Systems Prevention means transforming all of public policy and the relationships between its components. The authors call this reform the construction of a national Health Society. They identify the three main pillars of the changes required as institutional change, community change and technological change. Change affecting these three pillars needs to be concurrent. Health (as needs satisfaction) should be at the top of the agenda of all branches of national and local government. The critical role of central government is in coordination and this finds institutional expression in health becoming the responsibility of a Deputy Prime Minister and in the modern plagues all being identified as risks on the National Risk Register. The Health Society has significance for every department of government and some of these are explored.

In recent years, there have been calls to work against the ‘neo-liberal’ university in the UK, especially as metric systems such as the Research Excellence Framework (REF) and more recently the Teaching Excellence Framework (TEF) are introduced. With REF in particular, there is a need to demonstrate the impact academics have made with their research, which could include advising and sharing our research with governmental bodies. Being part of the neo-liberal university means that research is only deemed ‘impactful’ if it engages with the very structures which are creating and perpetuating the harmful policies scholars are trying to dismantle. For example, work on the Prevent duty may very well require scholars to engage with the Home Office to demonstrate they are trying to implement ‘change’. However, scholars of colour are aware that their bodies as visible Muslim women in these spaces can be harmful and so we often question who their research is really for. This chapter calls for a politics of refusal as a way to address how universities create uneven spaces of knowledge production and for a fundamental rethink of what it means to refuse the current conditions for engaging in ‘impactful’ work. Although the starting point is the university, the chapter seeks to demonstrate that a politics of refusal is also necessary beyond the university space, especially in these turbulent and violent times.

There are no significant technological obstacles to achieving the Health Society. However, there is work to be done in constructing national infrastructure: a secure, national data and sample management system is necessary. This will permit disiy and use of new biomarkers for estimating reduction in risk and will enable continual estimation of changes in health risks in the population.

In June 2017 Suhaiymah Manzoor-Khan had a poem go viral online, ‘This Is Not a Humanising Poem’. Accruing two million views in a few days, the poem seemed to resonate with people far and wide. It was a condemnation of the culture in which Muslims are asked to ‘prove their humanity’ by distancing themselves from ‘terrorism’. The poem was written a day after the London Bridge attack, as an attempt to resist the gazes upon her body and the multiple emotions raised – she asked whether her refusal to write a humanising poem meant she was radical – ‘Is this radical? Am I radical? ‘cos there is nowhere else left to exist now.’ This chapter outlines some of the thought process that went into the poem, and the trappings of performing it too, as, ironically, since then, whilst she has received invitations to appear, perform and talk on many stages both nationally and internationally, people have often reproduced and reduced her work and thoughts in a way that means she often struggles to navigate a line between palatability and honesty. The chapter homes in on a few key moments subsequent to the initial poem that highlight the way racism functions to trap us.

This chapter demonstrates how people perceive risk through a lens of hopes and fears. Perceptions of risk are illustrated by how we react every day to predictions of changes in the weather. When precise estimates of risk are hard to make, institutions manage risks to and within their organisations by using risk matrices based on experience of how severe are the effects of a risk being realised. This may take the form of a traffic light system that combines the scale and severity of a risk. In a health context where there is sufficient data such as the health risks of tobacco use, risk can be measured more precisely allowing the ascertainment of relative risk, absolute risk and attributable risk.

Many of the words that this book uses with precise definitions are in common usage with definitions that are less precise. Common usages and their limitations are illustrated and discussed in this chapter in order to prepare the reader for more precise definitions.