The ’15 minutes with…’ blog series aims to provide a glimpse into the career paths and personal lives of the researchers and employees at NDPH and showcase the wide range of roles and science conducted. In this blog series, we ask researchers, non-research staff and students, nominated by the students themselves, to reflect on their career to date – their proudest accomplishments and their lowest points – and how they came to be where they are today.

We will publish on a regular basis in the coming months – we hope you will enjoy. Today, we continue this series with an interview with Alastair Gray, Professor of Health Economics.

Could you describe your current role in one sentence?

I’m Professor of Health Economics. I was Director of the Health Economics Research Centre until handing over to Philip Clarke last year, which has changed my role – and life – quite a lot! But I am still involved in a number of projects, some of which have been running for many years. Mainly these involve running economic analyses alongside clinical trials, by collecting information on costs, survival and quality of life, and combining these to assess whether a new intervention is likely to represent good value for money for the NHS or other health care systems.

 What is your favourite thing about it?  

I know that the trials we are involved in are often providing completely new evidence that might well change routine clinical practice, and the moment when results are first unveiled is always exciting. Also, I get an opportunity to meet leading researchers and practitioners working in many different areas, including public health, general practice, psychiatry, surgery and medicine. I’ve even gone and watched my fair share of procedures, which often gives a much better understanding of what is going on and what is different about a new intervention.

… And what is your least favourite thing about it?

Like many researchers, I find that many of the regulations and requirements that have proliferated concerning data protection, information governance, etc. can be very time-consuming to navigate. No-one is arguing that data must be collected and handled very carefully, but sometimes the processes involved are really quite extraordinary and hard to understand.

Moving on to the science, could you tell us talk about what science you’re most excited about or interested in your own work?

Health economics, like economics generally, is basically concerned with the efficient allocation of resources, or making choices under conditions of scarcity. That might sound a bit dry, but I find that examples come up all the time in conversations with others: why are there waiting lists for elective surgery; why do new drugs have patent protection; who has the best health care system and how do you judge; why do we screen for some diseases but not others. And of course during the coronavirus pandemic these big questions have become impossible to ignore. So using the economist’s set of concepts or tools to think through these questions is always rewarding.  

And what about the science that you’re most interested in beyond your own work?

Not so far beyond my own work, I’ve always had an interest in health and health care over the life course, and in particular the consequences of our ageing societies. There has been a long-running debate in health economics about whether the association between age and health care costs is really about calendar age, or about comorbidities and proximity to death, with some age discrimination in the oldest age groups possibly mixed in. It matters, because in an ideal world we could live longer and healthier lives, which would be better and also more affordable! I was fortunate to supervise an excellent D.Phil student who made some very solid contributions to this area, and it is a topic that is certainly not going to go away. Further beyond my own work, one of my sons is now embarked on a research career in quantum physics: it’s fascinating, but I’d be kidding if I claimed I understood almost any of it.  

What’s the thing that you are most proud of in your professional life ?

It would have to be setting up the Health Economics Research Centre, back in 1996. Before then there had been a few individual health economists in Oxford, but no critical mass and no focal point. Fortunately I got great support from the local NHS and from the university and department, and thanks to all my colleagues and continuing departmental support it has gone from strength to strength. And our alumni are now doing great things in many parts of the world.

And what about your biggest failure or disappointment?

Well, that’s difficult. I’d say that health economics, perhaps in common with medical statistics, is a subject that other researchers often approach for help, either because they want to or need to add it into their research. As I mentioned previously, much of our work is about providing health economic input to clinical trials. It is great to be in demand, and I’m grateful that funding bodies such as NIHR and the MRC have done so much to embed heath economics in the projects they fund. But the danger is that we become completely demand-led, and don’t nurture our own research projects and ideas. We have not exactly failed on that score, but certainly it is hard to get the balance right.

Could you outline your route to where you are today?  

I was not very focused at school, scraped up some qualifications, got into my local polytechnic, and fortunately was then taught by some very stimulating and engaged social scientists, who sparked me into thought. When I graduated, I saw an advert for a research assistant post in health economics in Aberdeen. I knew almost nothing about that area, but it sounded interesting. I asked one of my economics professors what he thought, and said it was a growing area and I should go for it. He was right, on both counts. I spent some years in Aberdeen, finished a PhD while I was there, then moved to the Open University as the health economist in a team creating a new multi-disciplinary course on Health and Disease. There can’t have been many other economists anywhere working in a biology department. The OU hammered two things into me: one, no discipline has all the answers, and two, try to write as clearly as possible, with minimum use of jargon. I liked knowing that there were thousands of students all over the UK working from our course textbooks.

After the OU I had a part-time research post at the London School of Hygiene and Tropical Medicine, but my home was in Oxford and I was drawn into the then Department of Public Health here, providing health economics input and supervision. That’s when the idea of setting up a research centre took seed, and the rest is…well, see above.

Could you tell us one thing about you outside work?

I go for a walk every day; it clears my mind and keeps my step count up. During the pandemic, the home-working and the lockdowns, I’ve got to know a lot of lanes and tracks all around and through Oxford. It doesn’t quite beat the Scottish Highlands, but they will have to wait.

If you could give one piece of advice to your 18 year old self what would that be?

At 18, I’m not sure I would have been listening. But it took me a long time to realise that the people with most self-confidence are not necessarily the ones with most ability or knowledge.

Thank you so much!

Some references for the interested reader

Key papers from the DPhil work:

  • Seshamani M, Gray A. Ageing and health care expenditure: the red herring argument revisited. Health Economics 2004; 13:303-314. PMID: 15067669
  • Seshamani M, Gray A. A longitudinal study of the effects of age and time to death on hospital costs. Journal of Health Economics 2004; 23:217-235. PMID: 15019753

The Open University textbooks:


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