Our role in addressing inequalities

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It was fantastic to have an issue devoted to socioeconomic health inequalities; one of the defining issues of our time.¹

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’ .² 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.³ 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.

Although 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 of health through commissioning, advocacy, and service provision. We look forward to reading more articles on inequalities where the focus is on addressing them at a population level in our daily practice.

• © British Journal of General Practice 2017