Lives of the fellows

Walter Werner Holland

b.5 March 1929 d.9 February 2018
CBE(1992) BSc Lond(1951) MB BS(1954) MD(1964) MRCP(1971) FFCM(1972) FRCP(1973) MRCGP(1977) FRCGP(1982) Hon FRCP Edin(1990) FRCPath(1992) Hon FFPHM Ireland(1993) Hon FFPH(2010)

Walter Holland was professor of clinical epidemiology and social medicine at St Thomas’ Hospital, London from 1968 to 1994. He made substantial contributions to the development of epidemiology to investigate non-infectious disease and more particularly to improve health services. Working almost all his professional life at St Thomas’ Hospital, he developed an international programme of research while working closely with local service administrators to improve services.

Born in Teplice Sanov in Czechoslovakia, the son of Henry Holland, the managing director of an engineering company, and Hertha Holland née Zentner, his family resettled in England in 1939, where he was educated at Rugby School and St Thomas’s Hospital Medical School. Following National Service, he studied at the London School of Hygiene and Tropical Medicine and Johns Hopkins University, before returning to St Thomas’ as a senior lecturer in social medicine in 1962. A new department of clinical epidemiology and social medicine was set up in 1964 and he directed this and, from 1968, the Department of Health’s social medicine and health services research unit until his retirement in 1994. After retirement he continued working, mainly at the London School of Economics.

His early career focused on the epidemiology of chronic disease and particularly chronic lung disease with a strong emphasis on the development of improved methods of research. His seminal paper on the urban factor in chronic bronchitis established the role of air pollution in the development of chronic bronchitis – the acute effects on mortality were already well known (‘The urban factor in chronic bronchitis’ Lancet. 1965 Feb 27;1[7383]:445-8). In 1962, when he returned to St Thomas’, the hospital governors asked him to look into the feasibility of using computers to improve hospital records and, understanding that the role of the old voluntary hospitals would have to change, supported a survey into health needs in north Lambeth. The development of general practice services in the area, which this led to, and the appointment of a senior lecturer in general practice as part of the research unit to evaluate the changes, established the first academic general practice unit in England. On the strength of this work, the unit was asked to assess the new district general hospitals that were then being developed.

The establishment of the Department of Health’s research unit led to a wide range of studies to inform policy. His evaluation of multiphasic screening showed that it had no benefit for patients, while his assessment of the removal of free school milk showed that this had no effect on the health and growth of primary school children, an investigation which developed into a highly productive 20-year study demonstrating, among other things, growing problems with obesity and asthma. He played a major part in the work of the Resources Allocation Working Party, a largely successful attempt to redistribute NHS funding on the basis of need rather than on the historic pre-1948 distribution of health services. In the 1980s he started a major research programme in Europe to map the distribution of ‘avoidable deaths’. The idea of using deaths from treatable conditions to monitor the quality of the health care system came from a visit to the USA, but he recognised the method’s potential and the major European collaboration which he led produced three editions of the ground-breaking European Community atlas of ‘avoidable death’ (first edition, Oxford, Oxford University Press, 1988).

The unique success of his unit was due in part to the rigorous internal review on which he insisted and in part to his employment of staff from a wide range of disciplines when this was uncommon. Senior non-medical members of his team were encouraged to spend time each week with other departments, which he regarded as representing the highest standards in their primary discipline. Uniquely his unit had a commitment to training in its initial terms of reference and he developed a whole generation of leaders in the field of applied epidemiology. When he retired, there were 27 senior academics around the world who had spent substantial time in his unit and another 43 who held senior posts in government departments or international organisations.

He was strongly supported by the Department of Health and particularly by Sir George Godber [Munk’s Roll, Vol.XII, web], but applied research had its frustrations. Early on research into the new district general hospitals was temporarily blocked on advice that the government should not fund research which could question government policy, and after 1979 research was increasingly seen as a potential problem rather than as an aid to better policy. Results of research were also sometimes ignored, including early warnings about increasing levels of obesity in children, one secretary of state even issuing a press release contradicting his assertion that there was a problem.

In 1939 his family was dispersed, his aunt and uncles moving to the New World; his grandmother, feeling that she was too old to resettle, opted to stay in Czechoslovakia and perished in Theresienstadt. He himself was an only child and possibly because of this kept up a strong network of friends and colleagues around the world and was very supportive of colleagues long after they had left his department. He was modest and rather shy in private, but intolerant of what he judged to be poor standards in science. It was inadvisable for anyone, whether a member of his department or a civil servant, to meet him unprepared or poorly briefed. He never sought controversy, but his dogged regard for the evidence as he saw it made him from time to time a controversial figure.

He was highly productive as both an author and editor, editing the International Journal of Epidemiology and the first three editions of the Oxford textbook of public health (Oxford, Oxford University Press). In the UK, he was elected president of the Faculty of Public Health and appointed CBE in 1992. Overseas he was elected president of the International Epidemiological Association and was honoured by universities in Berlin, Bordeaux and Pavia. He received the Salomon Neumann medal from the German Society of Social Medicine and was recognised as a ‘Hero of Public Health’ by the Johns Hopkins University School of Hygiene and Public Health on their 75th anniversary.

He was survived by his wife Fiona (née Love), three sons, Peter, Richard and Michael, and seven grandchildren.

Peter Burney

[RADAR Institutional repository of Oxford Brookes University Professor Walter Holland CBE PPFPM FRCP interview with Dr Michael Ashley Miller 1996 https://radar.brookes.ac.uk/radar/items/1f811b63-9d03-452b-b950-bc082696e105/1/ – accessed 31 January 2019; King’s College London News Professor Walter Holland CBE, 1929-2018 14 February 2018 www.kcl.ac.uk/lsm/newsevents/newsrecords/2018/feb/professor-walter-holland-1929-2018.aspx – accessed 31 January 2019; London School of Hygiene and Tropical Medicine Alumni Blog Obituary Professor Walter Holland 1929-2018 http://blogs.lshtm.ac.uk/alumni/2018/01/21/obituary-professor-walter-holland/ – accessed 31 January 2019; LSE The London School of Economics and Political Science Professor Walter Holland (1929-2018) http://blogs.lse.ac.uk/healthandsocialcare/2018/02/14/professor-walter-holland-1929-2018/ – accessed 31 January 2019; The Guardian 1 May 2018 www.theguardian.com/society/2018/may/01/walter-holland-obituary – accessed 31 January 2019; The Times 3 May 2018 www.thetimes.co.uk/article/walter-holland-obituary-9bpzv36lh – accessed 31 January 2019; Lancet. 2018 391 1018 www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30558-0.pdf – accessed 31 January 2019]

(Volume XII, page web)

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