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Views & Reviews Between the Lines

The inverse care law

BMJ 2012; 344 doi: (Published 07 March 2012) Cite this as: BMJ 2012;344:e1633
  1. Theodore Dalrymple, writer and retired doctor

In 1971 Julian Tudor Hart, a general practitioner in South Wales, proposed his inverse care law: “The availability of good medical care tends to vary inversely with the need for the population served.” One might extend this a little: “The concern of a population for its own health tends to vary inversely with the actual state of health of that population.”

There is a good literary illustration of this in W W Jacobs’s short story “A Circular Tour.” Jacobs (1863-1943) was immensely popular in his day for his humorous stories of sailors ashore, his most famous book being Many Cargoes, published in 1896. He also wrote stories of the supernatural, the best known being “The Monkey’s Paw,” in which …

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