WORKING AT USHP
The Unit for the Study of Health Policy (USHP) was an inter-disciplinary team which Peter set up in 1975, with the aid of a 5-year grant from the King Edward’s Hospital Fund for London. The King’s Fund showed courage in funding this. The Unit was part of the Department of Community Medicine at Guy’s Hospital Medical School, under Jock Anderson who had a turbulent relationship with their rebellious offspring, but to their credit stayed with it. The Unit survived until 1984, struggling to find funding in its later years. I was a research assistant in the team from 1978 to 1981. It was only my second job! I was very fortunate to have this unique experience.
There was much debate amongst us on the difference between inter-disciplinary and multi-disciplinary! The professional backgrounds of the young team were extra-ordinarily wide-ranging. They included medicine, epidemiology, demography, social science, history and economics and demonstrate Peter’s breadth of vision. Team members included, amongst others and in no particular order, James Partridge, Jennie Popay, Gordon Best,Tony Smart, Linda Marks, John Dennis and David St George, amongst others.
The very clear purpose of the Unit was to “promote the informed public discussion of issues of health policy”, by publishing reports and working with the media. Its reports were deliberately aimed at the general reader, including politicians and civil servants, as much as professionals working in public health, and aimed to promote public debate.
The Unit was supported by an Advisory Council which was chaired for some years by Drummond Hunter, an outstanding leader who led the Scottish Health Service Planning Council, and included amongst others David Player who became Director of the Health Education Council in the early 1980s.

THE WORK OF USHP
It is hard to appreciate now how radical the Unit’s work seemed at the time. How contested it was. The concept of sustainable development which underpinned the Unit’s work, the need to balance economic, social and environmental development, was in its infancy in the 1970s
The availability of strong evidence on the health damage caused by anti-social, anti-environmental economic policy was quite new. I remember vividly the impact of, for example, Harvey Brenner’s work on mental illness and the economy; Marc Lalonde’s book “A new perspective on the health of Canadians”, and Schumacher’s “Small is Beautiful” all of which were published in the early 1970s. And then a little later there was of course the scandal of the suppression of the seminal Black Report on inequalities in health: just 260 copies were famously made available by the Department of Health in 1980, before it was published properly by Pelican.
The Unit for the Study of Health Policy published an unprecedented and unique series of ground-breaking publications which are still remembered in the public health community. Whilst preparing this, I found that a couple of them are still available in a library in Australia! They included:
Health, Money and the NHS (1976);
Economic Policy and Health (1976);
Health, The Mass Media and the NHS (1977)
The NHS in the next 30 years – a new perspective (1978);
And one that was particularly important for me, Rethinking Community Medicine: towards a renaissance in public health (1979);
And a paper in the BMJ in 1980 called “Three Types of Health Education” which was widely quoted for some years.

The NHS in the next 30 years
Importantly and perhaps unusually, Peter wanted to have an impact on both public health and also on the NHS. Most USHP publications (and Peter’s subsequent papers, articles and letters) had content on both, underpinned by a vision of a health-promoting economy. He always saw the need for balance – effective prevention of ill health, but also better treatment services.
The essence of the USHP’s work was the conflict between health and unselective economic growth, perhaps best summarised in “The NHS in the next 30 years”. Chapter 2 of this contains a trenchant critique of economic growth - that higher GNP means a better-off Britain and a happier world – on the grounds that GNP, used as a surrogate to measure social well-being, is misleading, partial and invalid (because it measures only the level of economic activity, not its purpose or constituents).
Chapter 3 set out the principles of a health-promoting rather than health-damaging economy, creating an environment where the healthier choices are the easier choices (a slogan we all used for years afterwards) for example though a radically-different basis for agriculture.
Then in Chapter 5, “The NHS in the next 30 years” describes the shift needed from an NHS dominated by modern scientific medicine undertaking “repair and salvaging”, to focusing upstream on a more positive approach to health. Crucially, it was mistaken to think that progress in health will be achieved by first getting the economy right, so that we can later spend more on health services.

Rethinking Community Medicine
“Rethinking Community Medicine: Towards a renaissance in public health” argued that Community Medicine which was then as you will recall a new medical specialty within the NHS, established in the context of the massive reorganisation of 1974, was being medicalised by the NHS. “Rethinking Community Medicine” recalled the glory days of the Medical Officer of Health, unafraid to take on major social issues in the fight for the public’s health.
To quote its analysis: “Within the reorganised NHS … with its focus on individual responsibility for health, Community Medicine has a … mistaken task. It has led to the neglect of effective watchdog activities in relation to contemporary health hazards. The unhealthy environment of today … is taken largely as given, as a series of problems to be adapted to, or as a subject for medical preaching to supposedly guilty individuals (refer to victim-blaming). As an approach to the prevention of disease and the promotion of health this is totally inadequate.”
“Rethinking” set out a vision for the creation of a contemporary public health movement which stimulated change towards a healthier social and economic environment, with health promotion teams focused on, for example, transport or food and nutrition. Peter often quoted from the Greek myth of Hygieia, the goddess of good health – the importance of people collectively governing their lives wisely.
It is both astonishing and sad to reflect that USHP publications are now nearly 40 years old, but are as true and valid today as when they were published. Times have NOT changed.
The shaping of public debate on health by the mass media (mainly newspapers in those days) was a crucial focus of the USHP’s work, with daily analysis of news content being undertaken and responses made. Peter’s attempts to influence the mass media continued throughout his life. I am grateful to Marcia Saunders for this one – perhaps the pinnacle of Peter’s coverage in the press – no less than a Daily Mail front page headline, “POP DOC SLAMS HEART SWAPS” – Christian Barnard was undertaking the first heart transplants at the time – the ultimate in repair and salvage.

WORKING WITH PETER
Peter was brave and fearless in tackling the “establishment” both within the NHS and in the political and economic system. He was prepared to take on formidable power blocks in society, and earned much hostility in the process.
He was a big-hearted, warm and generous person, charismatic and mercurial – both wonderful to work with, and at times quite difficult, as you might expect. He was exciting to work for. You never knew when you arrived at the USHP’s home, 8 Newcomen Street, near Borough Market, in the morning (glancing askance as you did so at the army of bowler-hatted men marching across London Bridge on their way to their city offices) what would be happening that day.
What happened often depended on something outrageous Peter had read in the media, the night before or earlier that morning which excited his passion and, in his view, required immediate response. Getting sustained work completed on USHP’s major publications could be difficult, because of the frequent need to craft reactions to anti-health opinions expressed in the media, which could take hours.
Discussion and drafting at lunch time and after work (the timing of which could be very elastic!) often took place over a swift half – or more - in the “other office”, the hostelry across the narrow road which is Newcomen Street.
Peter was an excellent writer with a brilliant use of language, prepared to spend much time on revising and re-revising drafts, and honing prose to the highest possible standard. He could come up with vivid, memorable phrases. One of these was quoted by Joanna Lyall in the BMJ obituary, describing public health as “raising hell to reach heaven”, which I think is wonderful.
My 3 years at USHP shaped the values and principles that have underpinned the rest of my life. It is impossible to overstate their importance for me and therefore my gratitude to Peter … As one small example, a Faculty of Public Health document I co-authored with Lindsey Stewart at the FPH a few years ago, currently sat on my desk awaiting an attempt at revision and re-presentation, is called “Sustaining a Healthy Future”. It is a direct descendant of Rethinking Community Medicine and The NHS in the next 30 years.
Jenny Griffiths