In Memoriam Adam Wagstaff 1959-2020

On the occasion of Adam Wagstaff’s death, Professor Tony Culyer reflects on his vast legacy to health economics, from Tony’s perspective of having been Adam’s PhD supervisor as well as a friend and collaborator.

On the occasion of Adam Wagstaff’s death on May 10^th, 2020, OHE pays tribute to his legacy with an obituary written by Professor Tony Culyer.

Adam Wagstaff, despite having just turned 61 years of age, leaves behind him seminal contributions to health economics. He greatly increased our understanding of: the demand for health and health production (see Wagstaff’s diagram of Grossman’s model, for instance); issues of health, poverty and the measurement of equity; the importance of universal health care; the efficient financing of health systems; health valuation; and much more.

Obituary by Tony Culyer:

It is a rare privilege to supervise DPhil students of such exceptional talent as Adam possessed, yet it’s one that fell to me, so I am immensely proud to have counted him as a friend and I am, vicariously, no less proud of all he has achieved. He was my brightest doctoral supervisee. As anyone who knew him would know, he needed next to no management, was never at a loss for an idea fit for the occasion, assiduous in his commitment to economics, diligent in all he undertook, imaginative in using the economics way of thinking and always keen to share his ideas through writing, workshops, talks and blogs. A dream student one would think – but no, at least not in the sense that he was easy. Adam challenged one. In the community of scholars, the university, what Jacques Barzun called “the House of Intellect” [1], he was hard work. His logic always relentless. His opinions evidenced. His attention to detail pedantic. But his attention to detail never came at the cost of the bigger picture. He often knew better what I had written than I did myself! His was a mind born to tackle serious questions of morality in public policy.  He made his teachers think – and rethink. That was what made him hard work and that, of course, is what made him an ideal colleague. I think it is as a colleague that I always thought of him, right from the beginning. Given who and what he was, it is hardly to be wondered at that he reached the pinnacle of his career at another House of Intellect: The World Bank, in which intellects and their application to relieve a suffering world are perfectly combined.

It was not surprising that our first joint publications were while Adam was still a postgraduate student at York [2, 3]. These were ad hoc (commercially funded) early cost-effectiveness studies with one or two ingenious twists that were down to him. I think they were honestly done. Equity was, however, the principal territory that kept us in touch when he had left both York and Sussex. It culminated for me in our joint paper [4], which must have been one of the last flowerings of economic geometry in economic literature. Thereafter, I became increasingly absorbed in university management, while he built his astonishing global health equity network, out of which a thousand PhD theses have doubtless been born. He had the charisma, enthusiasm, acumen, and organisational talent to make that network happen and, in the process, to bring into being an international league of friends and colleagues that must be second to none. Such were the working relationships he had that his very identity on at least one occasion merged with another’s: after years of writing with Eddy van Doorslaer he became “Adam van Wagstaff” in one paper [5: 409]!

His topical breadth was immense, though social concern remained at the heart of it all. His work led the world both theoretically and empirically: education economics, poverty, economics of social protection, health systems and their reform, the place of health in welfare economics, health insurance and the delivery of Universal Health Coverage in low and middle income countries, transitions and inequities that arise from threshold entitlements that violate the principle of horizontal equity, the demand for health and the demand for health care, incentives and the behaviour of agents in health care provision and health care policy, the measurement of health and associated inequalities of course, the pharmaceutical industry, bibliometry, health econometrics. In all cases, measurement was to the fore. He was never merely a fine theorist; his was theory that was there to be applied – and he applied it.

To teach and, later, to work with Adam was to engage with someone whose personality showed an unlikely combination of diffidence and self-confidence: diffidence in that he never bullied or relished intellectual aggression in debate or argument; self-confidence in that he held his ground tenaciously, with rigour, and pursued the case to the very end. There was never much doubt about who had won, but at least losing left few scars!

We have lost a very nice man and a wonderful scholar.

Tony Culyer

Emeritus Professor of Economics, University of York, UK

References

1. J Barzun, The House of Intellect, HarperCollins, 1959.

2. A J Culyer, J MacFie, A Wagstaff, “Cost-effectiveness of foam elastomer and gauze dressings in the management of open perineal wounds”, Social Science and Medicine, 1983, 17: 1047-53.

3. A J Culyer, A Wagstaff, J MacFie, “Foam elastomer and gauze dressings in the management of open perineal wounds: a cost-effectiveness study”, British Journal of Clinical Practice, 1984, 38: 263-8.

4. A J Culyer, A Wagstaff,  “Equity and equality in health and health care”, Journal of Health Economics, 1993, 12:  431-457 (reprinted in N Barr (ed.) Economic Theory and the Welfare State, Cheltenham: Edward Elgar, 2001, 231-257.

5. A Wagstaff, A J Culyer, “Four decades of health economics through a bibliometric lens”, Journal of Health Economics, 2012, 31: 406-39.