“The health of our nation is like a race. It is one in which the rich have been able to run faster than the poor.” Such was the clarity provided on issues of poverty and health by the doctor and academic Alwyn Smith, who has died aged 89. Alwyn played a major role in shaping public health policy and practice during the last part of the 20th century. His work improved take-up of breast cancer and cervical screening. He was elected president of the Faculty of Public Health in 1981 and again in 1984, the only president to be elected twice.
At the summit of his influence he led an authoritative assessment of the nation’s health, commissioned by the King’s Fund independent thinktank, published in 1988. Its recommendations for action focused squarely on government and public authorities, challenging the Thatcherite dogma of individual responsibility alone. The report, The Nation’s Health, became a bestseller and was the subject of fierce political and public debate. The pendulum swung decisively when John Major’s administration came to power after Margaret Thatcher’s fall in 1990. The health white paper of 1992, which carried the prime minister’s full printed endorsement, led to detailed strategies over the next decade, continued by the Labour governments, modelled on the approach outlined in the report for improving general health and reducing inequalities.
Born in Walsall, Staffordshire, the eldest of four children of Ernest, an engineer, and Constance (nee Webster), a teacher, Alwyn was educated at Queen Mary’s grammar school in Walsall. He was awarded an exhibition to New College, Oxford, to study history. During the second world war, he joined the Royal Marines, and, as a 19-year-old second lieutenant, commanded a platoon on active service in Belgium, Holland and Germany.
After demobilisation and a stiff conversation with his father, he decided to study medicine at the University of Birmingham. As a student he developed such a talent for debating that Richard Crossman suggested he enter politics. His skills as a public speaker served him well, and arguably enabled him to influence public policy more as a doctor than as an MP.
His future was sealed when, as a medical student, he was inspired by the teachings of Thomas McKeown, who was one of the first professors of social medicine, then a new discipline which brought together an understanding of the patterns and societal causes of disease in populations, and the evaluation of services intended to improve health.
After gaining a diploma in public health at the London School of Hygiene and Tropical Medicine, he began his academic career with a WHO-supported lectureship in Singapore, and then posts in Dundee, Edinburgh and Glasgow. In Edinburgh he combined an academic post with that of medical statistician to the registrar general for Scotland. In Glasgow he founded the Social Paediatric Research Group and seized the opportunities presented by the city council’s new IBM computer to create a congenital malformations register. This provided the basis for research into the re-emergence of rickets in the city as well as becoming a key part of a European research collaboration.
Alwyn was appointed professor of social and preventive medicine at Manchester University in 1967, and swiftly established a centre of educational excellence. In 1968 he published The Science of Social Medicine, in which he laid out the subject’s principles and methodology. For example, he showed that, although there had been reductions in perinatal mortality (stillbirths and deaths in the first week of life) in Scotland over the previous 25 years, the differences between social classes persisted. If all Scottish births experienced the same death rates of the highest social class, he observed that a further 1,500 young lives would be saved each year. He concluded this “would represent a total saving of years of human life comparable with that which would be achieved by the abolition of deaths from cancer.”
His peers marvelled at his erudite lectures, thought out during weekend walks and delivered to time without notes or visual aids. He introduced a multidisciplinary MSc course, soon complemented by one providing education for the public health doctors appointed following the 1974 NHS reorganisation.
In 1977 he was appointed to the Manchester chair of epidemiology and social oncology, a name he chose to signal his determination to bring social medicine into the clinicians’ domain of cancer. Once again he brought together researchers from a range of disciplines. His team achieved a substantial increase in the uptake of cervical screening, especially among poorer women, by using a call and recall system. This was adopted by the national screening programmes for breast and cervical screening, which continue to use this approach today.
When Alwyn became president of the Faculty of Public Health – which is responsible for training and standards in the public health workforce – he inherited a membership that was demoralised, following NHS restructuring in 1974, and which was “doctors only”. There had been a longstanding divide between doctors and non-medical public health workers. Alwyn’s leadership paved the way to opening up the faculty’s training programmes and membership to other disciplines – economists, social scientists, statisticians and other scientists.
Early in Alwyn’s presidency, the faculty was invited by the Department of Health to produce guidance on healthcare planning for nuclear war. The membership was bitterly divided between those who thought this was acceptable and those who thought such planning was a dangerous nonsense. In the event, Alwyn was able to steer both factions into agreeing a document that provided planning guidance at the same time as a call for the prevention of nuclear war.
The example he set by engaging politically to tackle the societal causes of disease was enthusiastically adopted by multidisciplinary colleagues and students alike. He was appointed CBE in 1986.
He remained a passionate advocate of the NHS, and after his retirement in 1990 he chaired the former Lancaster health authority. He was a keen musician, photographer and sailor, and had a love for powerful cars, buying a Porsche in his 90th year.
His wife, Doreen (nee Preston), whom he met at university and married in 1950, died in 2012; Alwyn is survived by their children, Jeremy and Wendy, a granddaughter, Annie, and his sister, Valerie, and brother, Roger.
• Alwyn Smith, public health doctor, born 9 November 1926; died 15 July 2016
Alwyn Smith obituary
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