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![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
A Canadian Study Compared with "The Inverse Care Law"
Socio-economic disparities in a health care system with universal coverage
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Dr. Ian R McWhinney, London, Ontario Professor Emeritus, The University of Western Ontario
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Anyone investigating morbidity in deprived areas can expect to find results like those in Mercer and Watt’s1 study in Glasgow. Look, for example at Woolhouse, Brown and Lent’s2 Canadian study which investigated experiences of women on the margins of society as a result of poverty or violence. Unlike W.B.L., M.W. have an affluent control group, allowing new data on the “Inverse Care Law.” Both studies collected data about doctor-patient relationships and, in both, empathetic doctors were an important aspect of the patient’s lives. Doctors who were not empathetic had negative effects on patient’s ability to obtain health care. Both studies found continuity of the relationship a positive factor in health care. In the M.W. study, significantly more in the deprived group were young, suggesting that this group might have many single parent families, often deprived. In W.B.L. three quarters of the women had children and three quarters were surviving on $1000 (505.58£) a month, and using some sort of social assistance. In M.W. the deprived group had a greater number of psychological problems. It seems likely that most of these were the multiple effects of poverty rather than mental diseases. A large part of morbidity in deprived areas can be attributed to long term poverty, which continues and even increases in many affluent Western countries. The political will to eradicate poverty would do more than health care to improve health in these communities. The British Government’s determination to eradicate child poverty is to be welcomed. Let us hope that it is fulfilled. In the mean time, the Inverse Care Law should be repealed. This means supplying deprived areas with more doctors, nurses, social workers, and teachers and the other resources which deprived areas need. References: 1. Mercer SW, Watt GM. The inverse care law: Clinical primary care encounters in deprived and affluent areas of Scotland. Ann Fam Med 2007;5:503-510. DOI: 10.1370/afm.778. 2. Woolhouse S, Brown JB, Lent B. Women marginalized by poverty and violence. How patient-physician relationships can help. Can Fam Phy 2004;50:1388-94. Competing interests: None declared |
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Azeem Majeed, London, UK Professor of Primary Care, Imperial College London
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The study by Mercer and Watt illustrates how disparities in health status and access in health services persists even in a healthcare system with universal access. [1] The substantial investment in quality improvement initiatives by the UK's National Health Service may have led to more systematic and equitable processes of care than in many other countries but much more remains to be done to address health disparities in the UK.[2] Investment in the health care system, particularly at a primary care level as suggested by Mercer and Watt, may help to further reduce such disparities. However, wider societal initiatives, for example in the areas of education and the workplace, are also needed. References 1. Gray J, Millett C, Saxena S, Netuveli G, Khunti K, Majeed A. Ethnicity and quality of diabetes care in a health system with universal coverage: population-based cross-sectional survey in primary care. J Gen Intern Med. 2007 Sep;22(9):1317-20. Epub 2007 Jun 27. 2. Millett C, Gray J, Saxena S, Netuveli G, Khunti K, Majeed A. Ethnic disparities in diabetes management and pay-for-performance in the UK: the Wandsworth Prospective Diabetes Study. PLoS Med. 2007 Jun;4(6):e191. Competing interests: None declared |
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