Mervyn Susser: Aids campaigner and world leader in epidemiology

l1921-2014

l1921-2014

MERVYN Susser, who has died at his home in Hastings on Hudson, New York, at the age of 92, helped to pioneer community-based primary healthcare in South Africa.

He was one of the first doctors in the world to study the ways in which social, cultural and psychological factors contribute to disease, and his work formed the basis of public health policy in post-apartheid South Africa.

Susser and his wife and lifelong collaborator, Zena Stein, quite literally wrote the book on epidemiology. Titled Eras in Epidemiology: The Evolution of Ideas , it was the first comprehensive history of the subject.

Susser was born in Johannesburg on September 26 1921. His parents, immigrants from Latvia, ran the Groenfontein Hotel near Mokopane in Limpopo. His mother, Ida, who was not happy in the bush, committed suicide and he was brought up by relatives in Durban.

After matriculating at Durban Boys High, he began studying humanities at the University of the Witwatersrand, but broke off in 1940 to join the war. The devastation sharpened his social conscience and persuaded him to switch to medicine.

Epidemiology was not yet even in the curriculum, but its principles were being practised by Sidney Kark, who, with his wife, Emily, was establishing a network of primary health centres in rural KwaZulu-Natal based on comprehensive community care and preventive medicine.

Susser and Stein, whom he married in 1949, were deeply influenced by the combination of rigorous science and social justice evident in the work being done by the Karks, and this became a hallmark of their own life.

Their driving motivation was to contribute to the health and medical care of blacks, which, in apartheid South Africa in the early 1950s, was virtually ignored in medical curriculums.

"Our medical curriculum addressed the conditions apparent in the segregated white fraction of the population," said Susser in an interview with the journal Epidemiology in 2003.

"What happened in the black majority of the population was foreign land. We learned about that independently out of hours in outpatient clinics and wards of black hospitals."

He jumped at the chance to run a clinic in Alexandra township, Johannesburg. While there, he and Stein carried out one of the first studies ever made of community health in the developing world, which was published in the Lancet in 1955 as "Medical Care in an African Township".

They established close ties during this period with leaders in both the ANC and the South African Communist Party such as Nelson Mandela, Walter Sisulu, Ahmed Kathrada, Bram Fischer and Joe Slovo.

They were regular visitors to the Sussers' house. Susser also allowed his clinic to be used for meetings of the SACP.

The chairman of the clinic's board, Judge Oliver Schreiner, who detested apartheid and was enormously sympathetic to the anti-apartheid struggle, was afraid that the government would close the clinic if it found out about this and so he asked Susser to leave.

Susser struggled for six months to find work. He believed his political activism was the problem, decided he had no future in apartheid South Africa and, in 1955, took his wife and three children to England.

He was given a senior academic post in the department of social and preventive medicine at Manchester University.

While there, he co-wrote an influential textbook, Sociology in Medicine, demonstrating the influence of social environment on health, and became recognised as a world leader in epidemiology.

In 1965, he was asked to set up a chair of epidemiology at Columbia University in New York, despite the fact that he had no formal training in the discipline.

He then produced perhaps his most influential book, Causal Thinking in the Health Sciences: Concepts and Strategies of Epidemiology , which grew out of a series of lectures he gave at the university.

Susser founded the Sergievsky Centre at Columbia University, which explores genetic, environmental and social factors of disease. He led it until 1990.

At the same time, he was editor of The American Journal of Public Health.

When HIV/Aids began spreading in New York in the early 1980s, he and Stein were among the first epidemiologists to study it.

In the later '80s, they engaged quite frequently with ANC exiles, notably Nkosazana Dlamini-Zuma and Manto Tshababala-Msimang.

By this time it was clear to Susser and Stein that HIV/Aids would be a calamity for South Africa and they tried to educate the future health ministers, among other ANC leaders in exile, about the disease.

In 1990, they organised a conference in Maputo to bring together public health experts from South Africa and the US and likely members of a future ANC government to focus on the potential impact of HIV on South Africa.

Their aim, principally, was to warn the future ANC government of impending disaster.

But owing to a combination of political cowardice and more immediate concerns, such as the increasingly bloody civil war in South Africa and approaching negotiations, their warnings were all but ignored.

Later, Susser and Stein, who was invited to join then-president Thabo Mbeki's toothless Aids panel in 1999, looked on in frustration and dismay as the ANC government's refusal to implement an effective Aids policy cost thousands of lives.

In 1999, when they were both retired and approaching 80, they agreed to return to South Africa as joint directors of the newly founded Africa Centre for Health and Population Studies in Hlabisa in KwaZulu-Natal.

They returned to the US after two years, but spent time at the centre every year thereafter until 2009.

The Susser-Stein partnership was one of the most productive in recent medical history. They quarrelled and fought over their research, which he said helped them to learn more and achieve better results. He said the sense of intellectual equality and free exchange of ideas that characterised their collaboration was critical to its success.

Susser is survived by Stein, 92, and their three children. - Chris Barron