Tribute to Gavin Mooney and Del Weston

The tragic deaths of Gavin Mooney and Del Weston shortly before Christmas last year affected many in the public health community. Whether we knew Gavin and Del or simply of their work and their activism, we are aware of the great loss this was to public health. Here are three memories from the Critical Public Health Editorial and Advisory Boards.

Gavin Mooney: a truly critical public health practitioner

Di McIntyre and John Ataguba

Health Economics Unit, University of Cape Town

No journal could have been more appropriate for Gavin to serve on the Advisory Board than Critical Public Health (CPH). The aims of CPH state that it “is committed to exploring and debating issues of equity and social justice”. Equity and social justice describe the very essence of Gavin; it is unlikely that anyone else has written as prolifically on the issue of health equity or fought as tirelessly in his everyday actions for social justice.

The other aspect of CPH’s aim that was so perfectly suited to Gavin is the commitment to “debating issues”. He constantly strove to stimulate debate and frequently published as part of a series with other authors, expressly to present a range of perspectives and to prompt debate and critical thinking in pursuit of identifying appropriate ways of addressing the challenges facing the society. As Gavin himself said, “[t]here is a need not only for greater tolerance of other voices but also for a burgeoning of encouragement of debate” (Mooney 2002).

But why did Gavin believe so passionately in the importance of debate? In his own words:

There is a responsibility to promote debate about issues that have a potential impact on the health of the public and to speak out even when that seems to be a minority view, perhaps especially when it is a minority view. This is not advocacy for health. It is advocacy for debate to inform and question and attempt to establish a more deliberative society and democracy. (Mooney 2002)

Even when Gavin was not publishing a paper as part of an explicit debate series, his work usually prompted debate, not least of all because he consistently and eloquently challenged the prevailing orthodoxy. As a (health and political) economist, his most vociferous challenges were directed at neoliberal ideologies (the first part of his most recent book, “The health of nations: Towards a new political economy”, was in his inimitable no-holds barred style titled “Neoliberalism kills”). He argued that neoliberalism is at the root of global poverty, rising inequality and ill health, and that there is a need for an alternative to neoliberalism (Mooney 2012a). He challenged the individualism prevalent in neoliberalism and argued passionately for a greater community focus in public health and for adopting a communitarian approach. One of his most important contributions in this regard was to advocate for community values and preferences to be the ones to guide health services:

… where is the concern to establish what working class people, indeed people more generally, want from public health? The lack of consultation is astonishingly elitist. We need to get out there, asking instead of assuming. … Eliciting community values and letting these drive the public health enterprise is the way forward. (Mooney 2000)

He not only advocated for such an approach, he demonstrated how it could be done. He was involved in several research projects that sought to elicit community views on a range of issues (see for example Wiseman et al. 2003) including how scarce public health resources should be allocated within the context of massive health inequities between Aboriginal and non-Aboriginal Australians. He initiated a number of citizens’ juries as a mechanism for giving voice to citizens and fought for their views to be taken into account in policy making: “Equity should be defined by communities/societies that a health care system services” (Mooney 2008). This focus of his work illustrates his contribution, through debate and action, to building “a more deliberative society and democracy”.

Part of the outcomes that Gavin envisaged would arise from building health systems on the basis of community values was for the health system to truly be a social institution, with greater power over decision-making in the hands of critically informed citizens, and not simply a means of providing health services. He frequently used the concept of compassion to highlight how the health system as a social institution can impact on societal values. Drawing on Martha Nussbaum’s work, he recently noted that “compassionate individuals construct institutions that embody what they imagine; and institutions, in turn, influence the development of compassion in individuals” and called for the development of “compassionate institutions” (Mooney 2012b). In this paper, which was the last of his work to be published (literally days before his death), he noted that “there have been positive developments on health equity – the Millennium Development Goals, the WHO Commission on the Social Determinants of Health and so on but health inequities across the globe remain massive”, that “poverty and inequality remain the world’s greatest killers” and asked “Is there a need for some new economic world order?” It is a travesty of justice that he should have been removed from these debates at this time, when the post-MDG agenda for “the world we want” is being developed (see www.worldwewant2015.org/). The first report that frames this initiative states that the “post-2015 UN development agenda should be conceived as a truly global agenda with shared responsibilities for all countries”, that “transformative change [is] needed for a rights-based, equitable and sustainable process of global development” (with these being the three principles on which this initiative is based) and recognises that these aspirations require “reforms of mechanisms of global governance” (UN 2012). Gavin would have seen this as an important window of opportunity to create a mechanism for holding all countries to account for truly sharing the responsibility of reducing income, health and other inequities, not only within countries but also across countries. However, the final report on the health sector consultations released in early April does not put forward practical strategies for achieving this, but instead presents generalised suggestions that are unlikely to promote transformative change (UN 2013). Gavin would have been deeply saddened that his fellow public health practitioners had not seized this opportunity.

The post-2015 development goals’ process is indeed a critical opportunity for making progress on the goals that Gavin held so dear. To us, honouring the contribution that Gavin has made requires all critical public health practitioners (many of whom Gavin mentored and inspired) to assume the “responsibility to promote debate … and to speak out even when that seems to be a minority view”, and so to seize the opportunity available to transform global governance and begin to address the imbalance of power that perpetuates inequities across the world.

In memory of Gavin Mooney

Alex Scott-Samuel

University of Liverpool, UK

To be honest, I am not sure whether Gavin and I ever met – if we did, it would have been at a conference in the distant past. Our friendship was essentially an electronic one – consisting mostly of comradely e-mails encouraging each other in pursuing some example of advocacy we had shared – but also a collegial one when we were both on the board of the International Society for Equity in Health in the mid-noughties. I had of course known Gavin’s work for much longer than this: the first material I remember was his ground-breaking 1982 Aberdeen University Health Economics Research Unit discussion paper Equity in Health Care: Confronting the Confusion, in which he defined seven types of health equity – of expenditure per capita; of inputs per capita; of input for equal need; of access for equal need; of utilisation for equal need; of marginal met need; and of health.

In the years that followed, he became established as THE UK health economist working on health inequalities. But even more, he became a much politicised advocate of ‘health economics as if people mattered’. And, around the turn of the century he became engaged with the People’s Health Movement (PHM) – which is where perhaps he made his most important contributions, culminating in the 2012 Zed Books publication The Health of Nations: Towards a New Political Economy – his fullest and most inspiring account of the political economy of health care, which was the materialist position he had come to adopt over the previous two decades. Gavin saw health care as a human right which could be instrumental in the creation of a truly communitarian society.

As befits an academic holding Gavin’s views while working in a society largely shaped by neoliberalism, he became a strong – and effective – advocate for social justice both in and beyond the health system. Here (http://tinyurl.com/cj6735j) is a typical recent example of Gavin in advocacy mode during the early days of the Egyptian revolution. Like many before him in a line stretching back through Allende, McGonigle and Virchow, he was proud and assertive in using the status and knowledge he had obtained through a materialist education to defend materialism’s victims.

Gavin, I hope it is ok for me to quote from an e-mail you sent after the 2005 PHM People’s Health Assembly in Cuenca, Ecuador – it speaks much of who you are.

Cuenca was great! Very moving on many occasions and fronts but especially confirming of the shit that the US are spreading across the globe in their selfish individualistic neo liberalism. And to begin to see this through the eyes of the Ecuadorian people. We were fortunate to be able to visit the Achuar Indigenous people in the Southern Amazon who are learning from the destruction of forest and culture that the oil companies have brought to the north of Ecuador and keeping them out. But realistically it is just a matter of time. Where do we start Alex? And it is not a rhetorical question. My partner and I left for Cuenca radicals and came home revolutionaries! Back to the joys of the nasty, vicious, Howard government. She and I ‘rejoice’ at the release from detention of an Iranian whom we have done a little to support over the five years he has been in detention in this country. FIVE years! – and why? To stop others trying to come here by boat ... Warped and nasty. We have a public service that is politicised and cowed by the Howard government and where our social institutions are being eroded before our eyes. Sorry Alex. I am not sure why I feel the need to unload on you. But there you are and I feel better. There are lots of good people on this planet (including your good self) but none of them seems to have any power.

Gavin used the power of economics in the way it was designed to be used but so rarely is – in the advancement of humankind.

In memory of Gavin Mooney and Del Weston

Robin Bunton

Hull/York Medical School, UK

When friends die, they so often leave memories on our bookshelves and the books can be very telling. Gavin Mooney left me two books I treasure, one is Rabbit Proof Fence and the other, Silencing Dissent: How the Australian government is controlling pubic opinion and stifling debate. The first of these is such a beautifully tragic picture of Australia that totally shadowed the film version that I had seen earlier and a very powerful image of Australian and colonial history. It was also a perfect foil for Gavin to talk about his interests in Australian people, in politics, and his commitments and forthcoming marriage to Del I recall. For me the other book is also quintessentially Gavin. Written at the height of the Howard administration’s attack on core public values and human rights, it spoke of the willingness of so many people in public life to give up the fight and turn aside in the face of the onslaught: academics who chose silence in the face of the many layered threats to their working and political lives, the media who gave way to global capital’s control of global culture, the research community who are pressured into abandoning their independence, public servants who are being forced to abandon their role as guardians of democratic institutions, and many more. Of course the book is compiled of people who are doing just the opposite and fighting every inch of the retreat whilst telling us so clearly how it is all going so wrong. The book begins with the boiling frog metaphor. It is said that if you drop a frog into boiling water it will jump straight out, whereas if you put it in cool water and slowly bring it to the boil, it won’t notice and perish. Similarly, the forces of neoliberalism slowly strangle and our life forces ebb away. Some frogs will notice, however, and the book bears witness to this. If ever I met someone who was going to notice that the temperature was rising, it was Gavin. And, he was going to shout about very loudly and with passion and humanity. His last book, The Health of Nations: Towards a New Political Economy, could be shelved alongside his gift, so similar in spirit and excellence. It is written in a voice that would be difficult to silence.

Also on my shelf is Del’s master’s thesis ‘Globalization, Neo-liberalism and Technology Governance’. This thesis which focuses on genomics is broad, passionate and exciting. Del’s academic career, like many women of her generation, was developed in later life and is now cut short. Although Gavin’s huge contribution to public health research has to be acknowledged, it was but a small part of his worth in my view. I met Del and Gavin seven years ago and I was not really familiar with any of their written work at that time. I was, however, immediately infected by the strength of their belief in social justice and their commitment to hearing the voices of those without power. Working in worlds where professional politics so often sets agendas, it was a breath of fresh air to meet two people who “said it as it was” without apology or irony but with a great wit and humour. They both stubbornly refused to make public matters technical ones and insisted that the voices of people were heard alongside those of experts. Del and Gavin personified their work values in so many ways: in their generosity as colleagues, and in their warmth and humanity as friends. In a world of shrinking collective values or struggling public spheres it is a rare gift to be able to create both wherever you travel, as they did. It seems particularly sad that such a private tragedy has robbed us all of their vibrant contribution to public health action and debate. It was a pleasure to be able to interest Gavin in contributing to Critical Public Health in recent years and that this work adds to a lasting legacy in public health and social justice. Although we will miss their work we will, I think, miss them both more.