Intended for healthcare professionals

Education And Debate

Children and the inverse care law

BMJ 1998; 316 doi: (Published 23 May 1998) Cite this as: BMJ 1998;316:1588
  1. Elspeth Webb, senior lecturer
  1. Department of Child Health, University of Wales College of Medicine, Cardiff CF4 4XN
  1. Correspondence to: Dr Webb

    It is over 25 years since Tudor Hart described the inverse care law. This states that “the availability of good medical care tends to vary inversely with the need for it in the population served.”1 Although Tudor Hart did not provide hard evidence to support his hypothesis, others have since. West and Lowe showed that for children's services need and provision were badly matched.2 Given the lack of strategic planning centred on children and the low priority given to the commissioning of children's services, this situation is unlikely to have changed.3

    The inverse care law also operates in terms of access to services. Those with least need of health care use the health services more, and more effectively, than do those with greatest need.4 This applies to preventive interventions as well as treatments. Health promotion based on providing information in standard formats to the population as a whole has had the greatest impact on people who are socially and economically advantaged.5

    Summary points

    Half a million socioeconomically deprived children and young people are marginalised within society in the United Kingdom

    Social exclusion is associated with poor health and very poor access to health services

    Addressing the needs of these young people ought to be a priority since poor health has implications for their adult health and welfare

    Strategies to improve their health care, with particular emphasis on the role of primary care, must be developed and implemented

    If Britain is to change its attitudes to children fundamentally, a children's rights commissioner must be appointed


    Over one third of the children in the United Kingdom grow up in conditions of socioeconomic deprivation. In consequence they experience poorer health than their more affluent peers.6 Within this socioeconomically deprived population exist several groups of children and young people who …

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