Both hero-worshipped and reviled for his radicalism, Ian Gray has been a controversial champion of public health throughout his career. He spoke to Cathy Savage about his work and his hopes for the profession

Ian Gray has been something of a love-hate figure for other EHOs. A vocal activist for the new public health agenda, a fierce critic of apathy and a member of the infamous ginger group PHLAG, he has made both enemies and admirers. Next-generation EHOs cite him as an inspiration - particularly for the talks he gives to final year students - while some of the older set still dismiss what he says simply because he's the one saying it.

Ian is best known for calling EHOs to action on HIV/Aids when the disease first came to light and most people were sitting on their hands, but he is not quite the spiky revolutionary you might expect. This year he celebrates 25 years' service at Hackney. Twenty-five years in the same borough may not instantly speak of radicalism, but they do show dedication. His main focus has remained unswerving over the years - to improve public health in the deprived London borough - and it is the force of these efforts which has pitched him into the national arena.

Ian's mother was born in Hackney and his grandparents both worked in the local sweet factory. He sees its faults, knows its problems and is proud of its achievements. The leftist politics of the borough have fitted in with the kind of humanism which first drew him to the work and keeps him there.
"I never wanted to do any other job," he says simply. "My father was in charge of administration at Leyton health department when I was a child and his mother used to take in pupil public health inspectors as lodgers, so way back when I was at primary school my Gran and I used to sit and test people out of this big book - Clay's Handbook," he smiles."It seemed to have answers to everything and I was fascinated."
Ian trained for four years at Tottenham technical college while working with Waltham Forest Council, qualifying in 1973. He was keen to make his skills count in the inner city and transferred to Hackney, for no extra pay, in 1975.
"They gave me a tiny bit of Stoke Newington as a district and I thought 'they don't trust me'," he remembers. "The comparison was so stark, I had responsibility for half an old-style borough in Waltham Forest, but problems in Hackney were so severe and widespread that a small area was just all you could cope with at a time.
"The housing conditions in particular were just awful," he says. "We were trying to deal with conditions that had developed over 100 years. The majority of problems were multiple occupation and disrepair." He rubs his head. "I can't exaggerate how bad conditions were. We had people living in attics - not loft rooms, but attics - people were living in cellars. The demand for rehousing couldn't be met.
"Poverty wasn't on the agenda then but it was a major issue for us," he adds. "People's capacity to deal with things is so limited when poverty is a factor. It often felt like we were trying to achieve the unachievable."

The situation deteriorated into the 1980s as the housing crisis took hold. "We had nowhere to house the homeless - we'd exhausted our stock and we began to make heavy use of bed and breakfast accommodation," he explains.
"It was shocking. We're talking about a family in a single room... and not just for weeks but for months, even years. The sheer impracticality of families with young children living in hotels has to be seen to be believed. There were no cooking facilities, there were cockroaches, people were at their wits' end, kids were falling out of windows and landlords were reaping profits.
"I hadn't thought how political our work was until then. Other boroughs were exporting their homeless to us (and Tower Hamlets) - so any support systems that these people should have had were too far away to use."
He shakes his head. "People were being dumped and they were desperate. They expected me to sort things out and I couldn't and that was soul destroying. I'm not joking when I say I sometimes burst in tears driving home in my car at the thought that I was leaving people to struggle through another night in those conditions."

He resolved to take action and got permission from his manager to start putting standards together - despite the threats and bribes rife in the B&B sector at the time.
"It came home to me that to be effective, you had to campaign," he explains. He wrote reports and argued his case.
CIEH general councillor Peter Archer invited Ian and his colleague, Ian Dick, to make a presentation to the Western Weekend School. It was the first time Ian had done a presentation of this kind and the pair produced a show-stopping exposŽ of government housing policy, showing the correlation between lack of funding and the increase in homelessness and bed and breakfast accommodation. People were shocked.

Back in Hackney, Ian was dealing in compromise. "We couldn't make all the properties fit, but they had to be lived in," he explains. "Just because you can't achieve the whole outcome, that's no reason for not tackling it at all."
From there, Ian was made special projects officer - with the opportunity to pick up on the latest agendas. This was the 1980s when environmental concerns were coming into their own and Hackney had declared itself a "nuclear free zone". It was a forward-thinking place to be.
"For someone like me, it was a licence to be adventurous," smiles Ian. He followed up initiatives on acid rain, lead fishing weights and light pollution, among others.
"Too often people sit back and wait for someone else to act first," says Ian. "Most good causes need a champion rather than a committee."
He was put in charge of Hackney's nascent noisy party patrol. The patrol was an unpopular initiative among council staff, so he involved them in redesigning the service.
"We changed the name from patrol to service - with the emphasis on turning the volume down rather than taking people to court. We wanted to take a persuasive approach and made the decision to do it without police assistance."

Meanwhile Ian and his like-minded friends' modern agenda was showing through to the profession. He was one of the Public Health London Action Group, the 1980s ginger group that tried to drag the Institute kicking and screaming towards the future, heckling about politics and equal opportunities as it went.
"It was never what people thought," Ian smiles. "It was just anybody who wanted to join in - an umbrella for lobbying. I make no apology," he says seriously,"- any good organisation needs a ginger group."
PHLAG turned up in force at AGMs, proposing initiatives on acid rain and radiation dose limits. Then in the mid-1980s, when Ian was working with the Medical Campaign Against Nuclear Weapons, matters came to a head over civil defence.
"We supported a motion saying that environmental health had no part to play in modern civil defence," he explains. "Defence then was all about the possibility of nuclear war, and if that happened, there was nothing we could have done."
The result was angry delegates and an Institution working party set up to examine the role of EHOs in civil defence. It reached similar conclusions.
"People wanted to hang on to defence because it had always been in their job descriptions," says Ian. "What made me so cross was that when something did come along - Aids - where EHOs could have an impact, they didn't instantly take it on board."
In the mid-1980s Aids exploded into public conciousness, hitting Hackney, and public health, like a bombshell.
"I think Hackney felt the impact particularly acutely," says Ian. "HIV became the ideal opportunity for people to discriminate - they would argue it wasn't because people were gay, or black, but because they feared for their safety.
"I felt EHOs were perfectly placed to get involved - and I couldn't understand why everyone else didn't see that."

He sits back. "If I'm known for anything it's for the clarion call I gave at Congress in 1986 to EHOs to accept responsibility for HIV work. I said that if we were responsible for public health then it was everybody's health - we had no right to pick and choose."
The speech struck home.
"Chief EHOs who'd been trying to get it on the books told me they were able afterwards to convince councillors to take the issue seriously and there were also councillors there who took it up themselves and pushed it forward."
It was a very demanding period for Ian, particularly as he still invested so much of himself in his work. There was an enormous amount of prejudice surrounding HIV/Aids in the early days and Ian often found himself at the end of it, yet he still pinpoints that time as the most rewarding part of his career. In the space of a year, Ian appeared at 65 different functions to talk about HIV, from major national conferences to advising individual councils on dealing with HIV-related industrial relations problems.
His policy at Hackney was leading the way for the Association of London Authorities, meanwhile he was putting together national guidance for the CIEH - the first to be produced by a non-medical profession that contained a guide to safe sex.
"I had to get it right all the time because so many people wanted to find fault," he remembers. "I was seen as controversial," says Ian. "But that time helped me see why the job we do is so important. It brought home to me how much trust people have in us - we were seen as honest brokers of information."

Vicious policies?
At about this time, Hackney secured funding for health promotion work and a health promotion unit was formed and led by Ian and Jenny Douse.
"The major part of the agenda was Aids work," says Ian, "but we were also tackling smoking and heart disease and supporting work in food and health and safety."
His passion for action kept Hackney a step ahead of the rest. When he first put forward his policy on smoking and tobacco it was derided by one person at the council as "another of Ian Gray's vicious policies" - a phrase which still leaves him with raised eyebrows. But the same policy succeeded and went on to win the British Heart Foundation award for setting an excellent model in the very year that Roy Castle won his personal award. "Ours was different because it seriously considered the condition of smokers," he explains. "What we aimed at was smoke-free environments." It is an aim which has since taken off nationwide.

The unit invented the Hackney healthy breakfast, to encourage local manual workers, who often relied on breakfast as their meal for the working day, to make it a healthy meal. This initiative was picked up by Loraine Ashton at the Health Education Authority and showcased as a model for others to emulate.
Ian was quick off the mark to recommend a beef ban in schools when the first waves of the BSE scandal broke, but his biggest regret is still that he didn't speak out strongly enough. "Anyone with basic biology who'd ever been in a slaughter hall, must have known the measures the Government were taking weren't effective, yet we all watched it on TV and we didn't speak out," he says gloomily. "I really regret that."
Other than that, his only worry is about alienating people with his work. "As offensive as reactionaries are, so are people who are so bloody right on," he says. "I worry I'm like that sometimes."
He cites an example of a conference where he had talked about Aids, and was then asked what everyone in the room could do to help sufferers. He suggested stopping smoking, to avoid adding risks to their health, and was scorned for the suggestion.
"It really upset me because I thought that's all they'd remember me for afterwards," he says.
At another conference on Aids, Ian talked about sexual preference being a matter of individual choice without clarifying his own, and afterwards someone came up and said exasperatedly "You're straight, aren't you? You should say so - we need you to show you're straight and on our side!"

In 1995, as local authorities tightened their belts the health promotion unit was taken into a wider department. Ian was actually promoted to manage a new combined environmental health and trading standards service but he still looks like he feels shortchanged by the result. He had his work cut out, integrating the two old rivals of environmental health and trading standards, but he threw himself into it with gusto and has made a great success of it.
Ian is an associate member of the Institute of Trading Standards Administration and full of praise for the attitude of TSOs. "My only disappointment is that I can't encourage them to take an interest in our Institute as we don't have the provision for associate membership,", he says.
Despite Hackney's troubles, Ian's combined department has achieved 100 per cent on its food safety indicators and boasts one of the cheapest trading standards services in the capital.
But Ian's main campaigning stance these days - and the message he passes on in lectures to final year EHO students - is the need to pull public health back to the fore.
He starts his lectures by pointing out that he has been to too many health conferences which ignore the environment and too many environment conferences which ignore health. "Why did LA 21 not have health consequences identified?" he asks. "How could we have Health for All initiatives without environmental targets?
"When I first came to Hackney I used to go to the health centre and swap cases with health visitors. These days the two have drifted apart."

The third factor which Ian is keen to weld in is poverty. He helped Sandra Whiles to draw these strands together in a policy document for the Association for Public Health, and is full of praise for Agendas for Change for its rhetoric on health inequalities.
"Where is the action plan though?" he asks. "It needs taking forward.
"One of the tasks I set final year students is to list the five greatest threats to public health at the moment," he continues. "They come up with a long list, very little of which is currently being addressed by EHOs.
"I know funding is tight and statutory duties must be met," concedes Ian, "but imagine a reconstructed environmental health department where the key concern was protecting public health.
"Air pollution would be much more important, health education would be vital, accident prevention, nutrition (not food poisoning), sexual health, stress at work, stemming the rise in tuberculosis, these would all be paramount," he says earnestly.
"It's not as if anyone else is doing these jobs - we wouldn't be taking them away from anyone else. But just think how different the world would be."
He contemplates the idea for a moment.
"When I talk to students I tell them, here are some differences I've made, and I'm not special, I'm not academic. You're just starting out, just think what you can do."
He stops again. "I don't want this to sound like I've finished yet," he smiles. "Who knows, maybe my best work is yet to come?"