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

1. God, evolution, global warming and
heart disease: a personal reflection on
population health
Mike Rayner
18th May 2015

3. 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'.

4. 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.

5. 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.

6. Richard Wilkinson

7. 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

8. 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.

9. The obesity system
http://kim.foresight.gov.uk/Obesity/Obesity.html

10. 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

11. 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

12. 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

15. Individual
Objective
Individual
Subjective
Group
Subjective
Group
Objective
Ken Wilber

16. Individual
Objective
Individual
Subjective
Group
Subjective
Group
Objective
Anthropological
Organisational
Sociological
Psychological
Historical
Cultural Economic
Physiological
Historical
Theological
Epidemiological

17. 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?

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 ?
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

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 ?
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

20. 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 ?

21. 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 ?

22. 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 ?

23. 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”

24. 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

25. 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