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Observations BMJ Confidential

Anthony Costello: Irreverent, melancholic, dogged

BMJ 2016; 353 doi: (Published 29 June 2016) Cite this as: BMJ 2016;353:i3550


Anthony Costello, 63, is head of maternal, newborn, child, and adolescent health at the World Health Organization. Trained as a paediatrician, he worked for Save the Children in a remote corner of Nepal, where he pioneered an approach to neonatal care that combined research with action. With Nepalese colleagues he has published many studies showing the huge benefits of women’s groups in spreading good care and cutting maternal and child mortality. As director of the Institute for Global Health at University College London, he chaired two influential reports on climate change. Born and raised in southeast London, he still supports Millwall FC.

What was your earliest ambition?

To be a doctor—and to play football for Millwall and cricket for England.

Who has been your biggest inspiration?

My grandfather, for his wit, charm, and principles.

What was the worst mistake in your career?

I don’t look back on career choices as mistakes, because my experiences were all opportunities to learn. Maybe I could have come to work at WHO a bit earlier than I did.

What was your best career move?

Accepting a job with the Save the Children Fund to work in Baglung in the middle hills of Nepal, two days’ walk from a road.

Bevan or Lansley? Who has been the best and the worst health secretary in your lifetime?

David Ennals was principled and commissioned the Black report [into health inequalities]. I have concerns about Andrew Lansley, who chose reform without evidence.

Who is the person you would most like to thank, and why?

My wife, Helen, and the children, for their love and support—and for tolerating my absences, idiosyncrasies, and obsessions.

To whom would you most like to apologise?

My colleagues in Malawi, Nepal, Bangladesh, India, and UCL for failing (so far) to land a grant to study the impact of women’s and farming groups working together on sustainable agriculture and on household ecosystems for better child nutrition. We’d worked on the proposal for two years.

If you were given £1m what would you spend it on?

If not on that research project, I’d buy farmland and woods to create apothecary and potager gardens and a cooperative permaculture community.

Where are or were you happiest?

With my family at Thornwick Bay, near Flamborough in Yorkshire.

What single unheralded change has made the most difference in your field in your lifetime?

Tablets for data collection that enable faster analysis and reporting of cluster randomised trials in large, poor, and remote populations. Also, recognition of the importance of empowering local people to transform their own health and to hold health systems accountable.

Do you support doctor assisted suicide?

Yes, but exceptionally: only if sanctioned by the judiciary and with widespread availability of excellent hospice and palliative care.

What book should every doctor read?

Poverty and Famines by Amartya Sen, a treatise on entitlements and the social and economic determinants of health.

What poem, song, or passage of prose would you like mourners at your funeral to hear?

Gil Scott-Heron’s “Save the Children” (live).

What is your guiltiest pleasure?

Swiss chocolate.

What television programmes do you like?

BBC Four’s archive documentaries on classical, jazz, and soul musicians; Sky Sports news, House of Cards, University Challenge, and The Thick of It.

What is your most treasured possession?

It’s a close call between my red Swiss Stromer electric bike and my Selmer tenor saxophone.

What, if anything, are you doing to reduce your carbon footprint?

Video lectures, cycling, less red meat, and train travel. But my carbon footprint is still utterly shameful: in my current job it’s difficult to practise what I preach.

What personal ambition do you still have?

To help WHO, countries, and national institutions enable women and children to survive, thrive, and transform their lives.

Summarise your personality in three words

Irreverent, melancholic, dogged.

Where does alcohol fit into your life?

I haven’t drunk a drop since 2005, when I started daily verapamil for right ventricular outflow tract tachycardia.

What is your pet hate?

Queues at airports.

What would be on the menu for your last supper?

Buffalo momos [dumplings], fish and chips, summer pudding, a Sprüngli chocolate rabbit, and an île flottante.

Do you have any regrets about becoming a doctor/academic?

None. I’ve loved every minute of my career in clinical practice, research, and global policy. Health is the commodity everyone values above all, and it’s been a privilege to work with so many amazing people.

If you weren’t in your present position what would you be doing instead?

Helping to strengthen research and practice with young people at a university or medical school in Malawi, Nepal, or Bangladesh.

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