On 1 July 2018, the world lost one of the most celebrated pioneers of social medicine. Born in 1927, Julian Tudor Hart was raised by left-wing physicians in the London home he described as a ‘transit camp for anti-fascist refugees.’ His father, Dr Alexander Tudor Hart, was a former student of John Maynard Keynes and an active communist who volunteered as a surgeon in the Spanish Republican Medical Aid Committee. His mother, Alison Macbeth, was also a doctor and a member of the Labour Party. Julian, despite his parents’ objections, followed in their footsteps and went on to study medicine at Queens’ College, Cambridge, before graduating in 1952. He then worked in a number of hospitals and research posts before, in 1961, setting up his own research-based general practice in the small mining town of Glynncorwg, South Wales.
All the while he was devoted to politics. Tudor Hart went on to stand unsuccessfully a number of times between 1964 and 1970 as the Communist Party candidate for the Aberavon constituency in the Welsh Valleys, before joining the Labour Party in 1981. During this period Tudor Hart became a founder member of the Socialist Health Association — an organisation he would later become a long-term honorary president of. It was here, alongside his membership of the Sigerist Society, that he did his most important work analysing healthcare from a Marxist perspective.
Since the end of the Second World War general practice had been undergoing something of a revolution, with movements in the field pushing for a more holistic approach to family medicine, considering lifestyle factors and focusing on preventative medicine. Tudor Hart began researching ways to improve the health of the community he served, and pioneered treatments for what is now the biggest killer of people worldwide: cardiovascular disease. He was the first ever doctor to measure the blood pressure of all his patients, managing to reduce deaths in his area by 28 percent compared to neighbouring villages. This approach to medicine — one that is preventative in nature and seeks to target communities that are of definite risk based on social factors — has been pivotal to our understanding of healthcare today.
However, Hart’s most famous work was his analysis of the impact of market forces on public health. In 1971, he put forward his theory of the ‘Inverse Care Law’.
The availability of good medical care tends to vary inversely with the need for the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced. The market distribution of medical care is a primitive and historically out-dated social form, and any return to it would further exaggerate the maldistribution of medical resources.
The Inverse Care Law predicted the glaring inequities in our health system that followed the Thatcherite and New Labour reforms of the eighties and nineties — but it also spoke to more general disparities. Outcomes such as life expectancy are highly varied across regions of our country.
Take, for example, England’s two Kensingtons: one, a London borough with the country’s richest street, and the other, a deprived area in Liverpool. In the former, a baby boy can be expected to live up to 13 years longer than his poorer counterpart. The Office for National Statistics have ascribed regional disparities of life expectancy to ‘socioeconomic, environmental (including working conditions), educational and lifestyle factors, which may act throughout the lifetime of those living in the north, and possibly over generations.’ As governments continue to cut public healthcare, the truth of Tudor Hart’s Inverse Care Law is evident.
After the Thatcher government closed the mines and destroyed the community that Tudor Hart had spent decades working for, he finally retired to the Gower, South Wales in 1987. There he grew vegetables, pursued his hobby of drawing, and campaigned tirelessly for the NHS, which he believed should be kept away from the market at all costs. Julian Tudor Hart spent his life pursuing a vision of a world without healthcare inequity. It was a world where every person would have a right to their health, where no one died or suffered because of their bank account and where no child’s life expectancy was determined by their postcode. Such a healthcare system, he believed, would be ‘a model for the socialist future of humanity.’