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God, evolution, global warming and heart disease

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Lecture given in the Nuffield Department of Population Health, University of Oxford, 18th May2015

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God, evolution, global warming and heart disease

  1. 1. God, evolution, global warming and heart disease: a personal reflection on population health Mike Rayner 18th May 2015
  2. 2. What is population health? Population health can be defined as: ‘The science and art of preventing disease and promoting health through the organized efforts of society, organizations, communities, families and individuals'.
  3. 3. World Health Organization definition of ‘health’ • ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’ • The correct bibliographic citation for the definition is: Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. • The definition has not been amended since 1948.
  4. 4. What is population health? Population health can be defined as: ‘The science and art of preventing disease and promoting health through the organized efforts of society, organizations, communities, families and individuals'. The health of a population is not just the sum of the health states of the individuals within that population.
  5. 5. Richard Wilkinson
  6. 6. Margaret Thatcher "They are casting their problems at society. And, you know, there's no such thing as society.. There are individual men and women and there are families. And no government can do anything except through people, and people must look after themselves first. It is our duty to look after ourselves and then, also, to look after our neighbours." – in an interview in Women's Own in 1987
  7. 7. What is population health? Population health can be defined as: ‘The science and art of preventing disease and promoting health through the organized efforts of society, organizations, communities, families and individuals'. The health of a population is not just the sum of the health states of the individuals within that population. Population health aims to promote the health of groups: societies, communities, organisations, families and not just individuals.
  8. 8. The obesity system http://kim.foresight.gov.uk/Obesity/Obesity.html
  9. 9. Age-standardised overall mortality rates from acute myocardial infarction and by type of event in women, 1999-2007, England 0 10 20 30 40 50 1999 2000 2001 2002 2003 2004 2005 2006 2007 Mortalityrate(per100,000) Overall Sudden AMI deaths Fatalhospitalised cases Smolina K, Wright FL, Rayner M, Goldacre MJ BMJ. 2012 Jan 25;344:d8059. doi: 10.1136/bmj.d8059
  10. 10. Contribution of average annual trends in event rate and case fatality rate to the average annual trend in AMI mortality rate by sex and age, 1999-2007, England -12.0 -10.0 -8.0 -6.0 -4.0 -2.0 0.0 30-54 55-64 65-74 75-84 85+ Annualtrendinrates(%) Age group, men Event rate 30-54 55-64 65-74 75-84 85+ Age group, women Case fatality Smolina K, Wright FL, Rayner M, Goldacre MJ BMJ. 2012 Jan 25;344:d8059. doi: 10.1136/bmj.d8059
  11. 11. Vascular death at ages 35-69, UK 2005: 7% Male, 3% Female Male rate 7.5 / 1000 (25% dead) Female rate 4.5 / 1000 (15% dead) Male Female ’4S’ study published Richard Peto
  12. 12. Individual Objective Individual Subjective Group Subjective Group Objective Ken Wilber
  13. 13. Individual Objective Individual Subjective Group Subjective Group Objective Anthropological Organisational Sociological Psychological Historical Cultural Economic Physiological Historical Theological Epidemiological
  14. 14. Individual/ObjectiveIndividual/Subjective Group/Subjective Group/Objective Why do I have heart disease? Why do they (as a group) have heart disease? Why does he/she have heart disease Why do we (as a group) have heart disease?
  15. 15. Individual/ObjectiveIndividual/Subjective Group/Subjective Group/Objective Why do I have heart disease? Why does he/she have heart disease? Why do we (as a group) have heart disease? Why do they (as a group) have heart disease ? 1 1.5 2 2.5 3 3.5 1 2 3 4 Adustedoddsratioforriskof heartattack Quartiles of income inequality Income inequality and risk of heart attack in US states
  16. 16. Individual/ObjectiveIndividual/Subjective Group/Subjective Group/Objective Why do I have heart disease? Why does he/she have heart disease? Why do we (as a group) have heart disease? Why do they (as a group) have heart disease ? 1 1.5 2 2.5 3 3.5 1 2 3 4 Adustedoddsratioforriskof heartattack Quartiles of income inequality Income inequality and risk of heart attack in US states
  17. 17. Individual/ObjectiveIndividual/Subjective Group/Subjective Group/Objective Why do I have heart disease? Why does he/she have heart disease? Why do we (as a group) have heart disease? Why do they (as a group) have heart disease ?
  18. 18. Individual/ObjectiveIndividual/Subjective Group/Subjective Group/Objective Why do I have heart disease? Why does he/she have heart disease? Why do we (as a group) have heart disease? Why do they (as a group) have heart disease ?
  19. 19. Individual/ObjectiveIndividual/Subjective Group/Subjective Group/Objective Why do I have heart disease? Why does he/she have heart disease? Why do we (as a group) have heart disease? Why do they (as a group) have heart disease ?
  20. 20. Robert Young “Science is a social activity, born of society, and mediating its structures and values, as least as much as it is born of nature”
  21. 21. Interview with Ian Swingland, iPM Programme, Radio 4, April 2013 • Ian Swingland: My girlfriend had just won a first prize fellowship at Magdalen. And as a result, I was invited to the Judge Randolph dinner in March of 1978, only eighteen months after Richard Dawkins had published The Selfish Gene. And I was close to Thatcher and I know Richard Dawkins was there. John Krebs I think was there. A lot of us who came from the Zoology Department in Oxford. And she was heard to say that society is the building block for the future. And immediately, many zoologists, lowly post-doctoral researchers like me said society doesn’t exist, and this was joined by a mighty chorus from those more senior than I. And this put her back and she challenged why we were saying it. And that brought us to essentially the argument from the evolutionary ecologists which indeed did prove that individuals mattered more than society • Eddie Mayer: Is it your belief, is it your assertion perhaps, that Mrs Thatcher’s well discussed views on society were perhaps put to her, she became persuaded of that, that evening ? • Ian Swingland: I think there is some likelihood it will have affected her thinking because at the end of the evening after the argument that goes with those statements and protestations, that society doesn’t exist, she then said well perhaps I ought to centre on the individuals hereafter. iPM https://www.youtube.com/watch?v=JeHqyFJ0Ric&feature=youtu.be
  22. 22. Spirit of truth arise Inspire the prophet’s voice Expose to scorn the tyrant’s lies And bid the poor rejoice O Spirit, clear our sight, All prejudice remove, And help us to discern the right, And covet only love. Give us the tongues to speak The words of love and grace To rich and poor, to strong and weak In every time and place Enable us to hear The words that others bring Interpreting with open ear The special song they sing

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