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Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Equity in primary health care: the legacy of Julian Tudor Hart and a personal journey he inspired

Felicity Goodyear-Smith A *
+ Author Affiliations
- Author Affiliations

A Department of General Practice and Primary Health Care, University of Auckland, PB 92-19, Auckland, New Zealand.

* Correspondence to: f.goodyear-smith@auckland.ac.nz

Australian Journal of Primary Health 29(2) 126-130 https://doi.org/10.1071/PY22081
Submitted: 19 April 2022  Accepted: 21 June 2022   Published: 19 July 2022

© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University

Abstract

Dr Julian Tudor Hart inspired me when I worked as a locum general practitioner in the neighbouring village to Glyncorrwg, southern Wales, in 1979. Our conversations helped shape my subsequent career. But it was only years later I learned that Julian was an icon of general practice and author of the famous ‘inverse care law’. Julian was both a truly compassionate dedicated general practitioner in Glyncorrwg, an impoverished Welsh working-class coal-mining village, and an epidemiologist, conducting robust research in partnership with his patients. Patients were co-producers of the research designed to improve their health outcomes. Julian led the way in advocating that first-contact, continuous, comprehensive, and coordinated care for everyone was necessary to achieve equitable health outcomes. He conducted research neither for its own sake nor for his academic advancement. His aim was always to help improve people’s lives. He identified that good medical care was least likely to be available for populations most in need. More than that, he demonstrated throughout his exemplary career how it was possible to work with a socioeconomically disadvantaged community to both discover their health needs and also provide equitable personalised health care to all. His legacy lives on.

Keywords: co-design, general practice, health equity, Julian Tudor Hart, personal narrative, practice-based research, primary health care, socially disadvantaged populations.


References

Brindle D (2007) Seeing red. British Medical Journal 334, 976
Seeing red.Crossref | GoogleScholarGoogle Scholar |

Lamont R, Fishman T, Goodyear-Smith F (2018) Travelling companions: a story told by a patient and her doctor. British Journal of General Practice 68, 282
Travelling companions: a story told by a patient and her doctor.Crossref | GoogleScholarGoogle Scholar |

Lamont R, Fishman T, Sanders PF, ‘Ofanoa M, Goodyear-Smith F (2020) View from the canoe: co-designing research Pacific-style. Annals of Family Medicine 18, 172–175.
View from the canoe: co-designing research Pacific-style.Crossref | GoogleScholarGoogle Scholar | 32152023PubMed |

Martel R, Shepherd M, Goodyear-Smith F (2022) He awa whiria a “braided river”: an Indigenous Māori approach to mixed methods research. Journal of Mixed Methods Research 16, 17–33. 10.1177/1558689820984028

Matheson D (2015) Will Universal Health Coverage (UHC) lead to the freedom to lead flourishing and healthy lives?; comment on “Inequities in the freedom to lead a flourishing and healthy life: issues for healthy public policy”. International Journal of Health Policy and Management 4, 49–51.
Will Universal Health Coverage (UHC) lead to the freedom to lead flourishing and healthy lives?; comment on “Inequities in the freedom to lead a flourishing and healthy life: issues for healthy public policy”.Crossref | GoogleScholarGoogle Scholar | 25584354PubMed |

Ofanoa M, Ofanoa SM, Heather M, Tu’akoi S, Lutui H, Dalbeth N, Grey C, van der Werf B, Goodyear-Smith F (2021) Design and implementation of a Pacific intervention to increase uptake of urate-lowering therapy for gout: a study protocol. International Journal for Equity in Health 20, 262
Design and implementation of a Pacific intervention to increase uptake of urate-lowering therapy for gout: a study protocol.Crossref | GoogleScholarGoogle Scholar | 34949187PubMed |

Starfield B (1979) Measuring the attainment of primary care. Journal of Medical Education 54, 361–369.
Measuring the attainment of primary care.Crossref | GoogleScholarGoogle Scholar | 374735PubMed |

Starfield B (1994) Is primary care essential? The Lancet 344, 1129–1133.
Is primary care essential?Crossref | GoogleScholarGoogle Scholar |

Starfield B, Shi L, Macinko J (2005) Contribution of primary care to health systems and health. The Milbank Quarterly 83, 457–502.
Contribution of primary care to health systems and health.Crossref | GoogleScholarGoogle Scholar | 16202000PubMed |

Tudor Hart J (1970) Semicontinuous screening of a whole community for hypertension. The Lancet 296, 223–226.
Semicontinuous screening of a whole community for hypertension.Crossref | GoogleScholarGoogle Scholar |

Tudor Hart J (1971) The inverse care law. The Lancet 297, 405–412.
The inverse care law.Crossref | GoogleScholarGoogle Scholar |

Tudor Hart J (1976) General-practice workload, needs, and resources in the National Health Service. Journal of the Royal College of General Practitioners 26, 885–892.

Tudor Hart J (1984) Salt restriction for borderline hypertension. Journal of the Royal College of General Practitioners 34, 140-1–144-5.

Tudor Hart J, Humphreys C (1987) Be your own coroner: an audit of 500 consecutive deaths in a general practice. British Medical Journal Clinical Research 294, 871–874.
Be your own coroner: an audit of 500 consecutive deaths in a general practice.Crossref | GoogleScholarGoogle Scholar |

Tudor Hart J, Thomas C, Gibbons B, Edwards C, Hart M, Jones J, Jones M, Walton P (1991) Twenty five years of case finding and audit in a socially deprived community. British Medical Journal 302, 1509–1513.
Twenty five years of case finding and audit in a socially deprived community.Crossref | GoogleScholarGoogle Scholar |

Tudor Hart J, Edwards C, Hart M, Jones J, Jones M, Haines A, Watt G (1993) Screen detected high blood pressure under 40: a general practice population followed up for 21 years. British Medical Journal 306, 437–440.
Screen detected high blood pressure under 40: a general practice population followed up for 21 years.Crossref | GoogleScholarGoogle Scholar |

United Nations General Assembly (2012) ‘Global health and foreign policy.’ The Sixty-Seventh Session. (United Nations: New York)

Warren P (2018) Julian Tudor Hart: visionary general practitioner who introduced the concept of the “inverse care law”. British Medical Journal 362, k3052
Julian Tudor Hart: visionary general practitioner who introduced the concept of the “inverse care law”.Crossref | GoogleScholarGoogle Scholar |

Watt G (2019) The example of Dr Julian Tudor Hart. In ‘The exceptional potential of general practice conference, Glasgow, Scotland, 14 February’. (GPs at the Deep End)

Watt G (2021) Julian Tudor Hart: medical pioneer and social advocate. The Lancet 397, 786–787.
Julian Tudor Hart: medical pioneer and social advocate.Crossref | GoogleScholarGoogle Scholar |

Watt G (2022) Julian Tudor Hart: a general practitioner for the world. (Royal Institution of South Wales) Available at https://www.youtube.com/watch?v=fjpJc6brNSw; https://www.gla.ac.uk/media/Media_838150_smxx.pdf

World Health Assembly (1998) Health-for-all policy for the twenty-first century. (World Health Organization) Available at https://apps.who.int/gb/archive/pdf_files/EB101/pdfangl/angr22.pdf

World Health Organization (1978) Alma-Ata declaration on primary healthcare: report of the international conference on primary health care. World Health Organization, Geneva.

World Health Organization (2010) The world health report: health systems financing: the path to universal coverage. (WHO, Geneva). Available at https://apps.who.int/iris/handle/10665/4437

World Health Organization (2017) Universal health coverage. WHO. Available at http://www.who.int/universal_health_coverage/en/ [Accessed 14 September 2017]

World Health Organization (2018) Declaration of Astana: from Alma-Ata towards universal health coverage and the Sustainable Development Goals. In ‘Global conference on primary health care, Astana, Kazakhstan’. WHO. Available at https://www.who.int/docs/default-source/primary-health/declaration/gcphc-declaration.pdf