Tony McMichael, who sadly died in September 2014, was an outstanding and visionary public health scientist who was particularly renowned for his pioneering work on climate change and health.
He showed early awareness of the need to address injustice and defend the disadvantaged. As a student he spent a summer volunteering at a leprosy colony in New Delhi, India where he saw how patients were treated as social outcasts suffering from the stigma of a disfiguring disease although they were no longer contagious. This experience made him committed to tackling prejudice and also gave him a compelling insight into the need to address the causes of disease to prevent premature death and disability. The following year, whilst on a similar service trip to Papua New Guinea he met social sciences student Judith Healy, whom he married shortly after graduation. He graduated in Medicine from the University of Adelaide in 1967 but rather than going immediately in to clinical medicine he spent a year as President of the National Union of Students in 1968 during a turbulent time in world history. He was subsequently invited to become the PhD student of Professor Basil Hetzel who had recently been appointed to launch a department of social and preventive medicine at Monash University in Victoria and who later became an influential figure in public health. He gained skills in epidemiological research which stood him in good stead throughout his professional career but also showed early evidence of independent enquiry informed by reading the works of thinkers such as Paul and Anne Ehrlich who questioned the capacity of the Earth to support a growing world population with increasing consumption of resources.
He was fortunate to be offered a position at the University of North Carolina studying the health of workers in the tyre industry. He recognised that workers were often in better health then the general population despite potentially hazardous exposures and coined the term ‘healthy worker’ effect which has become widely used in epidemiology.
Back in Australia he was asked to investigate the health effects of lead exposure including helping to find out why so many women experienced stillbirths in the town of Port Pirie, home to the largest lead smelter in the southern hemisphere. This work, which was to extend over a decade showed, for example, that children with high lead levels scored substantially lower on tests of cognitive function compared with those with normal levels. The finding resulted in a public outcry and massive efforts to clean up the local environment.
He also played a leading role in research on the epidemiology of Multiple Sclerosis which demonstrated the marked latitudinal trend of MS prevalence in Australia with rates in Tasmania being 4 or 5 times higher than in Queensland. This research pointed to the possible role of ultraviolet radiation exposure as an immune system modulator.
Any of these major advances would have been sufficient to guarantee Tony a global reputation as a leading epidemiologist but it is for his work on climate change and health that he became best known and where his long term legacy is greatest. His first book ‘Planetary Overload; Global Environmental Change and Human Health,’ published by Cambridge University Press in 1993 is a classic. It showed how humanity was on an unsustainable course as a result of patterns of resource use, greenhouse gas emissions and population growth. He made the convincing case that human health was underpinned by ecosystem health.
Around that time he also became extensively engaged in the UN intergovernmental Panel on Climate Change and 1993 was asked to chair the health risk assessment chapter team for its second assessment report. He co-edited a major WHO/WMO/UNEP report on climate change and health which appeared in 1996. The World Health Organization also asked him to lead work to estimate the annual global burden of disease attributable to climatic changes that had occurred by the year 2000 and he became immersed in the scientific challenges of estimating impacts across a range of health outcomes. These estimates suggested that over a hundred thousand people a year were already dying as a result of climate change but also pointed to the difficulties of estimating the indirect impacts on outcomes such as mental health.
From 1994-2001 he was Professor of Epidemiology at the London School of Hygiene & Tropical Medicine, before returning to Australia to follow Prof Bob Douglas as director (2001-2006) of the National Centre for Epidemiology and Population Health. In 2011 he was made an Officer of the Order of Australia, and in the same year was elected to the US National Academy of Sciences.
Tony published well over 300 peer-reviewed papers and 160 book chapters and two sole-authored books, the second being Human Frontiers, Environments and Disease: Past Patterns, Uncertain Futures(2001). A third When Climates Change. Famines, Fevers and Fates of Populations – Past and Future) was in an advanced stage of preparation at the time of his death and will appear posthumously. He also co-edited nine books.
A Festschrift to commemorate his extraordinary career was held in 2012. An associated book called ‘ Health of people ,Places and the Planet . Reflections based on Tony McMichael’s four decades of contribution to epidemiological understanding ‘ will appear next year and will be available for free download.
Tony was a warm and engaging friend to many and an inspirational teacher and lecturer. He was also unafraid to speak out when he disagreed with decisions. Shortly before his death he was the lead author of an open letter in the Medical Journal of Australia to Prime Minister Tony Abbott who had failed to include climate change in the agenda of the G20 meeting. The letter stated ‘We urge you to include human-induced climate change and its serious health consequences on the agenda for this year’s G20 meeting. The world community looks to high-income countries for a strong lead. Current climate trends, driven by global warming, threaten the basis of future economic prosperity, regional political stability and human health’.
Tony will be sorely missed by many of us but has left a rich and enduring legacy which constitutes a wake up call for humanity to address the underlying threat of global environmental change to the future of humanity. His message though was ultimately a positive one – wise decisions implemented soon can avert disaster. Ensuring that his seminal work lives on will be a major focus of public health in years to come.
Professor Sir Andrew Haines