Paul Cosford

Sir Paul Anthony Cosford (20 May 1963 – 5 April 2021) was a British emeritus medical director at Public Health England (PHE), the UK's public health agency, later replaced by the UK Health Security Agency. He had executive roles from 2010 at PHE's predecessor, the Health Protection Agency. From April 2013 to 2019 he was PHE's Medical Director and Director for Health Protection, making him responsible for advising on services to prevent and control infectious diseases and for preparations and responses to public health emergencies. He led the MMR vaccine catch-up campaign in response to the resurgence of measles following the MMR Scare, and contributed to the response to the 2014 Ebola outbreak, the Grenfell disaster in 2017, and the 2018 Novichok poisonings in Salisbury and Amesbury. Over the course of his career in public health he led programmes to reduce hospital-acquired infections and tuberculosis, and oversaw ways of dealing with health inequalities, tobacco, obesity, and responses to pandemic flu. Earlier in his career Cosford moved to North West London to train in psychiatry and in 1990 was appointed lecturer in psychiatry at St Mary's Hospital Medical School. He worked with people with learning difficulties and severe mental illness, and wrote on eating disorders in the elderly. He then transferred to public health and held posts in Hertfordshire and Bedfordshire, and later became director of public health with the Leicestershire, Northamptonshire, and Rutland Area Health Authority. In 2006, the year before he co-authored his Cochrane review on screening for abdominal aortic aneurysms (AAA), he was appointed Regional Director of Public Health for the East of England, which he served until 2010. In 2017 Cosford was diagnosed with advanced lung cancer, which obliged him to step down from his role as director for PHE in 2019. That year, he was lead author of a paper discussing lung cancer in people who had, like himself, never smoked. He subsequently wrote an essay, in which he called for policies on assisted dying to be reviewed. In 2020, in his emeritus role, he reported frequently on the COVID-19 pandemic and continued to work while self-isolating during the early COVID-19 lockdowns. For his services to public health, Cosford was appointed CB in 2016 and KCB in 2021.

Early life and education

Paul Cosford was born in Thornbury, Gloucestershire, on 20 May 1963, one of three children born to teachers Brian and Judith Cosford. Following a move to Exmouth, he entered Exeter School in 1974, and became deputy head boy and captain of tennis there. He completed his secondary education in 1981 and gained admission to study medicine at St Mary's Hospital Medical School, London, where he also participated in rowing. After graduating with at first a bachelor's degree and then a medical degree in 1987, he moved back to Devon.

Early career Initially, Cosford had planned a career in general practice, but following the loss of a child to a genetic disorder, he moved to north west London to take up psychiatry and worked with people with learning difficulties and severe mental illness. In 1990, he became lecturer in psychiatry at St Mary's. In 1992, he co-authored a paper titled "Eating disorders in later life: A review", which was published in the International Journal of Geriatric Psychiatry. It reported that not all anorexics were young, that the desire to be thin and happy with one's body did not lessen as women aged, and that eating disorders in older women could appear as a new problem, or recurrence or persistence of an earlier problem. It often occurred in association with severe depression or obsessive compulsive disorder, and the most common trigger for developing an eating disorder later in life, he noted, was the death of a spouse or a loved-one. He is noted to have membership of the Royal College of Psychiatrists.

Local and regional public health

Cosford began his career in public health in the early 1990s, taking on various management roles in the NHS, public health and social care systems. His early posts were in Hertfordshire and Bedfordshire, and later he became director of public health with the Leicestershire, Northamptonshire, and Rutland Area Health Authority. In 2006 Cosford was one of nine of the new Regional Directors of Public Health introduced by Chief Medical Officer Liam Donaldson, following the announcement of the reorganisation of the NHS. Designated to the East of England, he served as Medical Director of the East of England Strategic Health Authority and Regional Director of Public Health for the East of England in the Department of Health until 2010. He also established the NHS Sustainable Development Unit to reduce the NHS's carbon footprint, and oversaw ways of dealing with health inequalities, tobacco and obesity, responses to pandemic flu, and reducing hospital acquired infections. In 2007, Cosford coauthored a Cochrane review that established that men, particularly those over the age of 65 years, were more likely than women to develop an abdominal aortic aneurysm (AAA), and to prevent it rupturing and causing death, it was necessary to diagnose it early and arrange elective surgical repair of aneurysms larger than 5.5 cm. He reported that once ruptured, 80% died before reaching a hospital, and only half of those who received emergency surgery survived, but by repairing them early deaths were reduced. The four trials in his review formed the basis of introducing one-time screening for AAA recommended by the U.S. Preventive Services Task Force. A systematic review by the Norwegian Institute of Public Health in 2014 described Cosford's review as of "high quality" and included it in their report as it was at the time the only review that included women and looked at the incidence of AAAs that burst. At the launch of 'Improving Lives, Saving Lives' in 2007, Cosford said that obesity needed to be addressed as a priority and that intervening was necessary as early as when breastfeeding and weaning took place. Over the subsequent years he reported on high levels of obesity in the east of England. From 2010 he had executive roles at PHE's predecessor, the Health Protection Agency, and was its acting chief executive from October 2012 to February 2013.

Public Health England

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