An inverse care law for our timeBMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3216 (Published 31 July 2018) Cite this as: BMJ 2018;362:k3216
- Michael Marmot, director
- Institute of Health Equity, Department of Epidemiology and Public Health, University College London, London, UK
“We are still able to do the most civilized thing in the world—put the welfare of the sick in front of every other consideration.” Julian Tudor Hart begins his book on his credo as a general practitioner with this quote, as inspiring as it is famous, from Nye Bevan, the founder of the NHS.1 Bevan’s vision was animated by two linked concerns: inequalities in health, worse health in deprived areas; and inequalities in access to care, particularly for the poorer members of society who could not afford to pay. Tudor Hart linked these in his essay, The Inverse Care Law.2 Such a simple yet profoundly important idea: the availability of good medical care tends to vary inversely with the need for it in the population served.
We remember the inverse care law, not just because we mark Tudor Hart’s passing3 at the same moment that the NHS, which he served with such diligence, celebrated its 70th birthday, but because the inverse care law still resonates today. A quick citation (Web of …