Education And Debate

Using socioeconomic evidence in clinical practice guidelines

BMJ 2003; 327 doi: (Published 27 November 2003) Cite this as: BMJ 2003;327:1283
  1. Rosemary Aldrich, executive officer (,
  2. Lynn Kemp, senior research associate2,
  3. Jenny Stewart Williams, research officer1,
  4. Elizabeth Harris, director2,
  5. Sarah Simpson, research officer2,
  6. Amanda Wilson, research officer1,
  7. Katie McGill, research officer1,
  8. Julie Byles, director3,
  9. Julia Lowe, director of general medicine5,
  10. Terri Jackson, senior research fellow4
  1. 1Newcastle Institute of Public Health, PO Box 664J, Newcastle NSW 2300, Australia
  2. 2Centre for Health Equity Training Research and Evaluation, School of Public Health and Community Medicine, University of New South Wales, Sydney NSW 2052, Australia
  3. 3Centre for Clinical Epidemiology and Biostatistics, PO Box 664J, Newcastle NSW 2300, Australia,
  4. 4School of Public Health, LaTrobe University, Victoria 3086, Australia,
  5. 5John Hunter Hospital, Hunter Area Health Service, Locked Bag No 1, Hunter Region Mail Centre, NSW 2310, Australia
  1. Correspondence to: R Aldrich
  • Accepted 8 September 2003

The effects of socioeconomic position on health have been largely ignored in clinical guidelines. Australia's National Health and Medical Research Council has produced a framework to ensure that they are taken into account

The effects of socioeconomic position on health are well established1 2 but difficult to overcome. This is because the underlying causes are embedded in social and economic structures at all levels of society.3 Access to health services, the ability to act on health advice, and the capacity to modify health risk factors are all influenced by the circumstances in which people live and work.4 Studies have also shown that those most needing care are least likely to receive it,5 6 and that the quality of care received by people with lower socioeconomic positions is different from those with higher positions.7 Despite this evidence, guidelines for clinical practice do not take the effects of socioeconomic position into account, although some guideline groups acknowledge the need to consider the relevance and applicability of the evidence to the target group.8

Role of guidelines

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Guidelines need to recognise the problems associated with low socioeconomic position


Developers of guidelines for clinical practice attempt to identify, appraise, and collate the best evidence to ensure that the highest quality information is available for clinicians and patients. To date, clinical practice guidelines have been informed by clinical and, sometimes, economic evidence.9 10 The most robust evidence is considered to come from randomised controlled trials, but the results of suchtrials may not always be relevant and applicable to the needs of all groups in the population, particularly those who are socioeconomically disadvantaged.

Clinical practice guidelines have the potential to increase health inequalities …

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