Professor Martin McKee tells us about his passion for Public Health, his role at the European Observatory on Health Systems and Policies and his latest research on the adverse effects of movement restrictions in response to the COVID-19 pandemic.
About Martin McKee
Martin McKee is Professor of European Public Health at the London School of Hygiene and Tropical Medicine (LSHTM). He qualified in medicine in Northern Ireland and later trained in public health in London. He is Research Director of the European Observatory on Health Systems and Policies. He has published over 1,180 scientific papers and 46 books on health and health policy with a particular focus on countries undergoing political and social transition. He is a Fellow of the Royal Colleges of Physicians of London, Edinburgh, and Ireland. His contributions to European health policy have been recognised by election to the UK Academy of Medical Sciences, the US National Academy of Medicine and other academies. He was elected to the Academia Europaea in 2018.
How I became interested in Public Health
Martin, you are Professor of European Public Health. How did you first become interested in Public Health?
“I trained in internal medicine in Belfast and, as I was following a research track, I was awarded a fellowship in peptide biochemistry. However, there was a clear mismatch between the laboratory work that I was doing and the social determinants of the health of the patients I was treating. In the mid-1980s, I was seeing patients with scurvy and beriberi. I changed direction to public health and began a Masters degree at the London School of Hygiene and Tropical Medicine. I was somewhat familiar with the work done there, as I had completed an elective at the Hospital for Tropical Diseases in London, which was closely affiliated with the school. However, studying with students from across the world opened my eyes to the opportunities offered by public health.
In 1989, after completing my doctorate in health services research, I was offered a new post to develop the skills presence in the rest of Europe. As someone who had lived through the troubles in Northern Ireland, with direct experience of the consequences of tribalism, I have always taken an international perspective. In 1973, when interviewed for an English medical school, I was asked the completely inappropriate question of whether I felt myself English or Irish. As a 16-year-old, I answered that I was European. Just after I was offered the post the Berlin wall was torn down. Suddenly the opportunities open to me expanded dramatically. I was able to work with colleagues, initially from Hungary and the then Czechoslovakia, to study the health effects of what was a remarkable natural experiment on the political and economic determinants of health.
By the mid-1990s, my work had extended into the former Soviet Union. These experiences introduced me to the health effects of rapid political, social, and economic transition. This was excellent preparation for my subsequent work studying the health effects of the global financial crisis from 2008 onwards. Now, my work goes all the way from pathology to political science. I’ve been fortunate to be able to study some of the big questions facing humanity. And my early work in the laboratory in Belfast was not wasted, as I returned to peptides in a study of alcohol induced myocardial damage in Russia. But this time it was only part of a much bigger question, which drew on economic, social geography, and health policy”
Translating evidence into policy
Could you tell us about your role as Research Director at the European Observatory on Health Systems and Policies?
“I feel strongly that there is little point in doing research if it is not translated into policy. In the late 1990s, four of us worked with the World Health Organisation and a number of European governments to create the European Observatory on Health Systems and Policies. Over 20 years later, it has expanded to include 10 European governments, the World Health Organisation, the European Commission and several other organisations. With hubs in London, Brussels, and Berlin, we publish what have become recognised as the definitive descriptions of health systems in Europe and in high-income countries further afield, detailed analyses of key issues in health policy, and a portfolio of rapid responses and policy briefs, many of which feed into the rotating European Union presidencies.
More recently, we have created dedicated websites to monitor the health impact of the global financial crisis and now the COVID pandemic. Many of our analyses have fed into European legislation, most notably the directive on cross-border care, and we are taking on an increasing role with other organisations such as the G20. As Research Director, I have oversight of the analyses that we undertake, but working in close partnership with my colleagues in each of our hubs. Our work plans are approved by a steering committee meeting twice a year, but with considerable flexibility to respond to the needs of partners as they arise.
It is far too easy for researchers to lose touch with the world of policy. Often we seem to be speaking a different language. The Observatory has provided an opportunity to develop long-term relationships with policymakers, helping us to overcome many of the challenges that are inherent in translating evidence to policy. We understand much better what they need and when, and they understand the limits to what we can do. Hopefully, we have contributed in some small way to better policies and maybe even the health of the populations we serve.”
Learning lessons from the pandemic in different countries
Tell us about your latest research and how it may relate to the COVID-19 pandemic?
“My work on COVID-19 reflects the roles that I have described above. First, I’ve been working with colleagues in a number of countries to try to learn lessons from the pandemic. For example, we have published accounts of the early responses in Spain and Italy, and have several others under review. This has pointed us to unanswered questions that we have tried to address in rapid reviews, such as the evidence on transmission of airborne viruses at mass gatherings, something that has been surprisingly poorly researched. Our European Observatory response monitor is being widely used as a source of information by those looking for lessons they can learn from elsewhere.
Wearing my public health hat, I’ve been studying the wider health impacts of restrictions on movement, affecting everything from domestic abuse through education to psychosocial problems, and brought together what we felt was a clear infographic designed by the illustration team in the British Medical Journal to accompany our recent paper on this topic. I’ve also been looking at the relationship between countermeasures and changes in mobility, using data from a widely used app. I’ve been concerned that too much of the research on the coronavirus and the body’s response to it has been taking place in silos, and I’ve worked with clinical colleagues to try to pull together what we know and, as importantly, what we do not know.
I am a member of the Independent SAGE convened by Sir David King to provide additional evidence to inform policy. Finally, as would be expected given my commitment to translating evidence into policy, I’ve been doing a surprisingly large amount of work with the media, including interviews with newspapers, radio, and television from across the world, as well as op-eds and podcasts, trying to make sense of what is a very complicated situation.”