Ernest Donald Acheson

Abstract

UK epidemiologist and Chief Medical Officer who dealt with HIV/AIDS and BSE. He was born on Sept 17, 1926, in Belfast, UK, and died on Jan 10, 2010. One of the minor rewards of chairing a government working party is to be eponymously memorialised. Donald Acheson, UK chief medical officer (CMO) from 1983 to 1991, achieved this distinction twice. The first “Acheson report”, published in 1988, considered the role of public health; the second, in 1998, reviewed inequalities in health. Both were well received and influential, but the latter is the more remembered. Commissioned by the newly elected Blair Government the second report was intended to identify “cost-effective and affordable interventions to reduce health inequalities”. Acheson and his colleagues itemised a list of potentially beneficial policies encompassing many social determinants of health from housing and employment to pollution and nutrition. They argued that all government policies likely to affect health should be evaluated for their influence on inequality. Professor Cyrus Cooper, director of the Medical Research Council (MRC) Epidemiology Resource Centre in Southampton, has known Acheson since the late 1970s. The report on inequalities, he says, had an effect not only on health policy but on the research agenda within the population sciences. “It pointed to the life course origins of health inequality. Not just when you're at the age when you actually suffer the common morbidities that lead to premature death, but to their origins throughout life, and perhaps even in the generation before. And this led to a policy focus on the pregnant woman, infancy, and adolescence.” A New Labour Government was never likely to respond to work on inequality as dismissively as the Conservative Government had been towards a report on the topic published during its term of office. And so it proved. But this is not to suggest that Acheson's career had been free of strife. His period as CMO coincided with the emergence of HIV as a major problem, and with the advent of bovine spongiform encephalopathy (BSE). His response to the former was to successfully confront it. “I think what he did with HIV was truly impressive”, says Professor Sir Michael Marmot, director of the UCL International Institute for Society and Health. “This was early days, and it would have been easy to underestimate it or do nothing. He was very impressive.” He had to work hard to ensure that HIV/AIDS was treated with the seriousness it required. His handling of BSE was less surefooted, partly because of conflicting interests of the health and agriculture ministries. In a subsequent enquiry into the BSE outbreak he publicly regretted having been too insistent in his claims that eating beef could be judged risk free. Acheson's public responsibilities had been preceded by a distinguished academic career. The son of a public health doctor, he studied medicine at Oxford University, qualified in 1951, and subsequently worked at Oxford University for 10 years, latterly as director of the Oxford Record Linkage Study. A chair in clinical epidemiology took him to Southampton University, where he became the first dean of its new medical school, and then director of the MRC Environmental Epidemiology Unit before taking on the job as CMO. He was well suited to this task according to Cooper: “He was one of the few people able to span the range from discovery science through to policy implementation.” The late 1970s and early 1980s was a period of confusion and demoralisation for public health. Invited to chair a working party on its future, his findings (the first “Acheson Report”) marked a new beginning for the specialty. In Cooper's view, “It served as the stimulus to put public health on a strong intellectual, practical, and academic footing.” The role of CMO may have been the high point of Acheson's career, but it was not his final job. No sooner had he left government service than he responded to a request from WHO to go to Bosnia to assess the public health problems of that war-torn country. The work was exhausting and occasionally dangerous. He later became chair of the then UCL International Centre for Health and Society: another peace-making role, albeit a less hazardous one. He acted as a sort of eminence grise, Marmot recalls, keeping control of the intellectual wrangling between his enthusiastic younger colleagues. He is survived by a wife and a daughter, and also by a wife, son, and four daughters from a previous marriage.