Sir, – Your editorial gives a stark account of the realities of health inequalities in this country ("The ultimate inequality: age, deprivation and location affect cancer risk", June 13th).
You rightly suggest that the provision of services has a part to play in addressing the problem.
Northwest Dublin, where I am a GP, has the highest death rate from cancer in the country. It also has the lowest ratio of GPs to patients in the country, one for every 3,600 people, exactly half of the national average of one to 1,800. This is known as the inverse care law, where those most in need of health services are least likely to get them.
Even when patients do have a GP, the much earlier onset of multiple chronic illnesses, complicated by psychosocial problems in disadvantaged areas, makes it very difficult to provide proper care. A study in the British Medical Journal found that a 50-year-old patient in an area of most disadvantage consults at the same rate as a 70-year-old patient in the most affluent.
Just today I saw a woman in her 50s with a bad chest infection aggravating her asthma, whose diabetes is uncontrolled, and who has arthritis, high blood pressure and depression. She has not gone for her mammogram because she has been overwhelmed trying to support her homeless adult daughter and her two grandchildren.
GPs (and their patients) in these areas are so busy dealing with such acute health and social problems that they have no time for screening, prevention and early detection of cancer.
Funding in general practice (which is a fixed payment regardless of number or complexity of visits) is based solely on age, with no provision for the much higher health needs in areas of disadvantage.
This “flat” distribution of resources across the population according to numbers, and not need, pervades the system. This results in enormous differences in the quality of care provided to patients right through the health service, but especially in primary care – from general practice, to access to essential diagnostics, to critical supports for vulnerable children and families.
Carl O’Brien reports that the Minister for Education plans to expand the support to schools in poor areas, known as the Deis system, with a view to improving outcomes for poorer children (“New plan aims to tackle educational disadvantage”, June 13th).
It is extraordinary that no such mechanism exists in the health service where the unequal outcomes are so obvious, and are a matter of life and death.
Minister for Health Simon Harris could consider following Minister for Education Richard Bruton’s example, by providing specific support to primary care in areas of disadvantage.
His department has all the information to do this, whether as a weighted capitation payment, support for premises, or extra staff for GPs and primary care teams.
This is not about special treatment; it is about distributing resources so that the people who are the sickest and most likely to die get the same level of health provision from the State as everyone else in the country. – Yours, etc,
Dr EDEL McGINNITY,
Riverside Medical Centre,
Mulhuddart Village,
Dublin 15.