Intended for healthcare professionals


Is there a north-south divide in social class inequalities in health in Great Britain? Cross sectional study using data from the 2001 census

BMJ 2004; 328 doi: (Published 29 April 2004) Cite this as: BMJ 2004;328:1043

Health inequalities on Wirral: a living Black report?


I read with interest the recent paper by Doran et al. Living and
working across the Mersey from Liverpool I can vouch for a significant
further divide in healthcare awareness and access.

Wirral, with a population of approximately 320,000, is longitudinally
divided neatly,by the M53 motorway,into two: a largely affluent, educated,
employed and healthy west section and less prosperous areas such as
Birkenhead, Wallasey and Leasowe. Here there are documented greater levels
of urban deprivation(as measured by the Index of Multiple Deprivation),
increased childhood accidents and teenage pregnancy as well as lower
levels of educational attainment. More specificlly there are striking
contrasts between the divided populations for of coronary heart
disease(CHD). Despite a lower than UK standardised mortality ratio (SMR)
for CHD, affluent west-Wirral residents enjoy a far greater rate of
referral for coronary angiography, angioplasty and bypass surgery than
their poorer neighbours(with higher SMRs).

Private referrals from the affluent sector do not explain this divide
and I suspect belief systems underpin some of it. Affluent educated
patients with information gleaned from the broadsheet media are more
likely to request (demand?) referral for angiography etc. Patients in
poorer areas often tend to act in crisis mode only and do not behave pro-
actively to prevent development of more troublesome outcomes. They still
tend to accept their lot without question.They also are shackled by (?ill-
conceived)yet powerful belief systems. It has been my experience to hear
statements such as "if you have angina you expect to get it two or three
times a day" or patients retelling what relatives and friends had advised
them when they had had a diagnosis of angina made: "don't be taking any
exercise, you'll only give yourself a heart attack" not uncommonly.
Patients aren't the only ones who cling to belief systems: GPs may also
suffer from such gems as "betablockers are bad in heart failure" etc. Such
concepts and ideas as these may have a crucial role in requesting care as
a patient or making a treatment decision as a GP.

Awareness of this Wirral health divide has prompted me to look at
ways of redressing the balance: almost 4 years ago we developed a
primarycare-based , accessible service, Wallasey heart Centre, using a GP
with Special Interest (GPwSI, cardiac rehabilitation and primary
prevention lifestyle services.Locally accessible, patient and carer-
centred with lots of information giving and education, it has prompted a
return to basics with the whole service revolving round the users &
families. Some of our results are striking e.g. the reduction in SMR for
CHD in Wallasey to below UK average (a statistic never before achieved;
progressively improved evidence-based prescribing of aspirin,
betablockers, ACE inhibitors and statins; much greater patient and family
involvement through personal contact; group talks; email and web access to
our service; patient-held records; and all GP letters copied to patients
with terminology increasingly being slanted away from standard medical
jargon (but keeping Read codes for more prompt GP CHD register updating).
We are now looking at further specific aspects of the wider cardiovascular
scene: chronic heart failure and also targetting of type 2 diabetes

PCT-wide GPwSI-driven services: the way forward in reducing UK health

Competing interests:
None declared

Competing interests: No competing interests

06 May 2004
Dr. Anthony G Cummins
Clinical Director
Wallasey Heart Centre Victoria Central Hospital Wallasey Cheshire CH44 5UF