The inverse care law and the potential of primary care in deprived areas

Abstract

The 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 Hart JT The inverse care law. Lancet. 1971; 1: 405-412 Summary PubMed Scopus (2006) Google Scholar 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 Hart JT The inverse care law. Lancet. 1971; 1: 405-412 Summary PubMed Scopus (2006) Google Scholar it is still going strong. 2 Fisher R Dunn P Asaria M et al. Briefing: level or not? Comparing general practice in areas of high and low socioeconomic deprivation in England. Health Foundation, London2020 Google Scholar , 3 Gopfert A Deeny SR Fisher R Stafford M Primary care consultation length by deprivation and multimorbidity in England: an observational study using electronic patient records. Br J Gen Pract. 2020; (published online Dec 14.)https://doi.org/10.3399/bjgp20X714029 Crossref PubMed Scopus (7) Google Scholar In The Lancet, Richard Cookson and colleagues 4 Cookson R Doran T Asaria M Gupta I Parra Mujica F The inverse care law re-examined: a global perspective. Lancet. 2021; 397: 828-838 Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar provide a global re-examination of the inverse care law. 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 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 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