Obituary

‘Think global, act local’.” Except that “local”, for Epstein,

Photo by Liza Green. © 2007 President and Fellows of Harvard College on behalf of HMS Media Services (All Rights Reserved)

ranged from the predominantly low-income population of

east Boston to the even poorer inhabitants of Beira.
With a science degree from Cornell University, Epstein had
moved in 1965 to Albert Einstein College to study medicine
and then, after a stint at the Kaiser Foundation Hospital,
to Harvard Medical School. It was as a physician working
in a nearby neighbourhood health centre that he began
practising primary care medicine among east Bostonians.
Following his 2 years as chief of medicine at the hospital in
Beira, he returned to his old patch, but this time worked from
Cambridge Hospital. He remained there until 1996, leaving
to become a founding member of Harvard Medical School’s
Center for Health and the Global Environment.
Epstein first met the Center’s founding Director,
psychiatrist Eric Chivian, 30 years ago. Their shared interest
in the environment led them, in 1992, to attend the United
Nations Conference on Environment and Development
in Rio de Janeiro. They went expecting to hear something
about the impact of climate change on human health. They
were disappointed. As Haines points out, “In those early days
Paul Robert Epstein there was much discussion of environmental impact and
biodiversity, but very little about health.” Chivian recalls that a
For more on the Center for Physician and campaigner on the health effects report on the health effects of climate change commissioned
Health and the Global
Environment see
of climate change. Born on Nov 16, 1943, in by WHO had received little discussion. The final conference
document devoted only a short chapter to health. “When we
http://chge.med.harvard.edu Manhattan, NY, USA, he died from non-
identified ourselves as physicians,” says Chivian, “the universal
Hodgkin’s lymphoma on Nov 13, 2011, in comment was, ‘What are you doing at an environmental
Boston, MA, USA, aged 67 years. conference?’ There seemed to be a disconnect at the highest
levels of environmental policy making.” In response Epstein
“My first epidemic began quietly, as most epidemics do”, and Chivian held an impromptu press conference called
wrote Paul Epstein in his book Changing Planet, Changing “Where’s human health at Rio?” That started them thinking
Health published earlier this year. He was recalling May, 1978, that physicians ought to be alerting people to the issue.
when, as a physician at the Central Hospital of Beira in The outcome was the Center for Health and the Global
Mozambique, he faced an outbreak of cholera. More than a Environment, created to promote a wider understanding of
decade later, in 1991, he was to remember this episode when the health effects of environmental change. As its Associate
cholera appeared suddenly in Peru, and then elsewhere in Director, Epstein devoted his energies to writing, speaking,
Latin America. By that time, research on the cholera organism teaching, and campaigning on the topic about which he
had been revealing something of its natural reservoirs, felt so passionately. Haines describes Epstein as “a man of
and the temperature rises that could trigger its epidemic great personal warmth as well as tremendous commitment
re-emergence. Epstein himself had become increasingly to issues of social justice, sustainable development, and
concerned about the implications of climate change. Set improving the health of disadvantaged populations. He was
against what he described as “the backdrop of my time in also one of those able to spot issues before they’re apparent
Mozambique”, it was the Peruvian outbreak that helped to a wider audience.” The urgency of climate change spurred
to open his mind to the potential health hazards of global him on, according to Chivian. “But he was also fascinated
warming, and then to motivate the campaigning on this by the science. He read extremely widely, not just the
issue that would become a central part of his life and work. epidemiology, infectious disease, and public health literature
Andy Haines, Professor of Public Health and Primary Care but also meteorology and oceanography journals.” After a
at the London School of Hygiene and Tropical Medicine, first diagnosis of non-Hodgkin’s lymphoma he struggled with the
encountered Epstein in the early 1990s. Haines was among disease for a long time, says Chivian. But it didn’t stop him
the contributors to a set of Lancet articles on climate change working, almost to the end. “He felt he had to say what he
and health that Epstein had coordinated. “He combined needed to say.” Epstein leaves a wife, son, and daughter.
his concern for individual patients and clinical practice with
global concerns”, says Haines. “He epitomised the old adage Geoff Watts

24 www.thelancet.com Vol 379 January 7, 2012