- Emeritus Professor of Public Health
- Epidemiology & Public Health
- Institute of Epidemiology & Health
- Faculty of Pop Health Sciences
I trained in medicine at Cambridge and UCL, and in social medicine at the London School of Hygiene. I was senior lecturer in community medicine, at UCL department of epidemiology and public health, then director of public health for the NHS in Camden and Islington, and then returned as professor of public health at UCL, now emeritus.
I have held posts in both the NHS and the university in the same way as clinical colleagues in University College Hospital (where I trained before taking up the specialty that is now called ‘public health’ but then called ‘community medicine). However, this is a difficult path: colleagues daily treating individual patients do not readily understand the objectives of population approaches in medicine; colleagues undertaking epidemiological studies with national data sets do not readily understand local health service decision-making. I took the post of Director of Public Health for Camden and Islington to seek to integrate these perspectives: but the NHS has been subject to frequent management reorganisations which destroy strategic work and relationships, and I returned to UCL to maintain greater continuity and wider perspectives.
In the recent decade I have developed European perspectives on public health research and practice - whilst acknowledging the challenge that the UK has weak interests in European collaboration. I have worked with international organisations such as the European Commission and WHO, with national governments (for health and research fields), and with global companies including Shell and BP.
My research started in the organisation of health care, using cancer registration
to identify population-based samples and comparing place of care and mode of
treatment as explanatory variables for survival and social outcomes for childhood
leukaemia. In a randomised controlled trial of length of stay for maternity
care, I learned the difficulties of direct interventional studies in health
services research, and thereafter developed observational studies with both
quantitative and qualitative approaches.
Developing the field of cancer care outcomes, I was an early innovator in
research on palliative care. Irene Higginson and I created the Support Team
Assessment Schedule as a methodology for measuring outcomes in community-based services. Julia Addington-Hall and I measured outcomes of care of the dying across 21
health districts in England, producing the primary journal publications on
palliative care needs for cardiovascular, respiratory and neurological
illnesses. Mike Gill and I made innovative use of statistical models to review
the impact of treatment on osteosarcoma survival nationally. Jo Bore and I made
the first study comparing breast cancer treatments with clinical consensus
guidelines. More recent work analysed national health care data sets to assess
dimensions of quality of care for breast, colon, lung and prostate cancers in
relation to multi-disciplinary teams and regional organisation of care. In all
these studies, I have been concerned to relate organisational and policy inputs
to population outcomes – a central concern for health systems.
The second dimension of my work, on environment and health started with a
study with Rafi Alwash to explain socio-economic differences in child accidents
in the home, and then a review of the benefits (or not) of seat belt
legislation and cycle helmets in reducing road injuries. I made the first
population-based study of the causes of cyclist deaths in London, and wrote the
first health impact assessment of transport and health in London.i th Martin Utley, I developed modelling for health impact assessment, drawing population attributable risks from epidemiological studies, and developed an HIA on transport for the London
My third broad research theme has been on public health across Europe. My
PhD work looked at the development and outcomes of the Italian national health
system. I developed wider European contacts through working with the World
Health Organisation and the European Public Health Association, leading to five
successful collaborative programme grants from the European Commission. These
have focused on the development of public health research by European
Teaching was a main part of my work initially as Senior Lecturer at UCL, as I was appointed without supporting staff. I developed courses on medical sociology for pre-clinical medical students, and on community medicine (epidemiology, health promotion, health services) for clinical students. I was examiner in these subjects for the University of London.
Externally, I developed the London Health Services Research Group, which provided seminars for the wider NHS community in London. I held a grant at UCL to create a day-release course on community medicine for medical post-graduates, and taught a new course on health systems at the London School of Hygiene. For the NHS, I was regional advisor for public health medicine training.
I supervised PhDs within UCL and examined externally for the London School of Hygiene and University of Liverpool, as well as externally to the MSc in Public Health at the University of Cambridge.
Internationally, I have lectured at research meetings across European countries, particularly for the European collaborative projects I have lead.
||Professor of Public Health
||Epidemiology and Public Health
||University College London, United Kingdom
|01-FEB-1990 – 30-SEP-1997
||Director and Board Member
||Department of Public Health
||Camden and Islington (NHS), United Kingdom
|01-JAN-1979 – 01-OCT-1998
||Senior Lecturer in Community Medicine
||University College London, United Kingdom