“Enjoyable, witty, thorough … eye-opening”
“A treasure trove of facts, stories, science and philosophical nuggets”
Professor Alan Maryon-Davis, former Chair of the Royal Society of Public Health
Reframe alcohol with Alcohol for Nerds, a unique collection of reflections from the author of Alcohol Companion, the alcohol user guide. Find out what you know already with a quiz.
Also try Alcohol Companion.
Extract begins (pages 1-34)
Alcohol for Nerds
By Phil Cain
First Edition.
Copyright © 2020 Phil Cain
All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher, except in the case of brief quotations embodied in critical reviews and certain other non-commercial uses permitted by copyright law. Please direct permission requests to Phil Cain
ISBN-13: 978-3-9519886-1-0
ISBN-10: 3951988614
To my fellow nerds.
Contents
In these extracts
Acknowledgements
Introduction
My alcohol awareness journey
The personal story problem
See alcohol’s threat to freedoms
Think clearly to be free
Enhance your alcohol intuition
Go with the flow
Go easy on the amygdala
Full book
Alcohol’s biggest lessons
Our legacy social medium
Dedication versus addiction
Beware “persistent hangovers”
Find new ways to flavour
The usefulness of alcohol-free
“Sober sprints” are helpful
Make a sprint a start
Forging language for change
“Responsible drinking” is folly
The limits of alcohol’s laughs
Alcohol and high achievement
We can avoid the icebergs
Minimal alcohol is a good move
The upsides of improv
Get off the beaten path
Happiness on tap?
Embracing imperfection
Take courage from competence
Alcohol worsens disadvantages
Labels can empower drinkers
A coronavirus ethos for alcohol
Dry Jan a vital part of the debate
Sobriety sizzles
References
Acknowledgements
This book would not have been possible without encouragement, support and advice from many sources.
It would also not be possible without drawing on the work of thousands of researchers, practitioners and the experiences of non-professionals.
And it would also not be possible without the support of the readers of Alcohol Companion and viewers of the philcain.com web site.
I thank you, all. ■
Introduction
What is there to know about alcohol? What is a nerd? Am I a nerd? And why address a book on alcohol to nerds?
If questions like these are running through your mind, then, yes, consider yourself one of the gang. This instinct of asking awkward questions means you are ideally suited to reconfiguring your approach to alcohol.
Doing so would help solve one of the planet’s biggest mental and physical health problems while feeling better, avoiding mistakes, and saving heaps of money.
Science can make life better
Back in the 80s, as I grew up, being called a “nerd” was not something one would savour. It was a byword for social failure attributed to the misfits of the chess squad, bell ringers, the portly, gangly or poorly coordinated and, of course, the wearers of state-issued NHS glasses. I made the grade on a number of counts.
This was a nerd in its classical sense. It was an unkind label attributed to you rather than an identity one would leap to assume oneself. Why would you? In many ways a nerd was the embodiment of reason’s inevitable failure in an unreasoning, animalistic world.
I alas ticked many of the boxes to be a classic nerd, though I was thankfully not self-aware enough to let it bother me. There was, nevertheless, always the lingering feeling that attempts to deploy rational thought were open to mockery.
This background meant I baulked recently when told I was clearly a nerd. But I realised this was simply the knee-jerk reaction of someone who has had their dinner money stolen once too often. The world moved on, even if I did not.
In the internet age the term “nerd” has been reclaimed to mean something rather more positive. And this is how I intend it here. A nerd is someone who is rationally inclined, open, curious, questioning, wary of superficiality and suspicious of over-confidence.
Practically everybody can apply this approach to their lives. Healthier eating, falling smoking and alcohol drinking are partly the result of us being nerdier, informing ourselves and acting accordingly.
This collection of short pieces is my attempt to provide materials which can provide a shortcut to creating your own nerdy approach to alcohol.
These pieces are largely based on the findings of my first book, Alcohol Companion, in which I explored the scientific evidence on alcohol.
It aims to be comprehensive, covering the effects of early exposure, neurological and psychological effects, inebriation, hangover, dependence, withdrawal and recovery. And I also explore key misconceptions around freedom, happiness, bravery and wrongdoing, aiming to keep the positive aspects of drinking culture and ditch the bad.
Inevitably, since alcohol touches most of human activity, this short book left loose ends. One which went into every single aspect of alcohol would be impossible to read, not to mention impossible to write. The goal, instead, was to go deep enough to give a coherent overview.
Concision is important to allow us to see something as a whole, but it also stops us from dwelling on things that should be dwelt on. Here I take this second step.
Understanding the facts when sitting with a book in our hands is only part of the problem alcohol poses. We also need ways to reflect these facts in our behaviour when on the loose in real life.
This challenge is where we need stories and images which will help us create an intuitive grasp of a subject where first impressions are misleading, and the facts often confusing, paradoxical, slippery, uncertain, or a mix of all of them.
Nobody has this subject completely nailed down. It is an ongoing task to keep up with the research and then we need to internalise it. The impossibility of doing this completely should not prevent us from doing it as much as is useful to us.
There is no end to this matter, although significant progress is made. Alcohol faces a formidable rival for it historic role as a networking tool in the form of information technology. Policy, though blocked by vested interests, is slowly moving to reflect alcohol’s negative impacts.
The publication of this collection reflects the fact that my contribution is likely to be levelling-off, as I have now covered some of the bigger issues raised by my take. But nobody knows what the future holds. And I will continue to publish, so please follow me on the internet to stay updated.
There are many limitations to a book or internet stories, and even podcasts. If we are struggling with alcohol problems we should, as nerds or otherwise, harness whatever resources are available to us, talking with our doctors and taking advantage of the services they recommend.
Online communities have also sprung up around the world providing peer-to-peer support and advice. The success of these communities is a quiet triumph of grassroots nerdery over the forces of mindless mass movements.
Younger people are also avoiding alcohol in increasing numbers, leaving older generations with what increasingly look like outdated drinking habits. This is a significant cause for long-term hope the world can see sense, among many examples of the opposite
It is often uncomfortable and awkward, but discomforts to not stop it from being fascinating and rewarding.
I would never aspire to do more than provide a starting point for the exploration of this vast and multifaceted subject.
I wish you luck. ■
My alcohol awareness journey
Until recently my alcohol awareness was no more than a collection of half-remembered news items, fictional accounts, anecdotes and personal experiences. I was, in other words, completely normal.
And what a collection I had amassed? Where alcohol is concerned anything goes, from the disturbing, tragic and gruesome to the romantic, magical and hilarious, with all suggestions between and beyond acceptable.
Alcohol plus people produces surprises. These twists, in turn, spawn stories, which reproduce like saccharomyces cerevisiae, the yeast which excretes alcohol. And so it goes on.
The science-based stories I read left an impression of confusion and uncertainty, meaning nearly anything was still possible, once more freeing the imagination.
Ever the optimist I chose to believe there were so many stories that the chances were good that at least some were useful, just as haystacks are unfairly written off as hiding places for needles.
Craving explanation
This always seemed unsatisfactory. I remember wanting something better even as a child. In what other area of life would I be asked to rely on such a knowledge lottery? Space rockets and computers are not the products of common sense.
My concerns went underground but never went away. If a jumble of alcohol-related hearsay was a reliable guide, alcohol would not play the enormous part it does in mental and physical health problems, and many woes besides.
Deep down I wanted an understanding which looked beyond appearances, something adaptable, verifiable, generalised and explaining at a deeper level, something, in a word, scientific.
As I started to inch closer to my second childhood than my first I decided it was time to try to find it. I wanted to satisfy my own curiosity, but as a journalist, I also hoped it could be something I could find a way to share.
Packing my metaphorical bags, I set off on a metaphorical journey through several hundred scientific papers. I was very lucky in my timing. The science of alcohol had grown up over almost exactly the same time-frame as me.
Messages from a bottle
The most important message from this ongoing walkabout is that our relationship with alcohol can and does change. And we can shape it to our advantage, with alcohol awareness improving our chances of success.
Outlining the detail of this in Alcohol Companion was both more challenging and more rewarding than I expected. Beyond the dizzying complexity of the core subject, it gave me a new perspective on science, and on our need for belief and belonging.
Stories can play an important part in meeting our needs. Alcohol awareness is not as whizzbang as space rocketry but is no less awesome for it. Its potential payoffs far outweigh the alternative, putting it well on course to become the new normal. ■
The personal story problem
As someone writing about alcohol, I am often asked to tell my own story. I find it very difficult to know how to respond.
It is not that I don’t have one. I do. I even wrote it down once. But it is never the right moment to tell it.
Lived experiences make a huge contribution to the discussion around alcohol by giving us the insider-perspectives we need.
The openness of Labour MPs Jonathan Ashcroft, Liam Byrne and Caroline Flint has had an enormous positive impact.
At the same time adding one’s own tale into the mix can, in some circumstances, have significant drawbacks.
Not being the story
Journalists of all kinds typically avoid talking about themselves because it obscures the broader stories they try to tell.
We would hardly tolerate a political journalist book-ending each piece with an update on which way they were leaning.
Like them, I typically cover stories involving many thousands of other people, not just me. I am just a tiny drop in this ocean.
Alcohol is odd too. There is no perfect amount of personal experience of it that makes us more credible when talking about it.
Too much and some will think we are probably shaped by it. Too little and they will wonder if we can possibly know the subject.
Suffice it to say, I hope, I am somewhere in the middle, like most people, neither unaffected nor the most affected.
Researching my book shed new light on my experiences, making me see them afresh, and of myself as part of a vast continuum.
This motivates me to listen to other people, and try to explore the research with imagination, empathy and critical thought.
Striking a balance
Hearing stories and ideas beyond our own experiences is a vital part of assembling the jigsaw puzzle of alcohol understanding.
That said, we can also often have good reason to keep our own experiences to ourselves. And we have every right to.
We all share things in some circumstances and not others, and the same is true here. It is up to us.
It was a decision I agonised over. While I could see some positives, I could also see downsides. Would it add or subtract value?
I concluded that telling my own story comes second to uncovering and telling stories beyond myself.
Journalists are by no means the only ones with circumstances not always wholly suited to telling their own stories.
So, if there is a story I would tell about my own alcohol experience in the hope it helps others, it is this one. ■
See alcohol’s threat to freedoms
It is not surprising people see overcoming their alcohol problems as a great liberation because alcohol can undermine every form of freedom ever conceived.
My list of ways alcohol can do this to every idea of freedom developed over the last 350 years is “impressively comprehensive” says revered intellectual historian Professor Quentin Skinner, adding that the question is “very important”.
I would like to pretend this amounted to some major intellectual achievement, but I cannot. I simply overlaid my working knowledge of alcohol’s effects on to Skinner’s “genealogy of freedom”, an overview of the ideas of freedom in play over the last few centuries.
Choosing freedom
Politicians and commentators often talk with impressive certainty about what freedom is. But, in reality, there is no such certainty to be had. It is all rhetorical bluster, often with selfish ends. Freedom is an elusive idea which nobody can dictate.
What freedom means is a matter of personal preference and discussion. There is no absolute right or wrong answer. We need to weigh up the options and choose the account we think best. Skinner’s genealogy lays out the enormous range of coherent alternatives open to us.
“These are all just vocabularies,” says Skinner, who favours a pragmatist approach to choosing between them. “The question we should be asking ourselves is: Which one is going to go deeply into our society and do the most for us.”
Despite the huge range of coherent, sophisticated accounts, incoherent and potentially harmful accounts still abound. The freedom to tote guns, not wear a face mask in a pandemic or to purchase alcohol unhindered is unlikely to serve us well.
Beware self-serving dogmas
Alcohol sellers, as one might expect, simply champion a version of freedom which suits them, damning anything which impedes sales and implying that alcohol is inherently liberating to boost sales.
It is unwise to take this self-serving account seriously. We need to be able to think clearly to benefit from every form of freedom ever devised, with regulations there to help more of us do so.
Logic goes out of the window in likening lower US guidelines to “stealth prohibition”. It is an absurd exaggeration to suggest medical guidance even amounts to coercion, let alone a bygone legal bar.
Following the same approach, we might portray the posting of a sign saying “mind the step” as first stages in a banning free movement. It uses the rhetorical power of an idea of freedom to protect a commercial interest.
The goal is not a meaningful discussion but a distraction from it. Thankfully there remain many genuine and coherent ideas of freedom to choose from intended to serve human goals rather than commercial targets.
Real accounts of freedom
Over the past three-and-a-half centuries formulations of freedom have fallen into three main types, according to Skinner’s genealogy (see image): not having outside interference; not being answerable to arbitrary power; and in self-fulfilment.
Thinkers and countries shift from one school of thought to another, as did JS Mill to defend women’s rights and so too has the US ever since its foundation. We need not be any more wedded to a single vocabulary. Some ideas of freedom might work better in some areas of life than others.
To figure out which view suits us, it may be useful to look at the consequences for different areas of life, say family, education or health, for instance. And we could also usefully be aware of what threatens them since the price of freedom is eternal vigilance.
My rough shortlist of ways alcohol threatens every formulation of freedom so far invented includes:
- Alcohol dependence can put us under the arbitrary power of alcohol suppliers, so making us unfree in the “republican” tradition.
- In the “no-interference” liberal tradition, our freedom is undermined by coercion in the form social pressure, advertising and withdrawal.
- In the same tradition alcohol also acts on ourselves to arguably induce inauthenticity, impaired judgement or false consciousness.
- In the traditions of self-realisation alcohol inebriation, dependence and withdrawal may undermine our chances of realising our spiritual or political natures.
We do not need to exclude alcohol from our lives or societies to be free. But we would benefit from the awareness that the commercial exploitation of an addictive psychoactive poses a threat to freedoms we may cherish.
Positive alcohol experiences could also be included in the picture. Alcohol’s sedative effect may aid forms of self-realisation, allowing us to see the upside of being less uptight, perhaps finding it also without alcohol.
A debate we need
What adds and detracts from our freedoms is something we have to decide for ourselves. It has been discussed for centuries and the debate has never seemed more important. Science, society, technology, nature and our fellow humans are creating new threats and new opportunities.
New forms of demagoguery, authoritarianism, geopolitical rifts, pandemic, social division, deception, coercion and censorship threaten freedoms we value. We should be as clear as we can be about what these freedoms are and what they are not so we can defend them effectively.
Alcohol offers a warning that we can lose our freedom without realising it, perhaps partly because we seldom stop to think what it is. It also reminds us that, while freedom can be easily lost, it can also be rediscovered. ■
Think clearly to be free
It is worth remembering that it is our capacity for clear thinking which underpins our personal freedom.
Alcohol reduces our ability to make good decisions, while our decision to consume this mind-numbing substance is often made through coercion or misguided expectations.
In many situations we may expect immediate penalties for not drinking, which can seem like a mandatory entry-ticket for full social participation.
And, once across our blood-brain barrier, alcohol influences our decisions in ways we can only be partially aware of while experiencing alcohol-influenced thoughts and feelings.
Inebriation slows our brain activity, so reducing our brain’s role in informing our actions. From the inside, however, things seem to speed up. Our fate is left more to luck.
The gamble can sometimes pay off, sometimes not. About two in every five prisoners says they were drunk when they committed the offence which led to their abrupt loss of freedom.
Learning difficulties
Alcohol also often triggers brain responses which make inebriation seem to have great significance, making us more inclined to repeat it. We cannot be relied on to realise.
Alcohol also increases anxiety, mood and interferes with sleep, while we commonly feel the opposite. So we can easily find ourselves spending undue resources on consuming alcohol.
Heavy drinking can make our brains misfire sober, meaning we feel tense, forgetful and gloomy between sessions. Dementia and mental health problems are far more likely.
The discomfort of sobriety when alcohol dependent makes escape an ever-more attractive option. This is why we might spend our last few pennies on barely-drinkable budget brands.
Freedom is about more than the freedom to buy things. To be free we need an environment in which we are spared from harm, including damage to our mental capacity.
Commercial restrictions and timely and accurate information can help us avoid alcohol harm and in turn reducing our chance of other harmful errors.
Clarity before commerce
Our freedom to shop should not outweigh our freedom to think clearly. We would not champion our freedom to lock ourselves out of our own house, though it is among our freedoms.
A notice reminding us, say, to remember our keys before going out, or warning us of a blind bend are not oppressive. Similarly, alcohol warnings are no infringement of our freedom.
Nor is it oppressive to withhold instruments used almost exclusively for self-harm. Minimum alcohol unit pricing, on trial in Scotland, may be found to do exactly this.
Alcohol drinking can be pleasurable, but it also underlies many mistakes, small and big. Preventing these does not diminish our freedom to be spontaneous or take risks.
Measures to curtail heavy alcohol use can help share freedom’s benefits more widely. They are keys to greater freedom. ■
Enhance your alcohol intuition
Remoulding our intuitions about alcohol can deliver an enriched experience requiring less effort.
Over time we can shape our unconscious thoughts as well as conscious thoughts, allowing us to start to align our intuitive ideas about alcohol with scientifically established facts.
Replacing our existing intuitions about alcohol with more reliable ones can be incredibly rewarding, allowing us to make good decisions quickly with little effort.
The intuitive responses do not necessarily come easily and, in the case of alcohol, as in other areas, can require perseverance, creativity and a wider rethink to cement them in place.
Brain training
We typically only really learn to walk, talk, eat and interact as standard elements of our growing up curriculum. Beyond that what we learning is less uniform.
It is only thanks to years of practice and the efforts of our parents and wider society that most of us can draw, read, write and drive a car with ease. It is all down to training.
In the right circumstances we can acquire intuitive knowledge of obscure things too, like magnetic fields, like fluid mechanics, Russian irregular verbs, mitochondria, plastering or plumbing.
After years of consistent practice we all tend to become effortless performers in something likely to be marvelled at by people who have not had such immersion.
A similar learning process can also enable us to acquire softer skills like socialising, public speaking, or correcting our posture.
Liquid learning
We learn about things we ingest too, like food and drink, medicines and psychoactives, with alcohol the most common and potent.
Most of us learn about alcohol much as we learn about riding a bike, with almost no theory and a lot of painful trial and error.
The fatal flaw is that hearsay and our own perceptions cannot be relied on when trying to form an understanding of a psychoactive.
Drinking alcohol leaves the overwhelming impression it eases stress, trauma, sleep and social awkwardness, but really makes them worse.
Vast advertising budgets and our need to fit in make our false first-hand impressions the easiest takeaways.
This means we can often live for years with very strong but very inaccurate intuitions about alcohol which backfire on us.
Reshaping our intuitions
The good news is, however, that intuitions around alcohol are learned and can be remoulded to conform to reality.
A solid base of scientific research can be used to reshape them, allowing us to see where alcohol’s immediate impressions are misleading.
We can change our lifestyles and start gathering new impressions, so forming new intuitions, perhaps by having days and months off.
Like all learning remoulding our alcohol intuition comes most easily when seen as a creative process with rewards along the way and payoffs.
There are many such payoffs: avoiding mishaps and illness, lower costs, and improved relationships, memories, mood, cognition and resilience.
Remoulding our intuition can enrich our ideas, shedding inspiring new light on psychology, relationships, lifestyle, philosophy and social goals.
Why would we not attempt to enrich our lives in this way? ■
Go with the flow
Being alcohol aware can help us to be brain aware too, by going with the flow from which all our thoughts and feelings arise.
Our brain activity, like that of a road network, is altered by the demands placed on it, mainly from our bodies and environment.
Alcohol, like other psychoactives, alters the traffic flow by hacking the parameters, taking vehicles off the road and changing the traffic lights.
Paradoxically a slowed brain makes for greater excitement, just as a shopping trolley will give us a guaranteed white-knuckle ride.
A slowed brain can also make it easier for us to enjoy what is in front of us, with our capacity for wider thoughts reduced.
If we drink a very large amount we may find vertical and horizontal become harder to distinguish, and our limbs defy our commands.
When we stop drinking alcohol for the day the process goes into reverse, mental traffic is put back on the road at full speed.
Re-adjusting to this means our daily brain maintenance period, sleep, is not as effective, so we may wake less refreshed.
We may also wake to the even greater discomfort of a hangover, part of a typical return to brain network normality.
If we go through this slowing down and speeding up often enough, our brains may not re-adjust after just one day.
The symptoms of an incomplete re-adjustment vary, often including jumpiness, nausea, low mood, alcohol craving or cold sweats.
Beyond alcohol dependency, as these kinds of symptoms are often called, we might also find we get confused and forgetful, a kind of dementia.
As always, if we are concerned about our health, for whatever reason, the first step is to go and see our doctors, who can help find the cause and a solution.
Optimism is justified in the case of alcohol: We can expect to be relieved of symptoms after three months to a year with benefits long after.
If we drink no more than 14 UK units (140ml) a week the risks of developing problems are low. Sticking to none can be easiest.
Support and advice can be found from the likes of Club Soda, Soberistas, One Year No Beer and the UK charity Alcohol Concern.
For all the many problems alcohol causes it does offer us clues to positive habits, like slowing our mental traffic and lowering social barriers.
Being brain aware must means taking better care of ourselves, which has to include being alcohol aware.
Alcohol can upset the brain flows underpinning our well-being, flows which can be restored. ■
Go easy on the amygdala
Fear is often our friend, but alcohol makes it more difficult to quash unhelpful worries and so prolongs the ill-effects of our misfortunes.
Our sophisticated brains learn to make us wary of many things: speeding cars, public speeches, deadlines, double-dip recessions, emails from the HR department and letters delivered in brown window envelopes.
These connections are sometimes born of painful first-hand experience, but our intelligence also allows us to skip personal demonstrations and pick up our fears second-hand, from stories and images.
This pairing seems to happen in the amygdala, two almond-shaped structures buried deep in our brains (pictured). They specialise in linking emotions to memories, so informing our impressions and decisions.
Combining feelings with rational thoughts allows us to navigate the world better. Nervousness will tend to make us shy away from things which might harm us, while good vibes will attract us to positive things.
This interplay allows us to adapt to the demands of our surroundings. In the Australian outback it makes sense to fear spiders more than brown envelopes. In other places it makes more sense the other way round.
Activating our alarm bells helps us heed good advice, find objects and social connections which might benefit us, or give appropriate weight to warnings or more complex arguments.
But sometimes it goes wrong and we can be fearful of things which we needn’t be, like European spiders or clowns. A mixed-up amygdala may underlie many of our most common mental discomforts.
Sometimes these are merely an inconvenience, but they can also undermine our lives by making us feel generally anxious about things, feel the after-effects of a troubling experience long after, limit our range of choices or underlie poor decisions.
Managing our fears productively is not a sign of “character”, as we have often been brought up think, based on traditional ways of looking at ourselves. It has more to do with the way our amygdala are working.
Taking care of our amygdala rather than our characters is a better way to benefit from the emotional aspect of our thinking. Doing so is a choice which benefits us and others besides.
Looking out for amygdala
We might look at ways to look after our amygdala. We can recognise the burden they take and allow them to adapt and recover, like emotional limbs, with their strengths and limits.
Alcohol drinking is no help to them, though long used to allay anxieties, from snarling pitch battles, to interview rooms and first dates. We have often used it to get over the aftereffects of stresses too, a hard week at work, defeat or nasty shock.
But, while drinking alcohol provides almost immediate relief from feelings of tension, it prolongs the nagging emotions we might feel after. It seems to hinder our amygdala in attaching the right feelings to stressful experiences.
Nevertheless, perhaps three-quarters of Brits over 30 use alcohol to relieve stress with those of us who do being more likely to drink every day. If we keep it up for long enough we will develop a dependency, which shows itself in a range of ill-effects when we are not drinking, a long list which ironically includes anxiety.
Alcohol is no better when we encounter big problems than routine ones either, although we are often tempted to drink more than normal after a job loss, accident, breakup or some other unusual trauma.
But heavy alcohol use has been linked to post-traumatic stress disorder (PTSD), where our fear response does not turn off after a fearful event. Rats plied with alcohol continue to flinch longer after a threat is gone.
Rats made alcohol dependent in the lab tend to be more timid than ones which have not, preferring to stay in less-exposed parts of their environment. This anxiety might also give former dependents a motive to go back to drinking.
As with rats some of us seem to be more prone to drinking in response to stress than others. We might look at our relatives for a hint on this, but it is not uncommon. A more easily identifiable high-risk genetic group for drinking to alleviate stress is men.
Enduring stress, particularly the intense discomforts of trauma is difficult, even agonising, but it seems our amygdala have evolved to recover better if we do so without looking for temporary relief from alcohol.
Laying off alcohol can leave our amygdala working better. For those of us who have developed a dependency it might take between three months and a year, although there are benefits along the way and after. In the end, there is less to be afraid of. ■
Extract ends
Also, try Alcohol Companion.
“A treasure trove of facts, stories, science and philosophical nuggets.”
Professor Alan Maryon-Davis, former Chair of Royal Society of Public Health