FIFTEEN MINUTES WITH...
Professor Sir Andrew Haines
Authors: Graham Easton
Publication date: 15 Jan 2005
Professor Andy Haines, director of the London School of Hygiene and Tropical Medicine (LSHTM), received a knighthood in this year's New Year's honours. He has played a leading part in the development of the NHS research and development programme and made a major contribution to thinking about how to address the health needs of disadvantaged populations. His research interests include primary care and the study of environmental influences on health.
How did you first discover you had been awarded a knighthood?
I received a letter from 10 Downing Street when I returned from a trip abroad some weeks before Christmas. I was asked to keep it confidential until the New Year's honours list was published. I regard the knighthood largely as recognition of the outstanding work of colleagues at the LSHTM in advancing public health nationally and internationally.
What's been your career path to your current job?
After my house jobs in London, I spent five months in Jamaica. I undertook further hospital training in the United Kingdom and subsequently worked in Nepal for a year with the Britain Nepal Medical Trust, focusing on the treatment of tuberculosis. After returning to the United Kingdom I realised that I enjoyed tackling a range of clinical problems but that seeing patients in a hospital setting did not help to understand the natural history of disease or how ill health affected the patient and their family in their home environment.
I was fortunate to approach Professor Tom Meade, then director of MRC Epidemiology Medical Care Unit at Northwick Park, to ask for career advice. He recruited me to a position in the unit but initially based in Julian Tudor Hart's general practice in South Wales, which provided outstanding training in general practice as well as a good grounding in field epidemiology in a primary care setting. This was very influential in subsequent career choices.
I continued with general practice in north London and was appointed professor of primary health care and head of a new academic department at University College London (UCL). During my time at UCL I worked part time on secondment as regional director of research and development for North Thames. My practice commitment gradually declined, but I continued to see patients until I joined the LSHTM at the end of 2000.
What are the main health challenges in the wake of the Asian tsunami?
In the short term the main health challenges following the tsunami are likely to be infectious diseases, particularly waterborne diseases such as cholera, as well as other diarrhoeal diseases, and probably leptospirosis. Malaria could also be a major problem in some of the affected areas, particularly when populations are sleeping outside and are inadequately protected by insecticide treated nets. On the basis of experience of previous natural disasters the mental health effects of experiencing a disaster of this magnitude may be long lived, with increases in anxiety, depression, and perhaps suicide as well as increased behavioural disorders among children.
The sheer scale of the disaster has made it difficult for emergency aid to respond effectively, and malnutrition could be a problem in some isolated populations. This disaster has shown how aid needs to match the epidemiological profile of problems that are being encountered. Well intentioned but uncoordinated activities can actually increase the strain on local facilities and administration, but sometimes the understandable need for each non-governmental organisation (NGO) or national government to be seen to be acting has over-ridden the need for coordinated and properly targeted aid. The added danger is that once the spotlight turns away from the disaster to other events, the resources that have been pledged will not materialise and the necessary reconstruction phase will be seriously underfunded.
What do you enjoy most and least about your job?
I enjoy working with highly skilled and committed colleagues whose work addresses many of the public health challenges that confront us nationally and internationally. Although much of the focus is on generating knowledge to improve treatment, prevention, and health promotion and to ensure that research evidence influences policy and practice, there is also a strong interest in methodology and a real sense of intellectual ferment in the school, where new ideas are debated and developed. The thing I enjoy least is the growing bureaucracy of academic life. Much of it originated from good intentions but ends up by stifling research and innovation.
How would you advise doctors who want to do research or tropical medicine?
I think this can be summarised as: ensure that you get a good training in research methods, find a research topic area that really engages you, and do your best to work with the research leaders in your chosen field. If you are a clinician and wish to practise in tropical medicine, experience in a low income country setting will be important. Many of the research questions that interest you will probably arise from your clinical practice and from trying to improve the delivery of services to patients with limited resources.
You advocate the benefits of changing behaviour to improve health—what's the most important change you have made?
My own most important behaviour change is improving my level of fitness since I took up cycling. I also find cycling a great way to relax after a busy day. Although there are risks, I try to minimise these by avoiding roads with fast moving traffic.
Graham Easton editor