Ben Harris-Roxas (UNSW Sydney)
Elizabeth Sturgiss (Monash University)
Australian Journal of Primary Health
Volume 29 Number 2 2023
Special IssueEquity in Primary Health Care Provision: More than 50 years of the Inverse Care Law
This special issue highlights programs, policies and approaches to comprehensive primary health care that are influenced by the spirit of the Inverse Care Law. There are still significant gaps in research, including how the inverse care law affects different groups of patients and their carers within specific settings. The papers in this issue make an important contribution, but we cannot assume that the importance of the inverse care law in determining health outcomes has been demonstrated, is known, and is accepted in all settings. A strength of Tudor Hart’s original research was its clear clinical relevance, and demonstrating the nature and the impact of the inverse care law in clinical settings should remain a priority.
Cultural competency is often promoted as a strategy to address health inequities, although evidence linking cultural competency to patient outcomes is scarce. We conducted a narrative review of the recent literature on cultural education programs and found 13 published evaluations, mainly reporting improvements in health professionals’ attitudes and knowledge, and improved confidence in working with First Nations patients. Although cultural education has a positive short-term impact, none of the studies included measured improved patient health outcomes.
PY22020 Abstract | PY22020 Full Text | PY22020PDF (3 MB) Open Access Article
Providing an equity lens to measure cultural approaches used in smoking cessation interventions is important. Despite this, there is a research gap between how to provide culturally appropriate support for Aboriginal and Torres Strait Islander pregnant women that meets their needs, is accessible and evidence-based in Australia. We advocate the ongoing use of the ‘Cultural Identity Intervention Systematic Review’ Proforma tool within Aboriginal and Torres Strait Islander health interventions to assess scientific rigour and ethical standards associated with Aboriginal and Torres Strait Islander health research principles and values.
PY22023 Abstract | PY22023 Full Text | PY22023PDF (726 KB) | PY22023Supplementary Material (308 KB) Open Access Article
Meeting Dr Julian Tudor Hart, when I worked as a locum general practitioner in Blaengwynfi, the village neighbouring Glyncorrwg, southern Wales in 1979, helped shape my subsequent career. I later learned that Julian was an icon of general practice, author of the ‘inverse care law’, who conducted epidemiological research in partnership with his patients to improve their health outcomes. He worked with his socioeconomically disadvantaged community to discover their health needs and provide equitable personalised care to all. His legacy lives on.
Strong primary health care (PHC) is required to address health inequity. Well-resourced university departments of PHC and general practice have potential to drive key research and inspire a future workforce. Lessons learned in Australia and internationally, suggest strategies likely to enhance capacity of such departments to support and lead efforts to address health inequity.
PY22146 Abstract | PY22146 Full Text | PY22146PDF (668 KB) Open Access Article
This paper examines the implications of the second sentence in Tudor Harts statement about inverse care – that its operation was strongest when exposed to market forces. Examples of inverse care can be found in the disparities access to primary health care in Australia, which can be attributed to both supply-and-demand factors in Australia’s hybrid market model of health care. Correcting these requires changes to the funding and workforce models, as well as specific actions at the service and community level.
PY22160 Abstract | PY22160 Full Text | PY22160PDF (582 KB) Open Access Article
Trans and gender-diverse individuals tend to experience poor mental health, often exacerbated by culturally unsafe services in primary care. This paper offers four key frameworks for understanding and anticipating the potential benefits and harms of different psychological therapies when caring for trans and gender-diverse clients. The article concludes with recommendations for implementing the frameworks in practice, and discussion of the scope for involving peer workers in multidisciplinary care teams.
PY22156 Abstract | PY22156 Full Text | PY22156PDF (484 KB) Open Access Article
Cancer is the second leading cause of death globally. The benefits of cancer screening are well documented, yet its uptake is low in Wales, United Kingdom. We discuss key methodological issues associated with the recruitment and engagement of participants for cancer screening research in Wales. The paper highlights the importance of ongoing community engagement, the provision of appropriate study materials, the adaption to different data collection modes to ensure future research is more inclusive.
There is a GP workforce crisis across the UK, felt most acutely in deprived areas. The Deep End GP Pioneer Scheme involved recruitment of early career GP fellows, retention of experienced GPs, and their joint engagement in strengthening general practice as the natural hub of local health systems. This qualitative evaluation highlights the importance of protected time and peer support, and the recognition that more resources are required to mitigate health inequalities.
PY22162 Abstract | PY22162 Full Text | PY22162PDF (954 KB) | PY22162Supplementary Material (701 KB) Open Access Article
Diabetes is a complex condition that substantially impacts quality of life and disproportionately affects Aboriginal Australians. This qualitative study identified that patient-reported outcome measures do not adequately capture the health-related quality of life of Aboriginal adults in the Shoalhaven. Development of culturally tailored health outcome measure tools, resources or methods is feasible if Aboriginal community and researcher-led approaches are prioritised.
PY22150 Abstract | PY22150 Full Text | PY22150PDF (730 KB) | PY22150Supplementary Material (834 KB) Open Access Article
People with multicultural or refugee backgrounds are more likely to have poorer long-term health outcomes compared to natively born people, and experience barriers accessing health care. We piloted a multicultural healthcare coordinator service and demonstrated that it was acceptable to patients and primary healthcare practitioners, well-utilised and demonstrated good outcomes. The service has the potential to reduce healthcare inequities if implemented into ongoing primary care services.
PY22147 Abstract | PY22147 Full Text | PY22147PDF (1.4 MB) Open Access Article
Equitable access to gender-affirming hormone treatment (GAHT) for trans and gender-diverse people is universally poor, with most services located in highly medicalised, culturally unsafe environments. Normalising GAHT by locating services within culturally safe mainstream primary healthcare services increases engagement for the trans and gender-diverse community. This project identifies the impact of a trans and gender-diverse co-designed and led GAHT service on client engagement and satisfaction.
PY22149 Abstract | PY22149 Full Text | PY22149PDF (802 KB) Open Access Article