Anthony J HedleyBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h611 (Published 05 February 2015) Cite this as: BMJ 2015;350:h611
- Jane Parry, Hong Kong
Less than two weeks before his death, Anthony J Hedley made a trip back to Hong Kong, where he had lived and pursued an illustrious academic career in public health from 1988 until his retirement in 2010. The purpose of the trip was to attend a forum held by the University of Hong Kong’s School of Public Health—an event attended by more than 350 former colleagues, students, public health professionals, and friends—in honour of his contributions to public health both globally and within Hong Kong.
Hedley returned home to the Isle of Man with an emeritus professorship from the School of Public Health to add to the many other acknowledgements he had received. These included the honorary degree of MD, presented by Thailand’s King Bhumipol Adulyadej; a World Health Organization medal for outstanding contributions to public health; and, in 2000, the Hong Kong Special Administrative Region Bronze Bauhinia Star.
Hedley was a public health polymath—an old-school generalist who also became a deeply knowledgeable expert on a range of issues: air pollution, tobacco control, life course epidemiology, health services research, and the control of infectious disease. As well as producing a substantial body of research across these domains, he was also a passionate advocate.
“He had a major role in ensuring that public health was recognised for its behavioural, economic, political, and advocacy dimensions,” said Richard Fielding, a former colleague and friend. “He was very clear about the importance of getting the message across in a focused way to achieve a particular outcome.”
In the area of tobacco control, Hedley provided the scientific underpinning for public policy in Hong Kong, with a prodigious research output that spanned smoke-free public places, smoking cessation, secondhand smoking, the economic costs of smoking to both health services and employers, as well as the direct relation between tobacco control and taxation.
“What leaps out of Tony’s work is that it was all highly relevant to public policy,” said David Simpson, a friend and the director of the International Agency on Tobacco and Health. Hedley’s advocacy for change to government policy, both in tobacco control and air pollution, was not without frustrations. “He would get a senior civil servant onside, and then that person would be rotated to another department, and Tony would have to start again,” said Simpson.
Hedley’s response to government intransigence and slowness in implementing tobacco control legislation and air pollution reduction measures was twofold: to criticise the government in the local media, and to go away and do even more research that would generate incontrovertible evidence that the lack of policy change was costing lives.
“In his view, the loss of one child’s health was one too many, and he did not accept the tradeoffs that political people make between population health and other perceived priorities,” said his wife, Sarah McGhee, honorary professor in the School of Public Health, University of Hong Kong. “The motivation to devote so much energy to air pollution and tobacco—among other topics such as infectious disease, other environmental pollutants, and the efficient operation of healthcare services—was the number of people affected and the availability of remedial measures requiring, in many cases, only political will.”
Anthony Johnson Hedley was born in Lancashire in 1941 and was educated there and in north Wales. David Moore, a friend since school days, recalled that Hedley was “only average academically, and yet . . . he had incredible drive and determination.”
He read medicine at the University of Aberdeen and published his first two papers in the Lancet while still a medical student.1 In 1965 he became house surgeon at Aberdeen Royal Infirmary, the start of a career that would take him to Dundee, Edinburgh, Nottingham, and Glasgow, as well as to Fiji2 and Thailand, before he settled in Hong Kong.
When Hedley arrived in Hong Kong, he decided early on that this was a place with a great deal of potential for public health research and advocacy. He began to work on multiple fronts, and was quick to spot an opportunity to gather evidence. “He was always able to see a natural experiment in the making and capitalise on it towards a particular policy initiative,” said Fielding.
When Hedley became the head of the University of Hong Kong’s department of community medicine, it had only a handful of staff with little research experience, hardly any funding, and no clout in the faculty of medicine. Over the following 22 years, Hedley expanded the department and it became a vibrant source of public health research and teaching. The department has now become the School of Public Health, with approximately 300 staff. These include many of Hedley’s former students, who have gone on to have illustrious careers of their own, including the current dean of the faculty of medicine, Gabriel Leung, who described Hedley as his “single most important inspiration and motivation.”
Beyond the university, Hedley, as the founding chairman, had a pivotal role in establishing and running the government’s Health Services Research Fund. The fund, renamed the Health and Medical Services Fund, continues to be a major source of funding for public health research in Hong Kong.
This achievement was an example of his determination to fight hard for public health, and his ability to be confrontational when necessary. Never one to shy away from a fight, he went in to bat for his department, determined to get what he wanted. “Sometimes toes got trodden on and egos got bruised in the process,” said Fielding. Some of Hedley’s passion and tenacity played out in the local press. He became adept at working with the media, always went to journalists well armed with evidence, and was not afraid to be strident in his criticism of the government.
While his advocacy for real policy change had mixed results, one of his greatest sources of satisfaction was “seeing the staff he had mentored and the research students he had supervised get on in their careers and make their own contributions to public health,” said McGhee.
Friends and colleagues variously describe Hedley as pugnacious, determined, strident, tenacious, intimidating, grumpy, curmudgeonly, and passionate. “He was not a one-sided person,” said Jan Johnston, associate professor at the School of Public Health. He was also described as having had a softer side, generous with both his time and his money. He had a wide range of passions outside work, including history, astronomy, photography, classic cars, and flying (he obtained his pilot’s licence in 1992), as well as a lifelong appreciation for a glass of decent real ale.
After his diagnosis of neuroendocrine cancer in 2008 he continued to work, teaching public health trainees in Hong Kong and conducting classes via Skype until a few weeks before his death. “If anyone could make the most of the six years between diagnosis and death it was Tony,” said Simpson. “He treated the cancer as a bloody nuisance, but said after he underwent treatment in 2009: ‘I doubt I’ll make old bones.’” His determined nature remained to the end, however: in recent years, when he was undergoing treatment at the Liverpool Royal Infirmary, he insisted on being on his own clinical case review team.
Anthony J Hedley (b 1941; q Aberdeen 1965; MD, FRCP, FFPH (UK), FHKCCM, FHKAM), died from cancer on 19 January 2014.
Cite this as: BMJ 2015;350:h611