On Losing My Father To Prostate Cancer, And What We Must Learn From Him
An epidemiologist who helped eradicate smallpox and who wrote the book on public health medicine, Dr. Norman John Vetter imagined a better world than this. Our duty must be to deliver it.
My father died last week after six years battling prostate cancer, a disease that affects one in eight men. A systems thinker to the end, he believed greed was an illness born of fear, and that people could be empowered to rise above selfishness. We owe it to ourselves, and to each other, to learn from him.
Norman Vetter had every reason to be cynical about humanity. He was 18 months old when his dad was killed by the Nazis, on D-Day+2, 1944. Norman Senior had been driving a light reconnaissance vehicle through a little village in Normandy when he encountered a German tank regiment. His body was never recovered. My father’s mother, Ida Mary Hopkins, never accepted that her husband had died, preferring to believe he had “run off with a floozy to the South of France.” Whether she actually believed that is debatable, but her son would go on to inherit her wry sense of humour.
Ida brought up her son in the village of Penhow, on the border between England and Wales, in conditions nearing poverty, their meagre smallholding barely capable of producing enough food. But Ida, an avid reader, believed fiercely in the transformative power of education, encouraging her son to excel at school. The only child in his rural class to pass the Eleven Plus exams, Norman enrolled at Chepstow Grammar, and subsequently studied medicine at the University of Edinburgh. At Edinburgh, he didn’t have to worry about money: the Britain of the 1960s was in the business of investing in its young people. There were no student loans, and people without the means were given grants to see them through their studies.
Following graduation, Norman’s first jobs were in obstetrics and emergency medicine. His cool-headed demeanour earned him immediate respect. In the pressure-cooker environment of the emergency room, colleagues recall him being the one member of staff apparently immune to panic. “Accident and Emergency is chaotic enough,” he would say. “Why add to the chaos?” This was a forbearance born not of indifference, but of an almost inexhaustible kindness: from patients and porters to consultants and surgeons, all could expect to be treated with the same level of patience and generosity. It was at Edinburgh Royal Infirmary that he met my mother, Sarah Diane Grace Richards, a nurse. They would marry in 1972, and remain inseparable to the end.
But individual cases weren’t what motivated Norman: he wanted to understand and alleviate the causes of sickness and suffering at their roots. He recognised that, to help the most people possible, you don’t change individuals—you change systems. In 1975 he helped spearhead the World Health Organisation’s operation in India and Bangladesh to eradicate smallpox, a disease that had a mortality rate of up to 50%. Sarah accompanied him as they travelled by dhow to remote villages in the Ganges Delta, diagnosing cases and administering vaccines via the bifurcated needle. On Bhola Island, the couple met three-year-old Rahima Banu, Asia’s last ever case of smallpox, who celebrated her 51st birthday this year. Rahima’s subsequent struggles, it must be emphasised, are a case study in social and climate injustice.
Having come face-to-face with almost unimaginable suffering, the Vetters’ experience with the smallpox campaign left them with an abiding love of Bangladesh and its people, along with a profound recognition of their own privilege. Moreover, the ambitious, historically effective smallpox plan showed my father that, to really create change for those he loved, it was necessary to work at a far larger scale. Epidemiologists must be consummate systems thinkers: to combat an epidemic, you must zoom out to apprehend all the possible feedback loops in the population you’re observing.
Through the 1980s, recognising Britain’s neglect of its senior citizens, Norman headed the UK Research Team for the Care of the Elderly, in Cardiff. The team interviewed thousands of elderly people across the country, studying everything from housing quality to the impact of loneliness, and advancing the understanding of the issues that affect those in later life. It was unglamorous, compassionate, and desperately needed work—so the team was defunded and shut down in 1988 by the country’s Conservative government, under Margaret Thatcher’s plan to dismantle the welfare state. This cemented my father’s terminal disdain for authority, and inculcated in him a career-long refusal to toe the political line that would prevent him from ever achieving his professorship.
He threw himself into research on the effects of second-hand cigarette smoke—research that was used to develop a smoking ban in public places in the UK. Lobbyists and many in the media claimed such a ban would be impossible to implement, but Norman recognised that creating real change involved deliberately shifting people’s conception of what was politically possible. It involves the application of strategy backed by empirical fact and moral certainty to build public support. More than once, he appeared on the BBC to make the case for restrictions on tobacco, at one point debating the vehemently pro-smoking author Auberon Waugh (who, my father noted with uncharacteristic pride, died within days of the exchange).
By this point, Norman and Sarah had had four children, numbering three brothers and a sister, each of whom was inculcated with a love of living things and a keen, scientific curiosity. Above all, the four were shown—not told—that kindness is the utmost mark of strength.
Through the 90s, Norman published books on epidemiology and how to design health services (being the first to admit that one or two “were a little dry”), and was seconded to Moldova by the EU to help the ex-USSR nation develop its own public health system. As lecturer and Reader in Public Health Medicine at University Hospital Wales, he visited India and East Asia to advise on public health strategy. He was a formidable proponent of the NHS, and fiercely proud of the legacy of the great Welsh reformer, Nye Bevan. In his 1998 book The Public Health and the NHS, he emphasised that the principal function of the National Health Service was not to treat sick people, but to alleviate fear. Freedom from fear would, he thought, help people to live more meaningful, more generous lives.
Norman retired from the NHS in 2006, but continued his work as Editor-in-Chief of the British Medical Bulletin, under Oxford University Press. He would helm the journal for 18 years.
It was on a cycling trip to the Loire valley in 2018 that my father developed severe back pain. On returning home, tests revealed that he had metastases in his spine, with further analysis showing he had had prostate cancer for some time. He’d experienced none of the usual accompanying symptoms, such as urinary issues. And like many medics, he was hopelessly bad at following his own advice with regard to screening. The prognosis was poor.
In support, the four Vetter siblings headed back from around the world to the family home in Wales. But Norman’s subsequent six years would prove to be hard beyond measure. Unlike some malignancies, prostate cancer likes to take its time with its host; it gradually hollows you out from the inside, stripping away your strength and your dignity, until you’d really rather not continue living. Its course plays out as a grotesque pantomime of the universe at its most indifferent. And it was through experiencing this horror that my father taught us his final lesson: society, he said, didn’t exist to mimic that indifference. Its purpose was as a light in the darkness.
Norman had completed two courses of chemotherapy—riding his bicycle to and from every appointment—by the time the Covid pandemic struck, in 2020. The virus instantly laid bare the inability of Britain’s elected leaders to think in systems. On viewing the rampant ineptitude on display, my father said it was as if politicians had believed, right up until that point, that “epidemics were things that happened to other people”. Suddenly, tragically, privileged Westerners were finding out what an epidemiologist was.
Until his death, my father railed against the catalogue of failures, unseriousness and blatant corruption of the Boris Johnson government and its successors in the face of Sars-Cov-2. The attitude of governments at home and abroad, he said, seemed to be that the health of the public was optional; a “nice-to-have”, but ultimately an inconvenience. “They talk about the harms to the economy, without seeming to understand what it is for,” he told me. “The economy exists to support people, not the other way around.” Johnson’s exhortation that his government should “let the bodies pile high” was, in Norman’s view, the perfect expression of psychopathy in high places; the logical conclusion of elevating a vacuous narcissist to the most powerful executive position in the land. Indifference to suffering was not just immoral, he thought, but a manifestation of abject laziness and stupidity.
There were moments when his country’s wall-to-wall failure throughout the pandemic drove my father to despondency. Yet, as his body failed him, he refused to give up on humanity. He looked at advances in medicine and in renewable energy, and at the passionate defiance of young leaders like Greta Thunberg, as grounds for an enduring hope that made him excited about the future, and angry that he wouldn’t get to see it. He was dismayed by the knowledge that the foundational economic logic of the 20th century was almost completely wrong, so I introduced him to the work of such scholars as Amartya Sen, who reimagined how economics should be used. He found inspiration and joy in the work of writers such as Kate Raworth, creator of Doughnut Economics, who imagined a compassionate, equitable society capable of living within Earth’s fragile boundaries. “What’s the point of any of this, if we’re not here to look after each other?” he asked me.
Compassion was, in my father’s understanding, the ultimate expression of strength and of courage. Humanity’s extreme fallibility, in the end, only served to reinforce his indomitable love of people, and of life. Because he understood, as his whole family now does, that the cost of love is grief. But only in embracing that terrible price can we find our purpose.
In memoriam Dr. Norman John Vetter | 5th November 1942—19th April 2024.
He is survived by his wife Sarah, their four children, and four grandchildren.
To support Marie Curie, the end-of-life support charity that offered my father kindness and the highest standard of care in his final weeks, please visit https://www.mariecurie.org.uk/
To learn more about prostate cancer and to support research into the disease, visit https://prostatecanceruk.org/
The Climate Laundry will be on hiatus until May 10th, 2024.
ON THIN ICE: EVEREST
There is no Elsewhere in climate news this week, but please download our new and extremely exciting episode of ON THIN ICE, released on Earth Day. Episode 3 stars climbing legends Conrad Anker and Dawa Steven Sherpa, who talk about the impacts of climate change and human activity on Everest and the Himalayas, and discuss what is being done to save lives and livelihoods in the region. ON THIN ICE is on Apple, Spotify, YouTube and more.