Paradigmatic shifts in academic disciplines occur as a result of the interaction of a complex set of factors. The old paradigm must be exhibiting a demonstrable ‘crisis’. And the new paradigm must be championed by individuals that possess adequate commitment to mould it in the face of the inevitable resistances that will be posed by adherents and beneficiaries of the old paradigm. Peter Draper, who died on 30 July 2016, was a dogged champion of the need for public health practice to break out of the narrow medical and environmental focus that had characterised social medicine in the period immediately after the Second World War.
As early as 1953 Samuel Leff’s Social Medicine had heralded the importance of moving public health practice away from an individual focus to what subsequently became known as the social and economic determinants. This view was reinforced in the 1960s by the historical insights provided by Thomas McKeown’s critical analysis of the contribution of medical interventions to health improvement – initiated in Medicine in Modern Society and subsequently developed in The Role of Medicine. But it was the founding of the Unit for the Study of Health Policy at Guy’s Hospital in 1975 that provided the concrete platform for the development of a coherent approach to an analysis of the root causes of ill health.
Peter understood that the new paradigm would have to be multi-disciplinary. My own involvement with the Unit arose as a consequence of an editorial that I wrote for the New Scientist critiquing the prevalent practices within the discipline of operational research. Peter assembled a team from the disciplines of sociology, policy analysis, health economics, statistics, epidemiology and media analysis guided by an even broader based advisory network. The team was equipped to consider with authority the contribution of the economy, unemployment, the mass media, and the influence of governmental policies.
Peter understood that the new paradigm demanded political involvement. Peter’s politics (like many of ours to the current day) straddled the dichotomous strategic approaches of ‘greening the red’ and ‘reddening the green’. As an avowed rationalist (and humanist) Peter was deeply suspicious of entrenched doctrinaire positions, appreciating the need to draw eclectically on the insights of the old socialist movements and the emergent environmental movements. Peter embraced the local socialism that emerged from this dichotomy and specifically the local authority health movement that endeavoured to direct the insights of the new paradigm into the local government policies being pursued by progressive local authorities at that time.
Both of these understanding were brought together in the collection of contributions that Peter edited in Health Through Public Policy – The greening of public health. Peter had a ‘love-hate’ relationship with the media. Whilst being a vehement critic of the role of the media in reproducing perspectives which he felt held back health promoting opportunities he was an avid letter writer. His last letter to The Guardian appeared shortly before his death.
The subsequent ‘rediscovery’ of health inequality in the 1980s, the distinction between ‘cultural/behavioural’ and ‘structural/material’ influences, the development of the influential rainbow models all provided advances to the theoretical underpinnings of the new public health movement that developed in the wake of the work of the Unit for the Study of Health Policy. Peter might justifiably be considered to have been the earliest proponent and exponent of what was subsequently termed a Whole Systems Approach by the Who’s Commission on Social Determinants of Health. Peter’s formative role in what has now become the established and largely uncontested dominant paradigm in the practice of public health cannot be overstated.
Guardian obituary by Alex Scott-Samuel