I read Dr Moscrop’s review article regarding health inequalities in primary care1 with interest. It is an excellent article that clearly distinguishes differences between inequities and inequalities. However, although the article attempts to raise awareness of health inequality to GPs in the wake of the Marmot report of 2010,2 it did not highlight the 2-year update published by the UCL Institute of Health Equity in February 2012 which found that health inequalities had widened in most areas of England.3
The Equality Trust has been set up by authors of The Spirit Level4 to ‘gain the widest public and political understanding of the harm caused by inequality’. The striking messages are that members of more equal societies tend to live longer, have less mental health illness, less illegal drug use, less obesity, and higher levels of trust, with lower rates of homicide, and childhood violence.5
People are not oblivious to rising inequality — a Harris/Financial Times poll in July 2007 found that 78% of responders felt that the gap between rich and poor was getting larger in Britain.6 I feel the challenge is to engage people to tackle the issues — my suggestion is that by ending the article with ‘GPs (and GP leaders) surely have an obligation to take on …’ is vague, political rhetoric, and an abstract idea for most GPs.
In Scotland, work assessing ways to reduce inequalities includes the asset-based approach, which combining social and health care, aims to improve the sense of control a person has over their life by empowering individuals and communities; data are being gathered that may provide evidence for the effectiveness of this approach in the longer term.7
I believe to narrow the unjust gap of health inequities the solution lies with the whole of society. Initially raising awareness of health inequality issues is important, this has partly been done by previous national press coverage. With greater public awareness it is likely that developing and implementing government policies to tackle underlying socioeconomic problems would stay a priority: this fundamentally needs to be addressed to solve this problem.
It has been written that ‘Many of the policies and strategies designed to reduce inequalities appear to be beyond the scope of individual practitioners’.8 I suggest that individual GPs can tackle health inequalities by continuing to provide accurate tailored health promotion messages, signposting patients to local community groups and other relevant agencies (such as Citizens Advice Bureau). A job that I believe is done extremely well by the majority of dedicated GPs.
- © British Journal of General Practice 2012
