An Issue of Inequity
Poorer people suffer poorer outcomes across all of medicine. Can eyecare buck the trend?
When people ask me where I’m from, I usually answer, “Glasgow, Scotland.” (I’m actually from Coatbridge, two miles east of the city’s border, but few people outside of Scotland have heard of the place, so Glasgow is close enough.) True to my roots, I’d like to highlight the work of a Glasgow-based academic called Watt – not James, but Graham.
Graham Watt is a Professor of General Practice at Glasgow University, and is also a founder of “General Practitioners at the Deep End,” which works with the GPs serving patients from the most deprived areas of the city. The project has revealed Glasgow to be a stark example of the Inverse Care Law (1), which suggests that the availability of good medical care tends to vary inversely with its need in the population it serves. One finding was spectacular, especially in a country with universal social medicine: the life expectancies of men and women in the lowest socioeconomic groups were 57 and 61 years – compared with 76 and 78 years for the richest (2).
I recently read that there’s not only a difference of seven years in life expectancy between the poorest and richest members of society in the UK, but also a difference of 17 years in “disability free life” (3). There are many interrelated socio- and health-economic reasons at play here, but the reality is that being poor begets poorer outcomes.
And eyecare is not immune. Many vision problems are detected by eye tests in the community, usually by an optician or optometrist. In relatively affluent areas, people usually present regularly for tests, have any vision problems identified, and start down a suitable treatment path. But in deprived areas, far fewer people present (4). Why? Because they are scared of the perceived cost of spectacles. And so ocular disease gets caught later – with predictable consequences on outcomes.
What can be done? There are many societal issues that need to be addressed, but community engagement and a concerted investment in campaigns to drive awareness of ocular disease is one proposed route (5). Unfortunately, when it comes to healthcare funding in many countries, these are uncertain times. The battle to improve medical outcomes across the socioeconomic spectrum will cost precious time and resources. But surely it is a battle we should fight hard to win.
Mark Hillen
Editor
- JT Hart, “The inverse care law”, Lancet, 27, 405–412 (1971). PMID: 4100731.
- University of Glasgow, “GPs at the Deep end” (2013). Available at bit.ly/deependglasgow. Accessed January 17, 2017.
- UCL Institute of Health Equity (2010) ‘Fair Society Healthy Lives’ (The Marmot Review). Available at bit.ly/MarmotReview. Accessed January 17, 2017.
- D Hardiman-McCartney, P Alexander, “See the gap, growing eye health inequality” (2016). Available at bit.ly/seethegap. Accessed January 17, 2017.
- UK Vision Strategy, “Eye care: a public health issue” (2016). Available at bit.ly/UKvision. Accessed January 17, 2017.
I spent seven years as a medical writer, writing primary and review manuscripts, congress presentations and marketing materials for numerous – and mostly German – pharmaceutical companies. Prior to my adventures in medical communications, I was a Wellcome Trust PhD student at the University of Edinburgh.
