PEOPLE LIVING IN the most deprived areas have significantly poorer health outcomes than those living in the most affluent areas. They have a lower life expectancy and higher mortality at all ages. When they get cancer they tend to present later and are twice as likely to die from it.
Not only are they more likely to die prematurely, they also have higher rates of chronic conditions with more than twice the likelihood of having heart disease and stroke. They are also more likely to have multiple chronic conditions referred to as multi-morbidity.
Working in most deprived areas
Multi-morbidity occurs 10-15 years earlier in the most deprived population. GPs working in the most deprived areas tend to have approximately 40% more patients with multi-morbidity than GPs working in the most affluent areas.
This is further complicated by the fact that patients in deprived areas are more than twice as likely to have a combination of physical and mental health problems, with rates of 113/1,000 patients compared to 52/1,000 for practices working in the most affluent areas. These patients often struggle to manage acute and chronic conditions whilst facing other social and financial pressures.
Complex multi-morbidity is much more common in practices working in deprived areas. This is reflected in higher consultation rates in these areas but has ramifications throughout the health service. 10% of patients with four or more conditions account for 34% of unplanned emergency admissions and 47% of preventable unplanned admissions
The inverse care law describes how the people who are most likely to die prematurely have the least access to the health service. This happens when services are distributed according to number and not need.
If you have the same number of services for 1,000 people regardless of where they live, yet those in the most disadvantaged areas are more than twice as likely to die, you will have twice as many sick people in that area yet the same number of professionals – effectively half the service. The current structure and funding of our health services perpetuates the inverse care law and has profound effects on the health of our patients.
Deep End Ireland
Deep End Ireland represent a group of GPs working in deprived areas who are witnessing at first hand the inequalities in the current health service delivery model and its effect on our patients.
Our patients die younger, develop chronic conditions earlier and are more likely to need emergency hospital admission. The current healthcare delivery does not recognise the increased health needs of our patients.
The current two-tier funding system further disadvantages our patients. Waiting times for hospital appointments vary usually from a year to three years. Currently in the area I work the waiting time for neurology and dermatology is up to three years. Most other hospital speciality waiting times are a year or more.
However if you have private health insurance you can bypass this system and get private health care in a matter of months. This is not equitable and needs to be addressed.
The Sláintecare document
We welcome the recent publication of the Sláintecare document by the Committee for the Future of Healthcare. This report specifically highlights the inverse care law and the effects of the current “one size fits all “ approach to those on the margins , either in deprived urban areas or isolated rural areas. It recommends that the new GP contract needs to recognise the need to provide for and encourage GP development in areas of high need.
It also calls for a change to the way financial resources are allocated to ensure an equitable distribution of resources which would be based on addressing health need in an area rather than geographic location or ability to pay. (There is an example of this already in education ie the DEIS schools).
We believe these changes are fundamental to providing a solution to our current inequitable system and to providing much needed access to good health resources for patients living in deprived areas.
Dr David Gibney is a member of Deep End Ireland, a group of general practitioners working in the most deprived communities in Ireland. He has worked in Ballymun since 2000. It is now virtually impossible to attract GPs to work in these areas because it is financially unviable despite the fact that these are the areas of highest health need and chronic disease prevalence. Deep End Ireland was set up to support GPs working in such areas and to advocate for patients to have equal access to appropriate healthcare services.
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