‘They were great times and brilliant gigs’: from fiddle player to chief medical officer

It may be a long way from playing trad in Neachtain’s pub in Galway to becoming the first woman appointed as chief medical officer, but Prof Breda Smyth’s career has always seamlessly joined music and medicine.

An accomplished fiddle and tin-whistle player, the public health specialist added a new string to her bow this month with her appointment as the Government’s main adviser on health. She succeeds Dr Tony Holohan, who stepped down in July.

Speaking to The Irish Times this week in the Department of Health, Smyth doesn’t hide her “absolute delight” at the appointment. “It’s a real honour to be in the post and then to be the first woman. I’ve been doing it on an interim basis for three months now and that has really whetted my enthusiasm.”

She is effusive talking about music, but inclined to be more cautious and measured when discussing her new role. Still, she is clear about her priorities.

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“Covid-19 will have its own natural trajectory, but public health isn’t just about pandemics,” she stresses. “Prevention is a particular area I want to focus on, along with health inequalities.”

“The pandemic heightened the profile of the fundamentals of public health, and also the wider determinants of health and how they influence outcomes. Health is not just about the health system; it’s about the environment that people are living in, it’s about education, income, employment, water, air, housing, all these fundamentals that can create good health.”

During the pandemic, the risk of Covid-19 transmission was heightened in areas of deprivation, she says. Crowded living conditions were a factor, as was the fear of some workers that they might not get paid if they fell ill.

“We have a significant problem in Ireland with health inequalities and areas of deprivation. For example, obesity rates are high in lower socio-economic groups where there is less education and literacy, fewer spaces to exercise and fewer healthy food choices.”

Good health starts in the home, Smyth says, pointing to research showing preventative measures rather than medication can achieve a 60 per cent reduction in chronic diseases.

“We need to further embrace preventative behaviour. We need to reorient how we understand the pathway of health through life and how that impacts our outcomes.”

[ Prof Breda Smyth appointed State’s chief medical officer ]

Health also involves “bringing care into the home and community” and “reorienting the emphasis on care on ourselves rather than having predetermined visions of it being only about hospitals”.

One of the first campaigns she will lead aims to prevent 18- to 30-year-olds from becoming overweight or obese, after research showed many young people struggle to navigate this period of great transition in their lives.

Moving from the HSE to the Department of Health entails a switch from day-to-day operations to strategy, but Smyth says the strategic implementation of public health measures has always been part of her work.

Chief medical officers (CMO) in other countries often have a high profile, notably Dr Anthony Fauci’s long-term role in advising US presidents. In Ireland, the role was a relatively low-key one until the pandemic, when Dr Holohan became a household name. In the early months of the crisis, with the Government in disarray, he appeared to be running the State’s response to Covid-19.

While hoping for a quieter tenure, Smyth believes she will have to “amplify” her role as the circumstances dictate. Asked about her leadership style, she says it will “speak for itself in time”.

The new CMO is carrying out a review of the way the job works in other countries, as part of a reorganisation of the office.

‘Mandates are a very significant step, not to be taken lightly. There would have to be very significant rationale for the introduction of [masks]’

Music has been a constant throughout her life. She grew up in Straide, Co Mayo, raised by schoolteacher parents who were immersed in trad. Her father TJ, who died last August, taught all four children to play. Her brother Seán and sister Cora are also accomplished musicians and trained doctors.

“I love music, and played it all through my formative years. When we were at home it was our pastime. Our holidays rotated around county and provincial feiseanna, Slógadh and the Fleadh Cheoil.

“We all went to college in Galway. We used to play in Tigh Neachtain. The gigs gave us money to get through college; there wasn’t much money around back then. I would give music lessons on a Saturday morning to the horror of my flatmates because they would have to stay in their bedrooms while I monopolised the front room with the fiddle lessons.”

In the 1990s, she was Seán’s tour manager. “I was going around in his car, having only just learned to drive. They were great times and brilliant gigs.”

Writing the sleeve notes on one of Seán’s albums, renowned composer Mícheál Ó Súilleabháin noted that in the Smyth clan’s music “surgical precision comes with a deep sense of tradition from past generations of family in Mayo”.

She recorded a solo album in 2002. “Creative energy oozes from every tune set, wide-eyed enthusiasm fuels its manic pace,” said the The Irish Times reviewer, adding that the player had “untapped possibilities”.

She joined up with Cora to record a second album three years later, and gigged with a band, Odessa. There were also frequent appearances on music programmes on TG4 and RTÉ, giving her a familiarity with television that will stand to her as CMO.

Somehow she combined the trad sessions with her blossoming medical career. “You engaged with all the music and then when it came to the exams you battened down the hatches, locked the doors and put your head down.”

Even when in California, the show went on, as she joined Michael Flatley’s Lord of the Dance tour. She played at the Ryder Cup and for the royal family in Monaco.

She is married to Jimmy Higgins, the percussionist with The Stunning, and they have two children, Bláthnaid and Donal, who has played soccer for Ireland at under-19 level.

Music finally had to take a back seat after the birth of her children and a return to Ireland, though she continues to play.

While Seán and Cora are also doctors, another sister Maria has a PhD in biochemistry.

Why did she pick medicine? “I suppose I was fascinated by it. I was interested in the sciences. Then Seán went into it and I liked what he was doing.

“I really enjoyed the scientific element, the curiosity, how it was constantly changing and improving.”

A stint working with deprived groups in Cherry Orchard in Dublin was the “eureka moment” in her career. “For the first time it struck me that there are different cohorts in the population with very different needs, and that these need to be addressed.” She did a master’s in public health in UCD, a PhD in the University of Galway and post-doctoral work in the United States.

As for the coming months, she is concerned at the recent rise in the number of people in hospital with Covid, along with the “constellation” of variants currently circulating.

Covid-19 is “moving towards” an endemic state, though it continues to have “a life of its own” and the future cannot be predicted.

“The situation is complicated but the important things is that we have an effective vaccine, one that is adapted for current variants.”

She is keen to see greater availability of antivirals for vulnerable people who become infected with Covid, and has recommended the general use of masks in crowded indoor settings such as public transport.

As for compelling the use of masks again, she says: “Mandates are a very significant step, not to be taken lightly. There would have to be very significant rationale for the introduction of such a mandate.”

As CMO, one of her main tasks will be to ensure the State is better prepared for a resurgence of Covid-19, or the emergence of a new pathogen. The work started this week with the publication of emergency plans for this winter.

Critics of public health measures sometimes deride them as “nannyish”. Smyth says her goal is to empower people to lead healthy lives. “Personal empowerment is the direct opposite of the nanny state,” she says, “It’s giving people the appropriate tools to do what is best for them.”