Julian Tudor Hart: medical pioneer and social advocate

Abstract

Julian Tudor Hart is seen variously as a researcher, an expert on high blood pressure, an epidemiologist, scientist, writer, political commentator, and social advocate. But at heart he was always a practising family doctor. Few physicians manage to be expert in so many fields and none while also looking after the primary care needs of some 2100 people, which Tudor Hart did at Glyncorrwg, a former colliery village in south Wales, UK. His dedication to general practice meant his work was relevant and valued by fellow general practitioners (GPs). Tudor Hart's big idea was that a GP working “on a defined section of a world front in the war against misery and disease” could improve the health of a local population; general practice in the UK's National Health Service (NHS), with registered patient lists and no financial barriers, provided the opportunity. The inverse care law re-examined: a global perspectiveAn inverse care law persists in almost all low-income and middle-income countries, whereby socially disadvantaged people receive less, and lower-quality, health care despite having greater need. By contrast, a disproportionate care law persists in high-income countries, whereby socially disadvantaged people receive more health care, but of worse quality and insufficient quantity to meet their additional needs. Both laws are caused not only by financial barriers and fragmented health insurance systems but also by social inequalities in care seeking and co-investment as well as the costs and benefits of health care. Full-Text PDF The inverse care law and the potential of primary care in deprived areasThe inverse care law, whereby health care favours more assertive interests and in doing so compounds the disadvantage of patients and communities with the poorest health,1 exists in most health systems. 50 years after Julian Tudor Hart's landmark paper in which he first described the inverse care law in England and Wales,1 it is still going strong.2,3 In The Lancet, Richard Cookson and colleagues4 provide a global re-examination of the inverse care law. Full-Text PDF The inverse care law in the Anthropocene epochJulian Tudor Hart described the inverse relationship between the need for effective health care and its provision in compelling terms. During his career in primary care in a former coal mining community in south Wales, UK, he showed how, by integrating clinical care with an epidemiological approach, much can be done to improve health in disadvantaged populations.1 He wrote the inverse care law2 based on an analysis of the UK National Health Service (NHS) 50 years ago and yet its importance has transcended that historical period and its national context. Full-Text PDF 50 years of the inverse care law“The availability of good medical care tends to vary with the need for it in the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.” Full-Text PDF