Intended for healthcare professionals


Tackling health inequalities in primary care

BMJ 1999; 319 doi: (Published 14 August 1999) Cite this as: BMJ 1999;319:454

Exploring possible solutions to a problem is more important than describing the problem

  1. John Macleod, clinical research fellow (,
  2. Rhian Loudon, Clinical research fellow
  1. Health Inequalities Research Group, Department of General Practice, University of Birmingham, Birmingham B15 2TT
  2. Hartcliffe Health Centre, Bristol BS13 0JP
  3. Department of Primary Care and Population Sciences, Royal Free and University College London Medical School, London N19 5NF
  4. Health Inequalities Task Group, Royal College of General Practitioners, London SW7 1PU

    EDITOR—Smeeth and Heath discuss how health inequalities might be tackled in primary care.1 We endorse their views on the importance of accurate measurement of social position and their reminder that it is people who are most at risk of serious disease who have most to gain from effective medical interventions.2

    The authors emphasise the assessment of socioeconomic factors in individual consultations. Although this may sometimes be important, in general it is not the main issue, and their suggestion of yet another task to be completed in an already crowded agenda may put some people off The recording of accurate, useful data on social position need not involve general practitioners directly at all and can be recorded at registration.

    Occupational class and place of residence are not fixed, and some social mobility is now a feature of society in the United Kingdom.3 It should be sufficient, however, simply to ask patients to inform the practice of changes in their address or employment-as most general practices do now. The main use of such information is not to guide the treatment of individuals but to allow rational resource allocation at practice or primary care group level. Poorer people experience more serious disease …

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