Many thanks to Gopal and colleagues for providing a balanced article about poverty screening and for providing guidance to GPs who wish to take this further.1 However, we must separate our wish to help individuals facing poverty from our concerns about health inequalities: we cannot resolve the latter by doing the former; that just isn’t how health inequalities work.
As healthcare providers, we are potentially more able to intervene usefully in healthcare inequalities (unequal access, experiences, and outcomes of health care) than in the health inequalities caused by unfair social conditions. Still, if we are concerned about inequalities in health, and our role in furthering evidence and understanding of these, then we need to acknowledge the social gradient and move on from thinking purely about people ‘at the bottom’. If our concerns are to be widely shared, it will be when inequalities are recognised to impact everyone. Using a generic socioeconomic marker, such as occupation or education, and collecting this information from everyone, rather than identifying poverty alone, would not only seem fairer and less stigmatising, but would also provide comparative data.
Finally, there is no obvious reason why primary care should be the best place to identify people experiencing poverty or to signpost sources of support. Presumably HM Revenue and Customs and the Department for Work and Pensions already have a good idea of which people are facing poverty. Could they do the signposting? Or could they share information with the Department of Health and Social Care? Could the Royal College of General Practitioners propose this?
- © British Journal of General Practice 2021
