Alan Julian Macbeth Tudor-Hart (9 March 1927 – 1 July 2018), commonly known as Julian Tudor Hart, was a

general practitioner A general practitioner (GP) is a doctor who is a Consultant (medicine), consultant in general practice. GPs have distinct expertise and experience in providing whole person medical care, whilst managing the complexity, uncertainty and risk ass ...

(GP) who worked in

Wales Wales ( ) is a Countries of the United Kingdom, country that is part of the United Kingdom. It is bordered by the Irish Sea to the north and west, England to the England–Wales border, east, the Bristol Channel to the south, and the Celtic ...

for 30 years, known for theorising the inverse care law. He produced medical research and wrote many books and medical articles.

Early life

Hart was born in London on 9 March 1927, the son of Alexander Tudor-Hart and Alison Macbeth. He studied medicine at

Queens' College, Cambridge Queens' College is a Colleges of the University of Cambridge, constituent college of the University of Cambridge. Queens' is one of the 16 "old colleges" of the university, and was founded in 1448 by Margaret of Anjou. Its buildings span the R ...

, and then at

St George's Hospital Medical School St George's, University of London (SGUL), legally the St George's Hospital Medical School, was a public medical school from 1733 to 2024 in South London, England. It merged with City, University of London to form City St George's, University of ...

in London, graduating in 1952. He is a descendant of American businessman

Frederic Tudor Frederic Tudor (September 4, 1783 – February 6, 1864) was an American businessman and merchant. Known as Boston's "Ice King", he was the founder of the Tudor Ice Company and a pioneer of the international ice trade in the early 19th century. H ...

and Ephraim Hart, a

Bavaria Bavaria, officially the Free State of Bavaria, is a States of Germany, state in the southeast of Germany. With an area of , it is the list of German states by area, largest German state by land area, comprising approximately 1/5 of the total l ...

n Jew who became a prominent merchant in New York, and was reportedly partners with John Jacob Astor. The name was originally Hirz. His paternal grandfather, the Canadian artist Percyval Hart, married his Polish-French cousin Éléonora Délia Julie Aimée Hart Kleczkowska, and later changed the family surname to Tudor-Hart. Kleczkowska was the daughter of diplomat Michel Alexandre Cholewa, comte Kleczkowski (Michał Kleczkowski; 1818–1886) and granddaughter of Julie Sobieska, a direct descendant of

John III Sobieski John III Sobieski ( (); (); () 17 August 1629 – 17 June 1696) was King of Poland and Grand Duke of Lithuania from 1674 until his death in 1696. Born into Polish nobility, Sobieski was educated at the Jagiellonian University and toured Eur ...

, king of Poland in the 17th century. He was a member of the Sigerist Society from 1947 to 1955. Hart joined the

Communist Party of Great Britain The Communist Party of Great Britain (CPGB) was the largest communist organisation in Britain and was founded in 1920 through a merger of several smaller Marxist groups. Many miners joined the CPGB in the 1926 general strike. In 1930, the CPGB ...

, following his father Alex, and stood unsuccessfully as the CPGB candidate for

Aberavon Aberavon () is a town and community in Neath Port Talbot county borough, Wales. The town derived its name from being near the mouth of the river Afan, which also gave its name to a medieval lordship. Today it is essentially a district of Por ...

at the

1964 Events January * January 1 – The Federation of Rhodesia and Nyasaland is dissolved. * January 5 – In the first meeting between leaders of the Roman Catholic and Orthodox churches since the fifteenth century, Pope Paul VI and Patria ...

1966 Events January * January 1 – In a coup, Colonel Jean-Bédel Bokassa takes over as military ruler of the Central African Republic, ousting President David Dacko. * January 3 – 1966 Upper Voltan coup d'état: President Maurice Yaméogo i ...

and 1970 general elections.

Career

In 1961, he moved to

Glyncorrwg Glyncorrwg is a village in the Afan Valley, in southern Wales. Glyncorrwg is also the name of an electoral ward and formerly a community covering the village and surrounding countryside, in Neath Port Talbot county borough. Glyncorrwg is part o ...

. There, he worked for 30 years as a general practitioner. One of his partners was Brian Gibbons, later minister for health in Wales. Hart became involved in epidemiological research, with Richard Doll and

Archie Cochrane Archibald Leman Cochrane (12 January 1909 – 18 June 1988) was a Scottish physician noted for his book, ''Effectiveness and Efficiency: Random Reflections on Health Services'', which advocated the use of randomized controlled trials (RCTs) t ...

. He was a passionate advocate of the

National Health Service The National Health Service (NHS) is the term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...

and of socialism. He was President of the

Socialist Health Association The Socialist Health Association (SHA, called the Socialist Medical Association before May 1981) is a socialist medical association based in the United Kingdom. It is affiliated to the Labour Party as a socialist society. History The Socialis ...

. He was a Fellow of the

Royal College of General Practitioners The Royal College of General Practitioners (RCGP) is the professional body for general (medical) practitioners (GPs/ Family Physicians/ Primary Care Physicians) in the United Kingdom. The RCGP represents and supports GPs on key issues including ...

(RCGP) and the

Royal College of Physicians The Royal College of Physicians of London, commonly referred to simply as the Royal College of Physicians (RCP), is a British professional membership body dedicated to improving the practice of medicine, chiefly through the accreditation of ph ...

(RCP). In 2006, he was awarded the inaugural Discovery Prize by the RCGP as "a general practitioner who has captured the imagination of generations of GPs with his groundbreaking research". His practice in Glyncorrwg, Wales, was the first in the UK to be recognised as a research practice, piloting many Medical Research Council studies. He was also the first doctor to routinely measure every patient's blood pressure and as a result was able to reduce premature mortality in high risk patients at his practice by 30%. Graham Watt, professor of general practice at the University of Glasgow, nominated Tudor Hart for the award. Watt said: "His ideas and example pervade modern general practice and remain at the cutting edge of thinking and practice concerning health improvement in primary care. His work on hypertension showed how high quality records, teamwork and audit are the keys to health improvement. His life-long commitment to the daily tasks of general practice has always given his work and views a salience and credibility with fellow general practitioners. Julian Tudor Hart has been and will remain an inspiration to health practitioners and the communities they serve." Hart died on 1 July 2018 at the age of 91 years.

Author

He wrote many books and scientific articles. His last book, ''The Political Economy of Health Care: A Clinical Perspective'' explores how the NHS might be reconstituted as a humane service for all (rather than a profitable one for the few) and a civilising influence on society as a whole. The book provides 'a big picture' for students, academics, health professionals and NHS users that Tudor Hart hopes will inspire them to challenge received wisdoms about how the NHS should develop in the 21st century. Hart lists nine (9) characteristics of the

in its founding that are distinctive and essential to it. # A united national service devoted directly and indirectly to care, fully available to all citizens. # A

gift economy A gift economy or gift culture is a system of exchange where valuables are not sold, but rather given without an explicit agreement for immediate or future rewards. Social norms and customs govern giving a gift in a gift culture; although there ...

including everyone, funded by general taxation, of which the largest component was income tax. # Its most important inputs and processes are personal interactions between lay and professional people. # Its products were potentially measurable as health gains for the whole population. # Its staff and component units were not expected to compete for market share but to co-operate to maximise useful service. # Continuity was central to its efficiency and effectiveness. # Its local staff and local populations believed they had moral ownership of and loyalty to neighbourhood NHS units. # None of its decisions and few of its procedures could be fully standardised. All of its decisions entailed some uncertainty and doubt. They were therefore unsuited to commodity form, either for personal sale or for long-term contracts. # The NHS was a labour-intensive economy. Every new diagnostic or therapeutic machine generates new needs for more skilled staff able to control and interpret the work of the machines and translate them into human terms. His other writing includes many articles on the management of

high blood pressure Hypertension, also known as high blood pressure, is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms itself. It is, however, a major ri ...

and on the organisation of health services. His most influential, The Inverse Care Law, published in the Lancet 1971 asserts: "The availability of good medical care tends to vary inversely with the need for the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced."

Publications

Scientific articles

* * * * * * * * * * * *
Hart JT. "Two paths for medical practice. ''The Lancet'' 1992 sept 26; 340
* * * * * *
Hart JT. The National Health Service as precursor for future society. 2002

Books

* Hart JT. The National Health Service: in England and Wales. Communist Party of Great Britain; 1970. * Hart JT, Communist Party of Great Britain. The National Health Service in England and Wales: a marxist perspective. London Health Students Branch. Research and Study Group, Marxists in Medicine; 1971. * Hypertension: community control of high blood pressure. First edition. 1980. * Hart JT. An exchange of letters: hospital referrals. MSD Foundation; 1985.
A new kind of doctor: the general practitioner’s part in the health of the community. London: Merlin Press; 1988.
* Hart JT, Stilwell B, Gray M. Prevention of coronary heart disease and stroke: a workbook for primary care teams. Faber; 1988. * Hart JT, Pickering G. Hipertensión: su control en la comunidad. Doyma; 1989.
Hypertension: community control of high blood pressure. Third edition. Oxford: Radcliffe Medical Press; 1993.

Feasible Socialism: National Health Service past, present and future. London: Socialist Health Association; 1994
* Going for Gold: a new approach to primary medical care in the South Wales valleys. Swansea: Socialist Health Association; 1997. * Going to the doctor. In: Cooter R, Pickstone J (eds). Medicine in the 20th Century. Amsterdam: Harwood Academic Publishers; 2000. p. 543-58. * Hart JT, Savage W, Fahey T. High Blood Pressure at Your Fingertips: The Comprehensive and Medically Accurate Manual on How to Manage Your High Blood Pressure. McGraw-Hill Australia; 2003.
What you need to know in nine pages. In: Fahey T, Murphy D, Hart JT. High Blood Pressure. Excerpt from High Blood Pressure at your fingertips. Third edition: London: Class Publishing; 2004.

Hart JT. Storming the Citadel: from romantic fiction to effective reality.
In: Michael PF, Webster C (eds). Health and Society in Twentieth Century Wales. University of Wales Press; 2006. p. 208-15.
The Political Economy of Health Care: A clinical perspective. Bristol: Policy Press; 2006.

Hart JT. La economía política de la sanidad. Una perspectiva clínica. Madrid: Ediciones GPS Madrid; 2009.

Hart JT. The political economy of health care: Where the NHS came from and where it could lead (2 ed). Bristol: Policy Press; 2010.

Bibliography

References

External links

*
Personal website
{{DEFAULTSORT:Tudor-Hart, Julian 1927 births 2018 deaths Medical doctors from London British people of American descent British people of Canadian descent British people of Polish descent British people of German-Jewish descent British communists Communist Party of Great Britain members National Health Service people Alumni of Queens' College, Cambridge 20th-century Welsh medical doctors British general practitioners Fellows of the Royal College of General Practitioners Fellows of the Royal College of Physicians Public health in Wales