Dec 192013
Sian Bolton

Sian Bolton

The impact of poverty and inequality in our society is clearly seen in the field of healthcare. There is a significant difference in the life expectancy of the most deprived and least deprived people in our society – over a decade in some areas.

One factor in this is healthcare provision. Services in more deprived areas tend to be less effective in identifying illness and helping people look after their health, than those services in less deprived areas. This is known as the ‘inverse care law’.

The inverse care law is based on work done here in Wales by Dr Julian Tudor-Hart back in the 1960s that looked at inequities in health care. He noted that the most deprived people with the most health needs were the ones who least accessed services from a health point of view.

The whole idea of this work is to get to those people who don’t readily access health services to improve their health. We are currently supporting two health boards, Aneurin Bevan University Health Board (ABUHB) and Cwm Taf Health Board who are both focusing on improving access for cardio-vascular diseases services, particularly reaching people with those diseases who currently don’t access services.


1000 Lives Improvement has been asked to address the inverse care law as one of our national programmes, along with the work on patient flow, and supporting Improving Quality Together.

In Cwm Taf we are focussing on the whole of the area served by the health board, as much of the area scores highly on the deprivation index. Within ABUHB, we are focussing on two general practices in specific areas with high levels of deprivation. The learning we gain from these pilot areas can then be applied across Wales as we scale up the work.

We want to give people the means to live longer, and the medication and the care to do so. This means tailoring services to ensure they are accessible to deprived communities, and also tailoring messages so they are understood and acted upon by people in those communities.

Poverty is complex and people living in deprived communities have to overcome a great number of barriers that may prevent them from getting the health support they need. These can include low educational attainment, lack of access to online services, reliance on public transport, lack of employment opportunities or job insecurity, family dysfunction, debt, and other, more subtle, barriers relating to personhood: low self-esteem, expectations in life, and aspirations.

We know there are vast numbers of people who don’t currently access services who have diseases which are treatable. Addressing the inverse care law will help make sure NHS Wales services are reaching those individuals so they get the care they need to prevent them dying early unnecessarily.

Sian Bolton is the lead on the 1000 Lives Improvement work to tackle the inverse care law. Follow her on Twitter as @sianibolt.

Do you think there is a disparity in care in Wales because of the inverse care law? Tell us your thoughts in a comment.

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