Medicine and the marginalisedBMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7225.1589 (Published 18 December 1999) Cite this as: BMJ 1999;319:1589
They deserve the best, not the poorest, care
- Richard Smith, editor
And though I have the gift of prophecy, and understand all mysteries, and all knowledge; and though I have all faith, so that I could remove mountains, and have not charity, I am nothing.
Who, Christian or not, could disagree? The idea of paying special attention to “the poor and mean and lowly” is a central part of the Christmas story and of most religions. It is a belief that underpins medicine Yet it is a belief that is constantly forgotten. Medicine usually fails marginalised people.
It is more than a quarter of a century since Julian Tudor Hart's famous paper on “the inverse care law”—that those who need medical care the most are the least likely to get it.1 The law is seen in its most extreme form on a global scale: the highest rates of sickness and premature death are in the developing world, whereas medical care is concentrated in the developed world Evidence continues to accumulate that the law applies everywhere, and things are probably getting worse not better.2
Jonathan Mann, the Harvard professor who was killed in 1998 in the Swiss Air crash, introduced a new way of thinking about these issues by combining thoughts on public health …