Sir Donald Acheson

Chief medical officer who oversaw the UK response to the Aids and BSE crises
Donald Acheson
Donald Acheson was well placed, as an epidemiologist, to deal with the spread of Aids Photograph: UPPA/Photoshot

Sir Donald Acheson, who has died aged 83, was chief medical officer (CMO)between 1983 and 1991 and is widely acknowledged as the key policymaker of the UK's successful drive against Aids. He will also be remembered for raising the profile of public health and his 1998 Acheson report on health inequalities.

The shock of the emergence of a deadly new epidemic, Aids, is only equalled by the shock, in retrospect, of Acheson's ability to persuade Margaret Thatcher's Conservative government to adopt a liberal approach to tackling the sexually driven disease. It involved concentrating on massive health education programmes, in parallel with detailed plans to accurately track and combat the spread of the disease. He persuaded ministers to abandon a proposal for the compulsory testing of Aids and avoid making it a compulsory notifiable disease – on the grounds that it would deter patients from seeking help, as earlier exercises with sexual epidemic campaigns had experienced.

The focus was on harm reduction not prohibition. Safe sex rather than no sex. He even obtained Conservative consent to what was, in effect, a scheme which condoned illegal drug use – needle exchanges for drug addicts, which had demonstrated their success in dramatically reducing the spread of the disease in Amsterdam and Berlin.

How did he do it? Acheson, born in Belfast and educated at Merchiston Castle school, Edinburgh, and Brasenose College, Oxford, arrived at the Health Department after spending more than 20 years studying diseases in hospitals or medical research units in London, Oxford and Southampton. Better still, in terms of the impending Aids crisis, he was an epidemiologist: an investigator of the causes and control of epidemics. He brought with him an important epidemiological principle: all actions should be based on scientific evidence and, where evidence is lacking, a precautionary principle should be applied.

There were a mere 28 known Aids cases in the UK when he started work as CMO. There was no Aids policy and no known cure. One initial challenge facing the new CMO was the need to integrate two separate medical worlds: biomedicine and public health (screening, education, epidemiology). He also successfully bridged two other groups: the medical world and the gay community, where the disease initially was most prevalent. He set up an informal group of senior medics and public health officials, to which he also invited people from the Terrence Higgins Trust, an HIV charity with its roots in the gay community. From there he moved on to establishing an expert advisory group, which he chaired.

As one medical historian has noted: "His passionate conviction that this epidemic must be quashed before it could take hold was one of his main strengths in persuading the government and his colleagues to take the disease seriously." She added that Acheson "ate and slept Aids from 1985 onwards".

The large, well-funded and sustained education campaign began in 1986 with press and television adverts along with "Aids – don't die of ignorance" leaflets circulated to 23m homes. Ministerial press briefings followed. By February 1987, an Aids week involved 19 hours of public service broadcasting across all four existing TV channels.

The campaign achieved unstoppable momentum. Acheson went on to ­broker international guidelines within the World Health Organisation, ensuring the dominant ideology remained the British liberal consensus. By the time of his retirement in 1991, Aids in the UK had moved from initial shock through several intermediate phases towards being a manageable chronic condition. Many of the hundreds of hospital beds that had been earmarked were found not necessary.

His eight years as CMO ended less happily. First, on the day before he retired, at a press conference on his final annual report, he replied to a journalist who had asked about breast cancer that self-examination was not an effective method of detecting the disease. This was a complete contradiction of government policy and generated a media fuss. Within two weeks of the event, new government guidelines were issued reinforcing the benefits of proper self-examination.

More seriously, one ill-advised sentence on BSE 16 months before his retirement ended up with him being censured, long after he had left office, by the committee of inquiry set up to examine the handling of the epidemic. It was a vivid illustration of the perils that CMOs face in their tightrope walk determining risk management.

What triggered the furore was the disclosure in May 1990 of a suspected case of BSE in a cat. If there could be a transmission of the disease between animal species, then why not to humans too? Acheson was pressed by the department to make a prompt response. He issued a press statement that the risk posed to human health by BSE was still remote, but he also made a videotape that could be used by television news programmes during which he asserted there was "no risk associated with eating British beef". It was a much longer explanation, but it was this nugget that was extracted by television news editors. Nearly 10 years later, he told the Phillips committee of inquiry, which criticised him for giving the public "false reassurance", that "the use of such a phrase must have resulted from a slip of the tongue".

There was a third unhappy part to his final years as CMO: serious attempts to cull his medical staff. Historically within the Department of Health there were two parallel hierarchies: administrative staff who reported to the permanent secretary and medical staff to the CMO. This began in 1919 and by the early 1970s the CMO had a staff of 190. In a world of team medicine, this was questionable, but Acheson argued he could not have achieved his successful Aids campaign without them. He declared: "You cannot be independent if what you have access to is controlled by administrative staff who may have a ­different agenda."

But Whitehall efficiency reviews in the Thatcher years were unrelenting and merciless. Acheson survived, but only by spending 20% of his time fighting cuts and merger. His successor, Kenneth Calman, declared himself sunk when the 140 staff under him became merged. New Labour repaired some of the damage by the introduction of tsars for several important categories of patients.

Of all his achievements – the founding of the new medical school at Southampton University, his research reports on the health hazards of asbestos and the desperate state of inner-city primary healthcare – Acheson would probably have been most proud of raising the profile of public health. Both his father, a Northern Ireland doctor, and his older brother Roy, a Cambridge professor, were public health doctors.

His last public service, for which he gained widespread respect, was his report on health inequalities in 1998. Recruited by New Labour after the 1997 election, he was given one year to review the current state of inequalities and set out priorities for future policies. True to his reputation, he was on time and in a most thorough manner. He documented the degree to which health inequalities had brutally widened during the Thatcher/Major years and set out 39 recommendations. Many have been implemented – money for poor families, a restriction on smoking in public places, more money for inner-city schools, better sex education – but some of the most crucial, such as reducing the incomes gap, remain to be done.

Acheson was knighted in 1986. He is survived by his wife Angela and their daughter, and a son and four daughters from his first marriage, to Barbara (another daughter from this marriage predeceased him).

Ernest Donald Acheson, medical officer, born 17 September 1926; died 10 January 2010