Jonathan M. Mann, MD, MPH 1947-1998

On Wednesday night, September 2, 1998, the world lost a major force in the battle against AIDS and social injustice. Jonathan Mann, age 51, a renowned leader in public health and human rights, died in the crash of Swissair Flight 111, along with his wife, Mary Lou Clements-Mann, also 51, a prominent research scientist in the field of vaccine development. He leaves his former wife of 25 years, Marie-Paule Bondat, and their three children.

Dr. Mann, a member of the M&GS advisory board, was respected and loved throughout the world by those who worked with him or who benefited from his teaching and influence. He was a restless visionary, one who saw things clearly before others did, who in the course of his short life helped to develop the view that health and human rights are inextricably linked in concept and consequence, that health conditions arise from life circumstances, that epidemics such as AIDS spread first and most rapidly among those whom the world considers the wretched of the earth. He was an impatient and effective innovator, an eloquent and impassioned public speaker, and a courageous and demanding advocate for the causes that consumed his life. On the night he died, he was en route to a meeting on AIDS at the World Health Organization in Geneva.

The approach to AIDS now considered axiomatic was developed by the World Health Organization’s Global Program on AIDS from 1986 to 1990 under Dr. Mann’s leadership: that prevention is essential; that understanding of the social and behavioral dynamics and patterns of sexual transmission as well as promotion of safe blood supplies are crucial supports to preventive action; that national programs must be encouraged to participate in a comprehensive and sustained global program of surveillance, monitoring, and educational advocacy; that a vigorous and wide-ranging program of biomedical research must be organized in order to develop effective treatment, remediation, and ultimately preventive protection; and that the rights of the individual to confidentiality, treatment, and support must underlie all aspects of assessment and intervention.

Inevitably, the intensity of his work and the success of his program brought Dr. Mann into conflict with those in WHO who did not share his sense of urgency about the AIDS epidemic. He resigned in protest and frustration in 1990. His departure sent shock waves through the AIDS response network worldwide as well as within WHO.

Dr. Mann joined the Harvard School of Public Health in 1990 as a professor of epidemiology and international health. He began to articulate the ways in which the health of individuals and populations reflects access to basic human rights, using as his warrant his years as a public health practitioner and strategist and as his text the Universal Declaration of Human Rights. As the François-Xavier Bagnoud Professor of Health and Human Rights, he created a new discussion at Harvard and throughout the world’s academic community about the nature of illness and health and its relationship to isolation and stigmatization. He never failed to acknowledge the essential impact of sheer poverty and absence of key physical supports on health, yet he invited students, faculty, and colleagues around the world to think broadly and deeply about the ethical and rights dimensions of health care access and quality.

Most recently, he saw in the offer to serve as the Dean of the School of Public Health at the Allegheny University of Health Sciences an opportunity to build an entire multidisciplinary program in the image of public health he had envisioned. He departed Harvard for Philadelphia in late 1997, only to have his hopes for this new job constrained by the financial difficulties of the health care complex he had joined. In these last few months, excited by the new leadership at WHO and the chance that he might again devote his full energies to AIDS prevention, his attention was turning once more towards Geneva and the world campaign.

Jonathan Mann’s philosophic and strategic legacy will affect the fate of millions for generations to come. As his colleague Manuel Carballo stated at the WHO memorial service: “It is difficult to imagine what would have happened to the response to the AIDS pandemic had Jonathan Mann not been there to lead that response.”

Jennifer Leaning, M.D.
Cambridge, MA USA

Editor’s note: An extended version of the above obituary appeared in the British Medical Journal in September 1998 (BMJ 1998:754-755). It is reprinted here with permission.

The Swissair crash claimed the lives of 229 people, including humanitarian workers devoted to the causes of refugees and children. The editors of M&GS extend our sincerest sympathies to the families and friends of all who lost their lives in this tragedy.

The Future of the Global Physicians Movement

Jonathan M. Mann, MD, MPH

[Editor’s note: The following excerpts are from Dr. Mann’s keynote address to the 12th World Congress of International Physicians for the Prevention of Nuclear War, in Worcester, MA on 25 July 1996.]

Most people who decide to become doctors respond to a deep intuition about life and their own lives. To become a doctor implicitly places us on the side of those who believe that the world can change--that the chains of pain and suffering in the world can be broken....Thus, at a profound, even instinctual level... people become physicians to find a way to say “no” to disease and pain, and to hopelessness and despair--in short, to place themselves squarely on the side of those who intervene in the present to change the future.

The physician agrees to...stand by the patient regardless of what happens--through their suffering, and even to the edge of life itself. The physician steadfastly remains with the patient even when the only thing the physician can offer is the fact of his or her presence. This is as relevant to public health as for individual patient care. Public health must engage in difficult issues even when no cure or effective instruments are yet available and public health physicians also must remain with, and not abandon, vulnerable populations.

The Human Rights Model

Physicians face people who are literally and figuratively naked; the physician is the stranger who has a right to be present at some of the central moments of life--birth, illness, death. Physicians are also allowed, even required, to break the societal rules that define the space around each person which should not normally be entered...Abuse of this confidence or the privilege of entering personal space severely violates dignity; used properly, it is a source of legitimate and legitimized access to the intimate and sacred dimensions of the life of others.

Finally, medicine has the power to name the forms of human suffering and to seek their alievation.

Promoting Societal Change

These five elements together suggest the special character and nature of physicians working in a global movement. Physicians bring to this challenge a belief that the world can change, a tenacious commitment to accompany others even when no cure or even immediate relief may be available, a consistent affirming of human dignity, societal authorization to deal with and participate in the most private circumstances of human life, and the capacity to identify, name, describe, and legitimize forms of human suffering, while also seeking their alleviation.

The modern movement of human rights, arising in the aftermath of the Holocaust in Europe and born of the deep aspiration to prevent a recurrence of government-sponsored violence towards individuals...offers a more coherent, comprehensive, and practical framework for analysis and action on the societal root causes of vulnerability to disease, disability, and premature death than any framework inherited from traditional public health or biomedical science.

The aim of a global physicians movement may become, therefore, to promote and protect health by catalyzing, encouraging, and promoting societal change based on an analysis of how the lack of respect for human rights and dignity creates the preconditions for preventable disease, disability, and premature death.

Physician Citizens

The tasks of a global physicians movement--envisioning global healing and global health--reflect a clear understanding that societal-level forces are the major determinants of health. Moreover, they demonstrate an awareness of how human well being and human rights protection and promotion are inextricably linked.

The new global physicians movement calls upon physicians, as citizens of the modern world, to promote and protect health at a societal level. It embraces diversity within a movement that recognizes and defines itself through its expression of fundamental physician values. It views human rights and dignity as the key to coherence in its determination to act directly on the societal root causes of illness, disability, and death. And it accepts that to accomplish its mission, it will have to work for societal transformation, towards the realization of human rights and respect for human dignity that defines the societal essence of well being.

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