In the 1970s, public health campaigns were heavily focused on the individual, exhorting people to give up bad habits or adopt healthier ones, while ignoring the importance of social and political determinants on personal behaviour. The commercial sector, meanwhile, was pushing health-damaging products with only rudimentary controls on their activities. David Player, as director of the Scottish Health Education Unit (SHEU) and then director general of the Health Education Council (HEC), was determined to change that.
David, who has died aged 93, was a trailblazer, decades ahead of his time. He made the plea: “Let’s have no victim-blaming. The ideal of public health requires public commitment to health rather than a shift of responsibility to the individual.” He favoured a two-pronged approach: creating health-promoting environments, while exposing the commercial forces that damage health.
A neat example of the first approach is the deal he brokered in the 80s with the Federation of Bakers to cut the salt content of all its bread by 12.5%, in exchange for the HEC’s logo on the packaging. This contributed to a significant decrease in national salt consumption, by influencing the foods available to buy rather than merely exhorting people to eat less salt.
He used sports sponsorship to promote the smoke-free message, including SHEU sponsoring the Scottish football team in the 1982 World Cup in Spain – the first anti-smoking team in the world. To support those thinking of quitting, in 1984 he helped launch National No Smoking Day, which became an annual event.
David relished taking on the tobacco and alcohol industries. The HEC and BMA in 1985 published a report by Bobbie Jacobson and Amanda Amos on how the tobacco industry was targeting young women through tailored cigarette advertising in the most popular women’s magazines, catering for a collective readership of more than seven million 15-24-year-olds. The research led in 1986 to a ban on tobacco advertising in large-circulation women’s magazines.
Tobacco companies were also diversifying into so-called “safer cigarettes” with endorsement by public agencies, which David opposed strenuously. He did not believe that public health bodies should be promoting tobacco use in any form and warned that it gave false legitimacy to the products.
He also challenged tactics designed to make the tobacco industry look good, such as funding the Health Promotion Research Trust, which, however, explicitly excluded research on the health effects of smoking. David referred to this funding as “blood money”.
In 1986, the HEC announced that it would withhold grants from researchers who received any funding from this tobacco industry source. Much soul-searching in academia eventually led to a shunning of unethical funding sources in many British universities.
David’s passion for social justice and highlighting the effects of poverty on health grew out of his early experiences. Born in Queen’s Park, Glasgow, to John, a police inspector, and Agnes (nee Gray), David was educated at Bellahouston academy in Govanhill, from where he was the first pupil to win a scholarship to study medicine at Glasgow University. After graduating in 1949, he served as a doctor in the British Army in Hong Kong, before returning to train in psychiatry in Dumfries.
He worked in general practice in Cumbria, serving poor mining communities, where he saw at first hand the effects of poverty on health. This inspired him to return to Glasgow University to gain a diploma in public health in 1960. He was appointed medical officer of health for Dumfries, where he set up innovative services and also worked at national level on strategic issues. Then he served as director of prison psychiatry in Scotland before becoming director of the SHEU in 1972, and a decade later director general of the HEC.
He never gave up his conviction that it was the structural determinants of health – people’s living and working conditions and income – that made a real difference and needed urgent action. With economic recession in the 80s, he became particularly concerned about unemployment and increasing inequalities in health. David commissioned me to update the evidence in the 1980 Black Report on health inequalities, which was eventually published in March 1987 as an HEC occasional paper entitled The Health Divide.
The report was described as “political dynamite” by the chair of the HEC, Sir Brian Bailey, who cancelled the scheduled press conference on the morning of the launch; too late, however, to stop media interest. When rumours started to circulate of possible suppression by the Thatcher government, a perfect media storm ensued. David was in his element, gleeful at the way the publicity was spreading the findings of The Health Divide and provoking serious concern.
He could not save the HEC, though. Powerful vested interests had already successfully lobbied for its closure, scheduled for the end of March 1987 and the debacle over The Health Divide sealed his fate, as he was rejected for the leadership of the HEC’s successor.
He went on to serve as director of public health for south Birmingham (1987-91), continuing to advocate for the local population.
On his retirement, David fulfilled one of his youthful ambitions by studying for a degree in Scottish history and English literature at St Andrews University, where he could not resist spicing up student politics. He remained active in advocacy, including sponsoring and supporting the Homeless World Cup. He never gave up giving a voice to marginalised people in society.
In 1955 he married Anne Darragh, whom he met while they were both undertaking postgraduate training at Dumfries Royal Infirmary. She died in 2006.
He is survived by their two sons, John and Stewart, and four grandchildren, and by his sister, Bunty.
• David Player, public health doctor, born 2 April 1927; died 2 October 2020
