“The availability of good medical care tends to vary inversely with the need for the population served” Julian Tudor Hart: “The Inverse Care law” The Lancet 1971.
The NHS Confederation hosted a seminar on “Inverse Care and Health Inequalities” shortly before Christmas. They have produced a neat little report “In Sickness and In Health” available at www.nhsconfed.org/publications. It has some fascinating information in case studies. Did you know for instance that Manchester men have the lowest life expectancy in England at just 72.5 years? Men in Kensington and Chelsea can expect to live until they are 82.2 years old.
The seminar chaired by Nigel Edwards (Director for Policy at the NHS Confederation) looked at what research and information is already available in an attempt to identify the gaps and set some key priorities for action.
There is a lot known in general terms and I was particularly interested in the discussions about the reasoning behind the Quality and Outcomes Framework on the widening health inequalities gap.
Turning to kidney disease, we know that socially deprived patients have a higher incidence of CKD. In the UK, individuals living in the most socially deprived areas have a 45% increased risk of CKD compared to those living in the most affluent areas. Furthermore, CKD progresses more rapidly in socially deprived patients. Fergus Caskey (Consultant Renal Physician in Bristol), has looked into this from a UK and an international perspective and tells me that the social class effect is thought to be mediated through many intermediate factors working at the individual level (for example low birth weight, smoking, obesity, poor complaints, diabetes and hypertension) or area level (for example poor primary care services and inadequate access to secondary care).
Individuals from socially deprived areas commencing replacement therapy in the UK also tend to be younger, have more diabetic end stage kidney disease and have more co-morbid illnesses than their more affluent counterparts. They are also more likely to be referred late to a nephrologist and therefore have less time to be physically and mentally prepared.
Individuals from socially deprived areas in England are less likely to receive a pre-emptive transplant, than those from affluent areas. They remain less likely to have been transplanted 90 days and one year after commencing replacement therapy. Scottish data has also shown patients from socially deprived areas take longer to be registered on the national transplant waiting list than those from affluent areas.
Tackling the health inequalities of chronic kidney disease will be hard and will require a joint approach across all agencies locally. There are still unacceptable variations in the health status within and between our different communities.
“We shouldn’t just sit back and wait for someone else to do something”, Dr Sam Ramiah, Director of Public Health at Walsall PCT, “In Sickness and In Health” The NHS Confederation, 2007.