by Ruggiero Riamondi and Teresa Berganza, performed by the Orchestra of the Paris Opera, conducted by Lauren Marzell. Sally Davies, I want to ask about one of the biggest issues out there in terms of health policy at the moment, and one that you've campaigned on, obesity. In your 2015 report, you said that obesity proved such a threat to women that it should be on a national risk register along with terrorist attacks and natural disasters. I mean, that is a quite shocking statement. Is it exaggeration? No. If you look at the fact that I can no longer say people are not a normal weight or too many aren't, I have to talk about healthy weight because so many are overweight and obese. And then you think about what that causes. At the moment, we have a wonderful campaign from Cancer Research UK. Obesity causes cancer, just like smoking. It causes heart disease, diabetes, so much suffering for the families. We have to look at how we can help people not get obese. I mean, the campaign that you mentioned, the cancer research adverts, depicted a cigarette packet with the strapline, obesity is a cause of cancer too, and they have been heavily criticised for playing into a blame culture around obesity. What's your response to that?

Presenter26:46

Well

Presenter26:47

It does all come off the plate, but we know that 90% of people will have a gene which gives them a risk factor.

Presenter26:55

But it goes back to the environment issue.

Presenter26:58

We need to have an environment where it's easy to take the healthy option. And that does mean not displaying chocolates and sweets at the checkout. But in terms of a healthy environment, it's also about what you have access to, isn't it? I mean, you know, especially when you're looking at issues around poverty. You know, it's cheaper to eat food that isn't very good for us. That worries me immensely. The poorer you are, the higher the density of fast food outlets which don't have healthy food. We have to make sure that poor people can afford a healthy grocery basket. And that means low in fat, low in calories, low in salt. And that is not easy at the moment. And what about when it comes to the conversation? You know, if you're having a conversation about smoking, smoking is something that you do. Obesity isn't something that you do. You know, you are described as being obese. How do we remove the stigma and the shame from that conversation? So we're going to have to do quite a lot of work with marketing people to find the best way. But I do think we have to be honest about it and not pretend people aren't overweight or obese. But you know what makes this happen is on average women eat one or two biscuits too much each day. So we need people to think about the little less every day so that they're stable and the little less than that every day to steadily drop it. And do you feel sympathy for people who are seeing, for example, the cancer research adverts and feeling hurt and upset by them?

Presenter28:30

I do, but we also need to understand that it has a big impact on their health and on their mental health. So we need much better weight management services for people, easier to access in the community, which are not shaming, which say, how do we help you do what you want to do? And what's your evidence around how people are reacting to these messages? You know, are they taking this advice on board? I think it's very difficult for people for the reasons you've said. But, you know, children go into primary school and about 6% are overweight. When they come out, about 13% are overweight. It doubles. So we have to do something about it.

Presenter29:14

It's time to go to the music. This is your seventh disc. Tell me about this one. So, we're going for ABBA. And of course, I love the Mamma Mia movies. The first time I got my husband to go with Five Women, I think it was. The second time, he and I crept off on our own one Saturday afternoon. But I also remember the ABBA music from my student days. And this particular one I like because it was composed and given to UNICEF for the Year of the Child in 1979. Fast forward to my global health interests and UNICEF.

Presenter29:49

Chicken teeth on you and I know

Presenter29:54

All the hornets come and they go and the stocks they're leaving

Presenter30:00

You'll be dancing once again at the play

Presenter30:05

Till then, you will have no time to breathe.

Presenter30:12

She can keep dying Uh

Speaker 330:18

But the sun is peeling the sky and shining above you

Presenter30:24

Abba and Chiki Tita. Sally Davis, we've been talking about your plain speaking nature, the obligation that you have to deliver evidence-based messages that might prove unpopular. And the combination of those two things has led to some instances in the press of you being criticised, in one case described as nanny-in-chief by certain columnists. How do you react to that? I don't like it. I think there are two issues. One, it's suggesting that I'm wagging my finger when in fact I'm giving advice and people don't have to take it.

Presenter31:00

And the second thing is I think it's very sexist. The first woman as CMO gets accused that she's nanny in chief. Well, what are they going to say to the man? I bet they don't say that. And then, of course, there's a bit that that's assuming nannies are bad, when many of the complainants may well have had nannies and they will have revered them and benefited from them, I imagine.

Presenter31:28

On a more positive note, you've already had a hugely successful career and are embarking on a new challenge as the first female master of Trinity College, Cambridge. What are your ambitions for your tenure? I'm terribly excited that they've elected me and the Queen is going to appoint me on october eighth.

Presenter31:47

I think that they are a great set of students, wonderful fellows, lots of Nobel Prizes and brains. What more can one do? Well, it'll be evolution, but we do need to think about diversity.

Presenter32:00

Diversity in bringing in, as my parents were brought in, from places where there haven't been university students or they're poor, diversity in race and diversity of all sorts. And clearly these days one has to look much more to the wellness and the mental health of the students and the staff. So there's all of that while maintaining its excellence. And it has wonderful music.

Presenter32:26

Time for your final disc. What are we going to hear last and why have you chosen it? So we're going to hear Owain Park's The Wings of the Wind. He is a former organ scholar at Trinity, and he's been asked to compose the Te Deum for my installation as Master. And so I'm thrilled that we can use this one. And it's conducted by Stephen Leighton, who is the Senior Music Fellow.

Presenter32:53

Oh no, it's a bumming.

Dame Sally Davies32:55

You can fly

Speaker 333:19

Fire.

Speaker 333:22

Yeah.

Dame Sally Davies33:27

Okay.

Speaker 333:28

Even about seaweed of water

Dame Sally Davies33:29

How about seeing me talk?

Dame Sally Davies33:32

The faith comes to come and

Dame Sally Davies33:38

Human

Speaker 333:39

Yeah.

Dame Sally Davies33:40

Uh Yeah.

Speaker 333:40

Yeah.

Dame Sally Davies33:41

Uh

Speaker 333:41

What's from the end of the world?

Speaker 333:43

Yeah.

Presenter33:51

Owen Parkes, The Wings of the Wind, performed by the Choir of Trinity College, Cambridge, conducted by Stephen Leighton. Dame Sally Davis, I'm about to cast you away into the picturesque solitude of your desert island. I'll give you two books, The Bible and the Complete Works of Shakespeare. You can also choose a book of your own to take with you. What would you like? I would like to take The Art and Science of the Kitchen by Harold Magee. I'm really into food. And I like science, and it tells you why the protein of egg white solidifies at a certain temperature. You understand what's going on. So I think that'll be rather interesting. What about a luxury item to help while away the hours more comfortably? Well, you won't be surprised. I know that I'm going to get infections while I'm there. I'll cut my feet on seashells or something. So I'd like an antibiotic to which resistance never develops. Now, Sally, you know what I'm going to say to that. It doesn't get more practical than infection-resistant antibiotics. But it's become a luxury for the world. We need that. So you want something I hadn't thought of anything. Come on else. I'd like to demand that you coddle yourself in luxury, something purely for pleasure. Oh, I'd like something for a really beautiful bath in the sea, some wonderful smelling bubble bath. Now we're talking. That I can do. An inexhaustible supply is yours. And if you could only save one track from the eight that you've shared with us today, what would it be? I'm going to go for the Messiah, so I'll have the trumpet shall sound.

Dame Sally Davies34:57

Come on, oh.

Presenter35:22

Dame Sally Davis, thank you so much for sharing your desert island discs with us. Thank you.

Presenter35:37

I hope Sally will forgive me denying her her antibiotics on the island and that she enjoys luxuriating in her fragrant bubble bath instead. Desert Island Disc's back catalogue includes many scientists and doctors. Someone else for whom public health was their focus is epidemiologist Professor Sir Michael Marmot. In 2014, he spoke to Kirsty Young about the health gradient theory.

Speaker 436:02

At the time I started working on this study of British civil servants, the first Whitehall study,

Speaker 436:08

Everybody knew that stress caused heart attacks, and everybody knew that the people who were stressed were people who had highly responsible jobs, were managers, people at the top.

Speaker 436:20

What I showed in the Whitehall study is that was completely wrong.

Speaker 436:24

The lower people were in the hierarchy, the higher the mortality from heart disease, and a whole range of other diseases. People said, well, civil servants, they wouldn't know what it was like to be stressed. But what we found in civil servants turned out to be true everywhere else we looked. The lower people were in the hierarchy, the higher their rate of heart disease, and a range of other diseases. And that led me to say, whoever put out the rumour that it was more stressful to be at the top? That was presumably put across by people at the top.

Dame Sally Davies36:58

What about the possibility then that those who, as they were higher up in the stratas of management and so on in the civil service, presumably were on a higher income and were better educated and therefore were more likely to simply look after themselves better, you know, to smoke fewer cigarettes, to eat better food, to consume less booze and so on and so on?

Speaker 437:19

Well, the booze actually goes the other way. People consume more booze the higher up they are, and that's been a general finding in Britain. And forgive me, that's even more true of women than it is true of men.

Dame Sally Davies37:32

I don't know why you're looking at me the highest

Speaker 437:35

Higher the status, the more likely people are to drink. But the other things you say are correct. But what we found in people who were not smokers, who were not having a terrible diet, who were not obese, we still found the social gradient. So that was not the whole explanation. Now, people are not randomly allocated to positions in the hierarchy, so education is clearly important. And my later work has put great emphasis on early child development and education. But nevertheless, what we showed, actually studying it in the second Whitehall study, is that stressful circumstances at work are combination of low control

Dame Sally Davies37:37

Yeah.

Speaker 438:14

High demand.

Speaker 438:16

and low support at work.

Speaker 438:19

increased risk of heart disease and mental illness.

Dame Sally Davies38:21

The difficulty there is that somebody always has to be in charge and there always has to be a structure. Now we can think of probably off the top of our heads, you know, working environments, some of us will have experienced them, where there's this sort of gloss of participation. We're listening to you, of course, your view is as important as the managing director's view. But actually in the end, somebody's got to run the business and somebody's got to be underneath them doing the stressful work. How on earth do we reconfigure workplaces to make them

Presenter38:40

In the end.

Dame Sally Davies38:48

less stressful and still productive.

Speaker 438:51

What the evidence shows is that all workplaces are hierarchical, but the link between where you are in the hierarchy and

Speaker 439:00

this stress of high demand, low control or imbalance between effort and reward, that link can be broken. You can actually run a workplace that says the beating won't stop until morale improves.

Speaker 439:17

Or you can run a workplace that puts real emphasis on morale and involvement. And I would say that the evidence suggests a happier workforce is a more productive and a healthier workforce.

Presenter39:30

Professor Sir Michael Marmot speaking to Kirstie. You can hear this programme on BBC Sounds and on the Desert Island Disc's website. Next week, my guest is Bookshop founder Sir Tim Waterstone. I do hope you'll join us.

Speaker 340:00

Hello, I'm John Ronson, the author of So You've Been Publicly Shamed. This is my journey into the lives of the shamed, people ruined by a badly worded tweet or work faux pas.

Speaker 340:15

Along the way I turned from being a keen shamer myself into somebody unsettled by this new zeal to judge and condemn, often on very weak evidence.

Speaker 340:26

That's So You've Been Publicly Shamed, read by me, John Ronson, and abridged specially for BBC Sounds.