The Inverse Care Law
In this series of articles, medical students from across the country will discuss a range of topics from medical ethics to the NHS to public health to medical conditions to clinical governance
❓What is it?
The inverse care law is a principle that states there is an inverse correlation between availability of healthcare and the populations that require it.
It was first proposed by Julian Tudor Hart, a general practitioner in South Wales, in 1971 who stated that those who need better access to healthcare facilities are far less likely to actually receive it.
Why is it important?
Even though the concept of inverse care law was first described in 1971 it is a still a relevant issue that still needs to be addressed within the UK. It is something that affects thousands across the country due to unequal (and unfair) resource distribution happening even within miles of two locations. As a medic it is important to understand the implications of this law; since justice is a pillar of medical ethics which states that all patients should be treated equally and fairly, if allowing some people to access healthcare resources and services that others can’t, isn’t it causing an unethical imbalance to those groups?
The NHS was formed on three main principles by Aneurin Bevan, a Welsh politician, in 1948; one of these being that it’s services would be “universally available and based on need.” The NHS has now extended these to seven principles but they follow the same three foundations. It’s important to keep honouring these and ensuring that the patients in this country are being treated based on medical requirements and not on where they live or how much they earn.
However, the inverse care law is a problem that is happening because of certain policies that are actually restricting healthcare based on need in the communities with the poorest health. This seems really counterintuitive in providing the amount and adequate level of care for the people that have the most medical need.
Back in Hart’s time there wasn’t really much evidence to actually prove that the inverse care law exists, however that’s all changed in today’s time. Since then there have been a lot of investigations and studies done into the relationship between healthcare and socioeconomic status.
Unfortunately the majority of them show the same underlying result: lower socioeconomic status correlates with reduced access to healthcare services and generally poorer health. An article from the Telegraph describes that NHS funding data showed vulnerable people in England with the most expensive medical needs can be up to 25 times more likely to get their costs covered depending on where they live. This really shouldn’t be happening, especially at that scale. Within the UK there are over a third of children that grow up in socioeconomic deprivation. This isn’t something affecting a small minority of people, it’s a issue operating at a large scale within our country without a lot of the population actually knowing about it. Screening programmes for cervical and breast cancer are also shown to be lower in more deprived areas which doesn’t really make sense since this is where cancer mortality rates are actually the highest.
In order to tackle these issues it’s important to understand how and why they arise.
Many factors such as low income, education and even transport can all contribute to poorer health compared to populations in more affluent areas. Since there are inequalities in health outcomes mainly because of lifestyle differences it would make sense that those areas receive adequate funding to provide to patients that are more in need. This is still a current problem in many places, but there are efforts to help and address the inverse care law prevalence across the UK.
This includes Clinical Commissioning Groups (CCGs) realising their role in tackling health inequalities across England. Some have described doing this in various ways such as making the public more aware of their own role in their health. To keep improving its vital to understand what the needs of the areas the CCGs serve are so they can fund these appropriately in order to confront the inverse care law. If anyone is interested in learning more, here are some links below for some further reading into some studies mentioned about the inverse care law.