Lives of the fellows

Ernest Alwyn Smith

b.9 November 1925 d.15 July 2016
CBE(1986) MB ChB Birm(1952) PhD(1955) DPH(1956) MRCP Glasg(1967) MSc Manch(1971) FRCP Glasg(1971) FFCM(1972) FRCGP(1973) FRCP Edin(1981) FRCP(1983)

’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.’ This summary of the health divide was made by Alwyn Smith in The nation’s health: a strategy for the 1990s (London, King Edward’s Hospital Fund for London, 1988), written at the height of his influence as an academic and adviser on public health. The report became a bestseller and the subject of political and public debate; it was later endorsed as a white paper by John Major, the then prime minister.

InThe nation’s health, Smith, who served two terms as president of the then Faculty of Community Medicine and was professor of epidemiology and social oncology at Manchester, was advocating a perspective he promoted throughout his career – that the practise of public health must involve the application of scientific methods and insights to the organisation and provision of societal interventions and services. He summarised this approach: ‘…inevitably, public health and its associated sciences will always have a progressive political agenda. I don’t really see that it can be otherwise’.

Smith was born in Walsall, the eldest of four children of Ernest, an engineer, and Constance née Webster, a teacher. Educated at Queen Mary’s Grammar School in Walsall, he gained an exhibition to New College, Oxford, to study history, but instead served in the Royal Marines from 1943 to 1945, commanding a platoon in Belgium, Holland and Germany as a second lieutenant. After demobilisation, he decided to study medicine at the University in Birmingham. As a student he developed a talent for debating, but declined Richard Crossman’s suggestion that he enter politics.

Two teachers at Birmingham impressed and influenced him – Solly Zuckerman [Munk’s Roll, Vol.IX, p.612], an anatomist who became chief scientific adviser to Harold Wilson’s government, and Thomas McKeown [Munk’s Roll, Vol.VIII, p.311], professor of social medicine. At this time, social medicine was a relatively new discipline concerned with understanding the nature and determinants of disease in populations. It saw itself as different (and separate) from the traditional concerns of public health. McKeown in particular was important for Smith because of his interest in bringing the scientific approach of epidemiology to the evaluation and provision of health services. Smith’s PhD thesis on Down’s syndrome provided an early example of the ‘prevention paradox’ that continued to interest him in later years. Briefly, it is that the rate of an event may be higher in small groups of a population, but commoner in larger groups simply because of their size – the difference being levels of risk in the two groups. Other examples are found in his book The science of social medicine (London, Staples, 1968).

Later Smith was influenced by James Macalister Mackintosh [Munk’s Roll, Vol.VI, p.317] (on the nature of public health practice) and Margot Jefferys (on medical sociology) at the London School of Hygiene, where he gained a diploma in public health.

Prior to his appointment in Manchester, Alwyn Smith lectured on epidemiology in Singapore and then held three posts in Dundee, Edinburgh and Glasgow. In Edinburgh, he combined an academic post with that of medical statistician to the registrar general, and it was here that he developed his interest in large scale data sets and their uses for health planning. In Glasgow, he founded the social paediatric research group, which, among other things, created a congenital malformations register that became part of a European collaboration, and began investigations into the re-emergence of rickets in the Glasgow population.

In 1967 he was appointed professor of social and preventive medicine in Manchester, where he established a highly successful multidisciplinary MSc course. After 12 years he moved to a chair of epidemiology and social oncology. One example of the work of his group at Manchester was a system of call and recall, especially among poorer women, which achieved a substantial increase in the uptake of cervical cancer screening. These methods were adopted nationally and are in use today.

Alwyn Smith was elected president of the (then) Faculty of Community Medicine in 1981 and again in 1984; the only president to be elected twice. He inherited a membership that was still in the process of re-defining its role and functions following the NHS reorganisation of 1974; in particular the change from local government responsibilities to those that included the wider scope of the integrated NHS. The scope and content of the Faculty’s educational requirement were a part of these changes, but the need to adapt to the new requirements of professional practice was equally important. As president, his leadership was particularly important to this period of change, as were his efforts to bridge the then division between NHS practitioners and academics.

After his retirement in 1990, he chaired the Lancaster Health Authority, where he was able to demonstrate the local application of epidemiological methods to the planning of local services, a particular example being the provision of specialist services for a widely scattered and diverse rural population.

He remained a passionate advocate of the NHS. He was a keen musician, photographer and sailor, and retained his love for powerful cars. He met Doreen Preston when they were both undergraduates and they married in 1950. Doreen worked with the Citizens Advice Bureau as an expert on benefits and was a distinguished member of the Manchester Bench of Magistrates. She died in 2012. Alwyn was survived by their two children, Jeremy and Wendy, and their grand-daughter, Annie.

F A Boddy

[The Guardian 6 September 2016 – accessed 18 October 2016; Journal of Public Health 2005 Vol.27, No.2, pp.135-142 – accessed 18 October 2016]

(Volume XII, page web)

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