Tributes to the late Dr Nigel Gray AO are being inscribed here on the Cancer Council Victoria website, and the World Health Organization has also published a warm acknowledgement of one of the “pioneers and cutting edge thinkers” of its global tobacco control network.
In the article below, Rob Moodie, Professor of Public Health at the Melbourne School of Population and Global Health, explains why he believes Gray’s pioneering work in tobacco control is deserving of Nobel recognition.
A masterful scientist and a consummate artist
Rob Moodie writes:
If we use Charles Winslow’s definition of public health, as “the science and art of preventing disease, prolonging life and promoting health…”, then Nigel Gray was not only a scientist of great rigour and constant inquiry, but was also a consummate artist.
He was Director of the Anti-Cancer Council Victoria for over 27 years, from 1968. The University of Sydney’s Simon Chapman describes him as “the unequivocal father of global tobacco control”.
Gray started the International Cancer Control Union (UICC) Tobacco Program, which brought together a small group in the mid-70s to start making tobacco control happen in a co-ordinated way internationally.
According to the Professor of Health Policy at Curtin University, Mike Daube, who was a member of this group:
“Nigel was the absolute tops. We wouldn’t be where we are without him.
“He promoted the consensus policies in “Guidelines for Smoking Control”, ran workshops, spoke at conferences, met with health groups, somehow got in to see health ministers and the like in every continent.”
Gray was the driving force behind the first programs to promote global action on tobacco, including low and middle countries, where the ravages of tobacco smoking are only now being seen in epidemic proportions.
Later as President of the International Cancer Control Union (UICC), he brought together cancer societies and many other health organisations across the globe to battle the economic and political muscle of the tobacco industry, now more commonly referred to as Big Tobacco.
To lead and manage an organisation as successful as the Anti-Cancer Council Victoria (as it was then called) over 27 years is an extraordinary feat in itself. Very few people have the persistence, innovativeness, tenacity and skill to do this.
Yet over this time Gray led Anti-Cancer Council Victoria to become the pre-eminent non-government health organisation in Australia and a global leader in tobacco control.
Some of the key elements of this success have been the development and implementation of highly regarded epidemiological and behavioural research in both cancer and smoking; the regular monitoring of tobacco use; and the relentless commitment to evaluation of intervention programs and new policy initiatives.
He also led the introduction of skin cancer prevention – the Slip! Slop! Slap! campaign- as well as Pap smear and breast cancer screening.
Gray was a generous mentor, as his protégé and successor Professor David Hill says:
“I and many of my public health counterparts have been the beneficiary of Dr Gray’s generosity and willingness to encourage and mentor those working in public health and advocacy.”
Hill also acknowledges Gray as an “extraordinary mix of establishment persona and radical thinker and his ability to bring out the best in those working with him” which has “created a blueprint for creating change that will be used for many decades to come”.
He was known to give people the freedom to work and to not tell them directly what they should be doing. They knew, however, what he thought!
In 1947, just post-war, Gray began his medical studies at the University of Melbourne, graduating in 1953. His post-graduate career included roles at the Walter and Eliza Hall Institute in 1957, as a Research Fellow in Paediatrics at the Case Western Reserve University, USA and the Royal Melbourne Hospital Cleveland Fellowship from 1959-60.
He then moved to become the Deputy Superintendent of the Fairfield Infectious Diseases Hospital for four years, followed by another four years as Assistant Medical Director at the Royal Children’s Hospital in Melbourne before taking over the role as Director of the Anti-Cancer Council Victoria in 1968.
Knowing that rigorous evidence was essential, but not sufficient to produce the change needed for effective tobacco control, he elevated the “artistry’ of public health to new heights.
He instigated the use of forceful anti-smoking ads, in addition to using the humour of comedians Warren Mitchell, Fred Parslow and Miriam Karlin in the early 70s and working with John Clarke much later on.
John Clarke describes Gray as an unconventional and anti establishment figure – ‘Nigel’s genius was to wear a suit so that he looked like one of the establishment going about their normal business, but he was not one of them.’
Along with other leaders such as Cotter Harvey, the founder of the Australian Council on Smoking and Health (ACOSH), Gray played a crucial role in bans on tobacco advertising, as he knew by the late 1960s that the banning of tobacco advertising had to get onto the political agenda.
He sent off numerous missives about banning tobacco advertising and other tobacco control measure and repeatedly met with government ministers at both state and national levels. He wrote to 14 different Ministers for Communication under seven different governments over the following 20 years.
The fact that it took eight Victorian Health Ministers before he found one sympathetic to the notion of using a dedicated tax on tobacco to buy out and replace tobacco industry sponsorship of sport and the arts, has become the stuff of public health legend.
As Todd Harper, the current Director of the Cancer Council Victoria, and former CEO of VicHealth explains, Gray combined “rigorous science, clear thinking and more than dash of his legendary debonair approach”.
He made the most of a meeting to lobby the Health Minister (David White) about the need for mammography. As Gray and Hill were about to leave, it was the Minister who said “Now what more can we do about tobacco?”
Gray then led the campaign for the Victorian Tobacco Act 1987, which banned all forms of outdoor advertising of tobacco products and established a world first – the Victorian Health Promotion Foundation (VicHealth) to fund major health promotion initiatives at the same time as replacing tobacco sponsorships in sports and the arts.
His unwavering commitment to the long-term goal is manifest in another story – again from John Clarke. Clarke describes a time when when he had accompanied Gray to meet with a Minister for Health and had presented the case for tobacco control – which was roundly rejected by the then Minister.
Afterwards, Clarke mentioned that the meeting hadn’t gone well. Gray’s response, ever optimistic, was “No, we were able to give our material and information to the Minister and the government… and the Minister won’t be there for ever.”
Following his retirement from the Cancer Council Victoria, he remained remarkably active. He spent eight years working with Scottish epidemiologist Peter Boyle at the European Institute of Oncology in Milan and later at the International Agency for Research in Cancer (IARC) in Lyon, where his work focused on the constituents of tobacco smoke, and tobacco regulation to modify the risk.
Gray was never able to accept that he had done enough and was publishing and researching well into his ninth decade. And he was searching for new answers – as recently as 2012, he published a paper with the intriguing title “Tobacco control: reflections on our mistakes and those who made them.”
At the beginning of 2014 he sent an email to researchers across the globe asking them to select their best, most interesting and useful publications, as he was interested in looking at the nexus between “what we know, when we knew it, what the industry knew, when they knew it” – all arising from his “long held sense of frustration over the rate at which important research work gets into the arena of public health policy and is put to good use”.
Only a couple of weeks before his death, Gray attended a special dinner at the UICC World Congress where the guest of honour John Seffrin, the long standing CEO of the American Cancer Society (ACS), paid particular tribute to Gray as a major influence on his work.
There is little doubt that Gray and many others have produced huge benefits through their work in tobacco control.
A recent study has estimated that 8 million premature deaths have been averted in the USA over the last 50 years because of tobacco control. We would expect an effect size of similar proportions has occurred in Australia over the last 50 years.
Tobacco control is one of the most important health and medical successes of the last fifty years. Gray’s work is deserving of a Nobel Prize as I have no doubt that in the words of Alfred Nobel’s will, it has “…conferred the greatest benefit on mankind”.
Vale Nigel Gray (1928-2014).
• Rob Moodie is Professor of Public Health at the Melbourne School of Population and Global Health. He was CEO of VicHealth from 1998-2007 and benefited greatly from Nigel Gray’s work in establishing and guiding VicHealth in its first ten years.
• Previously at Croakey: Farewell Dr Gray
• At the BMJ, tributes to Nigel Gray and Tony Hedley