INTRODUCTION
When Julian Tudor Hart published his iconic paper ’The inverse care law’,1 it stimulated much interest and research into how poverty adversely affected health and access to health care. Although it is reasonable that resource allocation should match need, my observation is that increasing socioeconomic polarisation and ageing have caused unexpected, and underrated, pressures on health care in affluent areas. The four interlinked issues of morbidity patterns, attitudes to health, social interaction, and staff recruitment are worthy of consideration in planning future service configuration.
THE RICH MAN’S BURDEN
My observations stem from two decades as a GP in an affluent commuter town near London. The main driver is chronic disease in an older population, at the apex of which is demand generated by care homes. The working-age population overwhelmingly comprises affluent Londoners who have taken the well-trodden path into the Home Counties, but whose quest for a gentler pace of life is dashed by the reality of an exhausting daily commute on crowded trains back into the capital, atop a long working day. Stress-related presentations are frequent, as is health-related anxiety of the ‘worried well’. My experience tallies with what Des Spence explored in these pages recently:2 a severely disabling state and a significant burden on health care, …