I was very pleased to read Chris Weatherburn’s reply and to feel that my article may have prompted consideration of some important issues. However, the thought that I may be guilty of ‘vague political rhetoric’ and peddling abstract ideals prompts me to reply. Additionally, and less egotistically, I feel compelled to counter the implication that we, as GPs, are already doing all we can to tackle health inequities.1
Social injustices will not get resolved in the consulting room. However, as I tried to point out, injustices can be exacerbated by our failure to acknowledge social determinants of our patients’ health and behaviour. Or, as Dr Weatherburn more positively suggests, injustices may be ameliorated by efforts to empathise and respond to our patients’ needs. But we can do more than that. Outside the clinic, the RCGP can advocate politically, commissioners can maintain this issue on their agenda, and researchers can provide evidence for decision-makers. The rest of us would do well to consider our own values and priorities, for, to a considerable degree, tackling this issue will demand that we are honest about whether, or to what extent, we are prepared to put social justice before self-interest.
Events this year have not been encouraging.
In March, Julian Tudor Hart had to remind us that progressive taxation was a fairer way of funding the health service than means-tested patient charges (co-payments).2
In May, Alan Milburn highlighted the ‘palpable unfairness’ limiting access to careers in medicine for people from poor backgrounds. ‘Medicine has made far too little progress and shown far too little interest in the issue of fair access,’ he said, warning of a society of ‘entrenched disadvantage at the bottom’.3
In June, the BMA’s strike action prompted The Daily Telegraph to cynically quote back to us the words of RCGP President Iona Heath: ‘Dr Heath has written [that] people motivated by “economic self-interest” are “indifferent to the fate of others”. I wonder whether she will be going on strike…’4
As members of a profession committed to improving people’s wellbeing I feel certain that we are capable of making more positive contributions toward resolving health and wealth inequities in the future. My article was intended to prompt discussion rather than to claim to define solutions. Nonetheless, it is apparent to me that while the problem of wealth and health inequity worsens, any amount of complacency is not an answer.
- © British Journal of General Practice 2012
