Are poverty and deprivation relevant to general practice in 2021?

Abstract

February 2021 marked 50 years since Dr Julian Tudor Hart’s landmark paper described the ‘Inverse Care Law’. This article explores how applicable the ‘Inverse Care Law’ is today. How do poverty and deprivation have an impact on general practice today? We learn about the health effects of smoking, obesity and age, but it is important to also understand how relevant deprivation and socioeconomic status are to the health of our patients.

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References

Aldridge

Story

Hwang

, et al.(2018) Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: A systematic review and meta-analysis. Lancet 391(10117): 241–250. DOI: 10.1016/S0140-6736(17)31869-X.

Barnett

Mercer

Norbury

, et al.(2012) The epidemiology of multimorbidity in a large cross-sectional dataset: Implications for health care, research and medical education. Lancet 380(9836): 37–43. DOI: 10.1016/S0140-6736(12)60240-2.

Blane

(2018) Medical education in (and for) areas of socio-economic deprivation in the UK. Education for Primary Care 29(5): 255–258. DOI: 10.1080/14739879.2018.1512056.

Cassell

Edwards

Harshfield

, et al.(2018) The epidemiology of multimorbidity in primary care: A retrospective cohort study. British Journal of General Practice 68(669): e245–e251. DOI: 10.3399/bjgp18X695465.

Fairhealth (2021) Trialblazer background. Available at: https://fairhealth.org.uk/trailblazer/ (accessed 03 June 2021).

Felitti VJ, Anda RF, Nordenberg D, et al. (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine 14(4): 245–258. DOI: 10.1016/S0749-3797(98)00017-8.

Fisher RDP, Asaria M and Thorlby R (2020) Level or not? Available at: www.health.org.uk/publications/reports/level-or-not (accessed 09 September 2020).

Food Foundation (2020) The impact of Coronavirus on children’s food. Available at: https://foodfoundation.org.uk/new-food-foundation-data-sept-2020/ (accessed 18 November 2020).

Hart

(1971) The inverse care law. Lancet 1(7696): 405–412. DOI: 10.1016/s0140-6736(71)92410-x.

10.

Hood

C M

Gennuso

Swain

, et al.(2016) County health rankings: Relationships between determinant factors and health outcomes. American Journal of Preventive Medicine 50(2): 129–135. DOI: 10.1016/j.amepre.2015.08.024.

11.

Luchenski

Maguire

Aldridge

, et al.(2018) What works in inclusion health: Overview of effective interventions for marginalised and excluded populations. Lancet 391(10117): 266–280. DOI: 10.1016/s0140-6736(17)31959-1.

12.

Lunan C, Liiv A (2020) Poverty, health inequalities and the role of general practice. In: Tzortziou-Brown, V. (ed.) RCGP Council. London: RCGP. https://www.rcgp.org.uk/-/media/Files/My-RCGP/Council-papers/september-2020/C78--Poverty-Health-Inequalities-and-the-Role-of-General-Practice.ashx?la=en.

13.

Marmot

(2020) Health equity in England: The Marmot review 10 years on. BMJ 368: m693DOI: 10.1136/bmj.m693.

14.

Marmot

Allen

(2020) COVID-19: Exposing and amplifying inequalities. Journal of Epidemiology & Community Health 74(9): 681–682. DOI: 10.1136/jech-2020-214720.

15.

Marmot

Bell

(2012) Fair society, healthy lives. Public Health 126: S4–S10. DOI: 10.1016/j.puhe.2012.05.014.

16.

Marmot

Friel

Bell

, et al.(2008) Closing the gap in a generation: Health equity through action on the social determinants of health. Lancet 372(6950): 1661–1669. DOI: 10.1016/S0140-6736(08)61690-6.

17.

McLean

Guthrie

Mercer

, et al.(2015) General practice funding underpins the persistence of the inverse care law: Cross-sectional study in Scotland. British Journal of General Practice 65(641): e799–805. DOI: 10.3399/bjgp15X687829.

18.

Mercer

John

Robson

, et al.(2021) The inverse care law and the potential of primary care in deprived areas. The Lancet 397(10276): 775–776.

19.

Mercer

Watt

(2007) The inverse care law: Clinical primary care encounters in deprived and affluent areas of Scotland. Annals of Family Medicine 5(6): 503–510. DOI: 10.1370/afm.778.

20.

ONS (2019) Exploring the UK’s digital divide. Available at: www.ons.gov.uk/peoplepopulationandcommunity/householdcharacteristics/homeinternetandsocialmediausage/articles/exploringtheuksdigitaldivide/2019-03-04 (accessed 20 June 2021).

21.

Palmer B (2020) Chart of the week: Covid-19 kills people in the most deprived areas at double the rate of those in the most affluent. Available: www.nuffieldtrust.org.uk/resource/chart-of-the-week-covid-19-kills-the-most-deprived-at-double-the-rate-of-affluent-people-like-other-conditions (accessed 01 February 2021).

22.

RCGP. GP curriculum. Being a general practitioner. Available at: www.rcgp.org.uk/training-exams/training/gp-curriculum-new/being-a-general-practitioner.aspx (accessed 8 February 2021).

23.

Rees

Gay

McKinley

(2016) The epidemiology of teaching and training general practices in England. Education for Primary Care 27(6): 462–470. DOI: 10.1080/14739879.2016.1208542.

24.

Reilly J, Hassanally K, Budd J, et al. (2020) Accident and emergency department attendance rates of people experiencing homelessness by GP registration: A retrospective analysis. BJGP Open 4(5): bjgpopen20X101089. DOI: 10.3399/bjgpopen20X101089.

25.

Rogans-Watson

Shulman

Lewer

, et al.(2020) Premature frailty, geriatric conditions and multimorbidity among people experiencing homelessness: A cross-sectional observational study in a London hostel. Housing, Care and Support 23(3/4): 77–91. DOI: 10.1108/HCS-05-2020-0007.

26.

Starfield

(1994) Is primary care essential? The Lancet 344(8930): 1129–1133. DOI: 10.1016/s0140-6736(94)90634-3.

27.

United Nations (2015) Transforming our World: The 2030 Agenda for Sustainable Development. New York: United Nations. Available at: https://sdgs.un.org/2030agenda (accessed 24 June 2021).

28.

Watt

(2015) Developing general practitioners for the deep end. Education for Primary Care 26(3): 132–133. DOI: 10.1080/14739879.2015.11494330.

29.

Watt G (2019) The Exceptional Potential of General Practice, CRC Press.

30.

WHO (2018) Declaration of Astana. Available at: www.who.int/docs/default-source/primary-health/declaration/gcphc-declaration.pdf (accessed 20 June 2021).

31.

YoungMinds (2018) Addressing adversity: Prioritising adversity and trauma-informed care for children and young people in England. Available at: https://youngminds.org.uk/media/2142/ym-addressing-adversity-book-web.pdf (accessed 20 June 2021).