As a doctor in a coalmining community in the Welsh valleys, Julian Tudor Hart, who has died aged 91, pioneered much of what is now accepted as routine preventive care. He led a research practice for almost 30 years, and coined the term “inverse care law” to argue that communities most in need of good healthcare are those least likely to receive it.
The key to his research, which brought him worldwide renown, was the remarkable and sustained cooperation of his 2,000 patients, given in return for his unswerving commitment to them. As a lifelong socialist and one-time Communist party candidate, he was a staunch defender of the founding principles of the NHS, which marked its 70th anniversary in the week of his death.
Working in, and with, a Welsh mining community had been Tudor Hart’s ambition since he began his medical career in 1952. The opportunity came nine years later when he moved to Glyncorrwg, a village in the Afan valley, and set up a research practice in what was little more than a wooden shed. Mary Thomas, a medical researcher of equally radical convictions, followed him and in 1963 became his second wife.
By gradually winning the trust and confidence of what was then still a thriving, close-knit and critically – for research purposes – stable community, he built an unparalleled database which formed the basis of his groundbreaking work in blood pressure monitoring and hypertension, the effects of salt in diet and the benefits of warfarin as a preventive medication. In the case of one double-blind warfarin trial among miners at risk of coronary heart disease, 85% of participants were still involved after 12 months.
Tudor Hart’s son, Ben, who is a GP in east London, recalls how miners would dutifully comply with collection of stool samples and take “pee bottles” underground with them so that the doctor and his researchers, headed by Mary, could analyse their urine for salt content. He himself was obliged to take one to school.
The Glyncorrwg practice was the first to win funding from the Medical Research Council. Standardised death rates for the village in the 1980s were found to be 28% lower than for a comparable community, while smoking rates fell over 25 years from 56% of the adult population to 20%.
Writing in 1988 in A New Kind of Doctor, one of several books and many articles he authored, Tudor Hart described what he called this “anticipatory care” and how it worked in the case of a miner who had become hypertensive at 36, was obese and a heavy drinker: “For the staff of our health centre, it was a steady unglamorous slog through a total of 310 consultations (over 26 years). For me, it was about 41 hours of work with the patient, initially face-to-face, gradually shifting to side-by-side.
“Professionally, the most satisfying and exciting things have been the events that have not happened: no strokes, no coronary heart attacks, no complications or diabetes, no kidney failure with dialysis or transplant. This is the real stuff of primary medical care.”
Born in London, Julian came from a leftwing medical family: his father, Alexander, was a Communist party member who volunteered as a surgeon for the International Brigades in the Spanish civil war; his mother, Alison Macbeth, was also a doctor and a member of the Labour party. Alexander was later to marry, then divorce, the photographer Edith Suschitzky, recently revealed to have been the matriarch of the Cambridge spy ring.
Julian was educated at Dartington Hall, the former progressive boarding school in Devon, and, after evacuation to Canada during the second world war, at Pickering college, a Quaker-founded school in Ontario. He returned to the UK in 1945 and, following national service, studied medicine at Queens’ College, Cambridge, and St George’s hospital in London.
On qualification, he took a succession of hospital posts in London, Essex and Northamptonshire, but it was an experience in primary care in deprived north Kensington, west London, that was the most formative. He also gained research experience alongside epidemiologists who were to become illustrious figures in the field: first, Richard Doll at the London School of Hygiene and Tropical Medicine; subsequently, in a move that took him to south Wales, Archie Cochrane at the then Welsh National School of Medicine.
Tudor Hart retired from clinical practice in 1987 and he and Mary moved from Glyncorrwg, which by then had gone into steep decline following the closure of its pit, to a house on the Gower peninsula overlooking Oxwich Bay, where he found more time for his drawing – he was a talented cartoonist – and precision modelling.
He kept up a demanding pace of work, however, continuing his research interests at Swansea Medical School, where he was a fellow, and through honorary positions at the universities of Cardiff, Glamorgan and Glasgow. He continued to contribute to medical journals, though he became ambivalent about his inverse care law, which he had first described in the Lancet in 1971, because it became widely cited only in part – omitting his qualification that it “operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced”.
Tudor Hart, who was a founder member and first honorary president of the Socialist Health Association, never wavered in his opposition to what he saw as marketisation of the NHS. He was allowed to join the Labour party in 1981, having stood for Westminster three times on a communist ticket and having retained his Communist party of Great Britain membership until 1978, but he was a critic of the Blair government’s courting of private health interests.
He welcomed Jeremy Corbyn’s election as Labour leader and was especially pleased that the Welsh Labour government had used its devolved health powers to resist England’s market reforms.
He is survived by Mary, and by their children, Ben, Robin and Rachel; by Penny and Alison, the daughters of his first marriage, to Joyce (known as Jo, nee Murison), which ended in divorce; and by 16 grandchildren. A son, Adam, predeceased him.
• Alan Julian Macbeth Tudor Hart, doctor, born 9 March 1927; died 1 July 2018
