The inverse care law in the Anthropocene epoch

Abstract

Julian 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 Hart JT Thomas C Gibbons B et al. Twenty five years of case finding and audit in a socially deprived community. Br Med J. 1991; 302: 1509-1513 Crossref PubMed Scopus (53) Google Scholar He wrote the inverse care law 2 Hart JT The inverse care law. Lancet. 1971; 1: 405-412 Summary PubMed Scopus (2006) Google Scholar 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. The key messages of his landmark paper 2 Hart JT The inverse care law. Lancet. 1971; 1: 405-412 Summary PubMed Scopus (2006) Google Scholar apply within many countries and on a global scale, as reviewed in The Lancet by Richard Cookson and colleagues. 3 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 The insights from the inverse care law and from Tudor Hart's legacy of critical thinking about health care and the political economy of health can guide us today as we navigate the challenges of the Anthropocene epoch. In the Anthropocene, humanity has a dominant role in driving environmental changes as a result of accelerating demands for energy, food, water, infrastructure, and consumer products. 4 Whitmee S Haines A Beyrer C et al. Safeguarding human health in the Anthropocene epoch: report of the Rockefeller Foundation–Lancet Commission on planetary health. Lancet. 2015; 386: 1973-2028 Summary Full Text Full Text PDF PubMed Scopus (921) Google Scholar 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 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 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