Better Health For All

This is the second in a series of blogs written in appreciation of Dr Julian Tudor Hart who died on 1 July 2018. To read the post written by Prof Sir Andy Haines, click here.

In the book Health and Society in the Twentieth Century Wales, there is only one chapter devoted to an individual and that individual is Julian Tudor Hart putting him firmly in the lineage of other Welsh Giants in health care provision including:
• Lloyd George introduced the National Insurance Scheme
• Lady Emily Talbot endowed the first full time public health chair to usher in a new type of medicine – preventive medicine
• Aneurin Bevan introduced the NHS
• Archie Cochrane and Sir Ian Chalmers’ revolution in evidence-based medicine and the establishment of the world wide Cochrane Collaboration credited with preventing millions of deaths and disability

Julian Tudor Hart was a general practitioner and epidemiologist, as well as a passionate advocate for socialism, for progressive developments in the NHS and medicine in the community. In 2006 he was awarded the inaugural Discovery Prize by the RCGP ‘for capturing the imagination of GPs with his ground breaking work’.

Julian Tudor Hart studied medicine at Cambridge University and at St Georges Hospital Medical School followed by a few years in general practice in London.

In1960 he took a post as an epidemiologist at Archie Cochrane’s Medical Research Council unit, in Cardiff, working on the Rhondda Fach Survey. Archie regarded him as “one of a remarkable series of talented young men”. However, after completing one survey “meticulously” he decided to move back into primary care where he felt he could have a direct impact and bring about improvement to the lives of working people more immediately than by conducting research.

Despite his parents efforts to discourage him from studying medicine, he’d always had ambitions to be a GP in a coal mining community. His father had worked in 1934 in South Wales in a salaried medical post in Llanelli employed by the miners and tin plate union and who had represented south Wales Miners’ Federation in a dispute over medical care.

From 1961-87 he served as a GP in the uplands community of Glyn Corrwg in South Wales, a small mining village. Significantly, he not only provided medical care for his patients but also conducted extensive research and his practice was the first to be recognized as a research practice piloting many MRC studies.

In his practice of medicine he advocated the importance of the GP and the community health team carrying out work to identify problems at an early stage and with a crucial role in preventive medicine, to influence health behaviours on an individual and community level. Hart also developed ideas about the role of the medical practitioner in primary care and wrote a booked called ‘New Kind of Doctor’, and he was a keen advocate for departments of general practice in medical schools. As a result, he significantly influenced the new generation of doctors.

Between 1966 and 1986 Glyncorrwg experienced rising unemployment following the collapse of basic industries with a loss of its vigorous social, cultural, and commercial life. He observed that although health conditions generally were improving during the second half of the twentieth century the gap between the health experiences of people in the poorest and richest areas were widening. As such, he developed the ‘inverse care law’, which is the principle that the availability of the best and most comprehensive health services are concentrated in areas of relative affluence, and the poorest health services are concentrated in those areas of greatest need, where people find it harder to access health care.

Tudor Hart had a keen sense of commitment to an economically and socially deprived community and took a critical view of the commodification of the NHS. In his book ‘The Political Economy of Health Care’, he challenged policy makers to think critically about the values of our society in the UK and the future of health care services with a reminder that patients were both citizens and co-producers of health gain rather than consumers or customers as part of a continuum requiring a population health approach. These values are embedded in the Bevan Commission’s four principles of prudent health.

In the week of his death, we were celebrating the 70th anniversary of the NHS. At the same time, the Welsh Government published ‘A Healthier Wales: our plan for health and social care’. It sets out a long term whole systems approach, with distinctive values and culture. It focuses on health and wellbeing throughout life, preventing people getting ill and improving people’s health and tackling health inequalities as being key to sustainable development.

I would hope the plan would have been welcomed by Julian Tudor Hart as a continuation of the matters that he pursued throughout his whole professional career. It’s “a revolution from within”: an NHS that brings certainty and security, especially for people who needed it most everywhere according to need and not the ability to pay. And it meets the needs now and of future generations, recognising that treating people in hospital when they are ill is only a small part of modern health and social care.

After all, the list of Welsh Health Giants, including Julian Tudor Hart, should enable those charged with leading change today and in the future to rediscover the confidence and bold ambitions that made Wales a birthplace for some of the greatest ideas for health services in the world.

Written by John Wyn Owen CB FFPHM FLSW, Bevan Commissioner, Director NHS Cymru Wales 1984-1994