Inequality a feature of all healthcare systems - GP

Inequalities were a major feature of any healthcare system where market forces determined who got what, according to a leading…

Inequalities were a major feature of any healthcare system where market forces determined who got what, according to a leading academic general practitioner.

Addressing an Irish Times/ Royal Academy of Medicine in Ireland lecture last night titled "Facing up to Health Inequalities", Prof Graham Watt, professor of general practice at Glasgow University, said we must be aware of other barriers, apart from financial ones, which prevent certain people from accessing adequate healthcare.

The delivery of care also depends on the different ways in which health services are "used, provided and delivered", he said.

"We know that people living in deprived areas tend to make less use of preventative services, being more concerned with today's problems than tomorrow's." Prof Watt suggested that in such deprived areas, where the need for good medical care was greatest, both its provision and use by the public were often very low.

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"There is plenty of evidence for this, as shown by Scottish data showing less prescribing of cholesterol-lowering drugs and of anti-depressants to patients in the most deprived section of the population."

Referring to the substantial range of medical interventions of proven effectiveness, he said: "Resources should be spent on activities which are not only effective, but which also offer the best return for the resources expended.

"There should be no special pleading, even for political correctness."

However, these interventions are more difficult to apply in deprived areas, he said, noting there are additional costs in delivering effective care in such areas.

"Unless formulae for the distribution of resources take account of these added costs, people living in more affulent areas are more likely to see the benefits of evidence-based medicine."

The reality of medical practice in deprived areas often fails to register in official documents and reports, according to Prof Watt.

He warned that deprivation payments, as applied to the NHS, do not shift money into areas of bad health but merely ensure an adequate number of GPs in deprived areas.

"We need more research evidence that is pertinent to general practice and primary care in deprived areas," he said, "rather than specific initiatives for coronary disease, cancer or mental health."

Even when the evidence is collected, there will still be a need for debate, "albeit a much better-informed one", on the values we hold, he concluded.