Doctor who pi­o­neered rou­tine pre­ven­tive heath­care in a Welsh min­ing vil­lage

The Guardian - Journal - - Obituaries -

As a doctor in a coalmin­ing com­mu­nity in the Welsh val­leys, Ju­lian Tu­dor Hart, who has died aged 91, pi­o­neered much of what is now ac­cepted as rou­tine pre­ven­tive care. He led a re­search prac­tice for al­most 30 years, and coined the term “in­verse care law” to ar­gue that com­mu­ni­ties most in need of good health­care are those least likely to re­ceive it.

The key to his re­search, which brought him world­wide renown, was the re­mark­able co­op­er­a­tion of his 2,000 pa­tients, given in re­turn for his unswerv­ing com­mit­ment to them. As a life­long so­cial­ist and one­time Com­mu­nist party can­di­date, he was a staunch de­fender of the found­ing prin­ci­ples of the NHS.

Work­ing in, and with, a Welsh min­ing com­mu­nity had been Tu­dor Hart’s am­bi­tion since he be­gan his med­i­cal ca­reer in 1952. The op­por­tu­nity came nine years later when he moved to Glyn­cor­rwg, a vil­lage in the Afan valley, and set up a re­search prac­tice in what was lit­tle more than a wooden shed.

Mary Thomas, a med­i­cal re­searcher of equally rad­i­cal con­vic­tions, fol­lowed him and in 1963 be­came his sec­ond wife.

By grad­u­ally win­ning the trust and con­fi­dence of what was then still a thriv­ing, close-knit and crit­i­cally – for re­search pur­poses – sta­ble com­mu­nity, he built an un­par­al­leled data­base which formed the ba­sis of his groundbreaking work in blood pres­sure mon­i­tor­ing and hy­per­ten­sion, the ef­fects of salt in diet and the ben­e­fits of war­farin as a pre­ven­tive med­i­ca­tion.

Tu­dor Hart’s son, Ben, who is a GP in east Lon­don, re­calls how min­ers would du­ti­fully com­ply with col­lec­tion of stool sam­ples and take “pee bot­tles” un­der­ground with them so that the doctor and his re­searchers, headed by Mary, could an­a­lyse their urine for salt con­tent. He him­self was obliged to take one to school.

The Glyn­cor­rwg prac­tice was the first to win fund­ing from the Med­i­cal Re­search Coun­cil. Stan­dard­ised death rates for the vil­lage in the 1980s were found to be 28% lower than for a com­pa­ra­ble com­mu­nity, while smok­ing rates fell over 25 years from 56% of adults to 20%.

Writ­ing in 1988 in A New Kind of Doctor, one of sev­eral books and many ar­ti­cles he au­thored, Tu­dor Hart de­scribed what he called this “an­tic­i­pa­tory care” and how it worked in the case of a miner who had be­come hy­per­ten­sive at 36, was obese and a heavy drinker: “For the staff of our health cen­tre, it was a steady, unglam­orous slog through a to­tal of 310 con­sul­ta­tions (over 26 years). For me, it was about 41 hours of work with the pa­tient, ini­tially face-to-face, grad­u­ally shift­ing to side-by-side.

“Pro­fes­sion­ally, the most sat­is­fy­ing and ex­cit­ing things have been the events that have not hap­pened: no strokes, no coro­nary heart at­tacks, no com­pli­ca­tions or di­a­betes, no kid­ney fail­ure with dial­y­sis or trans­plant. This is the real stuff of pri­mary med­i­cal care.”

Born in Lon­don, Ju­lian came from a leftwing med­i­cal fam­ily: his fa­ther, Alexan­der, was a Com­mu­nist party mem­ber who vol­un­teered as a sur­geon for the In­ter­na­tional Bri­gades in the Span­ish civil war; his mother, Ali­son Mac­beth, was also a doctor and a mem­ber of the Labour party. Alexan­der was later to marry, then di­vorce, the pho­tog­ra­pher Edith Sus­chitzky, re­cently re­vealed to have been the ma­tri­arch of the Cam­bridge spy ring.

Ju­lian was ed­u­cated at Dart­ing­ton Hall in Devon, and, af­ter evac­u­a­tion to Canada dur­ing the sec­ond world war, at Pick­er­ing col­lege, a Quak­er­founded school in On­tario. He re­turned to the UK in 1945 and, af­ter na­tional ser­vice, stud­ied medicine at Queens’ Col­lege, Cam­bridge, and St Ge­orge’s hospi­tal in Lon­don.

On qual­i­fi­ca­tion he took a suc­ces­sion of hospi­tal posts in Lon­don, Es­sex and Northamp­ton­shire, but it was an ex­pe­ri­ence in pri­mary care in de­prived north Kens­ing­ton, west Lon­don, that was the most for­ma­tive. He also gained re­search ex­pe­ri­ence along­side epi­demi­ol­o­gists who were to be­come il­lus­tri­ous fig­ures in the field: first, Richard Doll at the Lon­don School of Hy­giene and Trop­i­cal Medicine; sub­se­quently, in a move that took him to south Wales, Archie Cochrane at the then Welsh Na­tional School of Medicine.

Tu­dor Hart re­tired from clin­i­cal prac­tice in 1987, and he and Mary moved to Gower, where he found more time for his draw­ing – he was a tal­ented car­toon­ist – and pre­ci­sion mod­el­ling.

Tu­dor Hart, who was a founder mem­ber and first hon­orary pres­i­dent of the So­cial­ist Health As­so­ci­a­tion, never wa­vered in his op­po­si­tion to what he saw as mar­keti­sa­tion of the NHS. He was al­lowed to join the Labour party in 1981, hav­ing stood for West­min­ster three times on a com­mu­nist ticket and hav­ing re­tained his Com­mu­nist party of Great Bri­tain mem­ber­ship un­til 1978, but he was a critic of the Blair govern­ment’s court­ing of pri­vate health in­ter­ests.

He was es­pe­cially pleased that the Welsh Labour govern­ment used its de­volved health pow­ers to re­sist Eng­land’s mar­ket re­forms.

He is sur­vived by Mary, and their chil­dren, Ben, Robin and Rachel; by Penny and Ali­son, the daugh­ters of his first mar­riage, to Joyce (known as Jo, nee Muri­son), which ended in di­vorce; and by 16 grand­chil­dren. A son, Adam, pre­de­ceased him.

David Brindle

Tu­dor Hart built an un­par­al­leled data­base at his prac­tice in Glyn­cor­rwg Alan Ju­lian Mac­beth Tu­dor Hart, doctor, born 9 March 1927; died 1 July 2018

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