Intended for healthcare professionals

Rapid response to:


The global impact of income inequality on health by age: an observational study

BMJ 2007; 335 doi: (Published 25 October 2007) Cite this as: BMJ 2007;335:873

Rapid Response:

The Less Privileged Poor Have Poor Access To Health Care System Than The Rich.

One thing is true from all the above references. The rich have better
access to health care system, whereas at the same time the poor struggle
to find basic health care to stay alive.

The rich can seek health care in hospitals and also have the luxury of
visiting their physician in private opd's where definitely the doctor
devotes more time on one patient examining him/her. Rich can also have
the luxury of calling the doctor at home at the dial of a ph call. So the
doctor is a ph call away for them. Whereas for the poor, even if they need
basic health care they have to travel relatively longer distances, maybe
they will have to wait a longer time in queue’s for getting a simple
medical care, maybe the best doctor available won’t be seeing them in the
first instance.

Because of financial constraints, the poor can’t afford the best of the
medicines, hence there is a compromise when medication is prescribed to
them. Eg a poor patient may be prescribed a cheaper trimethoprim-
sulphamethoxazole combination for fever where as the rich would be
prescribed a costly 3rd or 4th generation cephalosporin, that would act
faster and cover a broader spectrum of organisms. So the chances of
recovery increase with better antibiotic selection.
In India a daily wage worker with a family of 10 to support, earning 40-50
rupees a day won’t be able to afford costlier forms of treatment for
certain medical conditions, like thrombolytic therapy in acute myocardial
infarction, or he won’t go for laproscopic surgery for acute appendicitis,
or he would decide against seeking treatment for cancer, or he may not be
able to afford to vaccinate his children against preventable diseases.
At the same time incidence of illiteracy, overcrowding, poor hygiene, poor
diet are seen more amongst the poor population. These again predispose the
poor to more illnesses and hence increased mortality. I think more stress
needs to be laid for government health organizations and other non profit
organizations to look into this problem more deeply to narrow this gap
between treatment of rich and poor.

Competing interests:
None declared

Competing interests: No competing interests

07 November 2007
Robert James
MD Medicine
Christian Medical College and Hospital, LDH, Pb, In.