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- Page navigation anchor for Response to Dead UnequalResponse to Dead Unequal
As a GP with an interest in palliative care my eye was drawn to your January 2017 briefing entitled “Dead Unequal.” Referring to Graham Watt’s “Deep End” work in Scotland, you highlighted the economic differences between rich and poor which contribute to differential morbidity and mortality. Just as in life there are postcode inequalities, in death there are equally significant inequalities. As well as a postcode lottery, there is a diagnostic lottery. Much better to have cancer than a non-malignant condition. Support to help people with cancer at the end of life is much better resources and more accessible than other conditions. Despite the Scottish End of Life Strategy six years ago highlighting this diagnostic iniquity as a key target there is still so much to do. Indeed the 2016 Scottish strategy again has this as the number one priority again – to identify more people with non-malignant disease for end of life care. Charities, such as Marie Curie, have now doubled their non-malignant effort, but the differential is still great as care models are so cancer-centric. So in the end, you would probably benefit more from the right diagnosis even more than the right postcode.
Competing Interests: None declared. - Page navigation anchor for Our role in addressing inequalitiesOur role in addressing inequalitiesIt was fantastic to have an issue devoted to socioeconomic health inequalities - one of the defining issues of our time.As doctors we have an important role to play in ‘improving and protecting the nation’s health and wellbeing, and improving the health of the poorest fastest’.1 However in general practice most of our interventions are aimed at the individual level. Compared with population-level interventions like taxing alcohol, banning trans fats from foods, enforcing smoke-free public places, and promoting healthy urban design, individual-level interventions can actually exacerbate socioeconomic inequalities.Julian Tudor Hart's inverse care law states that services are used most by those who need them least.2 Aside from health service utilisation, all interventions that require health literacy or healthy choices tend to widen inequalities. Living in conditions of deprivation imposes a 'poverty tax' that impedes people's ability to align their short term actions with their long-term interests.Whilst it is important that we continue to quantify health inequalities, we need to be careful not to inadvertently promote them by restricting our activities to those that disproportionately benefit the well-off.GPs have an important role to play in addressing local-level social determinants...Show MoreCompeting Interests: None declared.