INVERSE CARE LAW
INVERSE CARE LAW
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DOI：
10.1016/s0140-6736(71)92410-x
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发表时间：
1971-01-01
期刊：
影响因子：
168.9
通讯作者：
HART, JT
中科院分区：
文献类型：
--
作者：
HART, JT
朱利安·都铎·哈特的论文《逆向关怀法》的这些低调的开场白，在今天(发表50年)和1971年一样具有现实意义。这篇论文是《柳叶刀》近200年历史上具有里程碑意义的出版物之一，都铎·哈特对逆关怀定律的定义具有全球性和永恒的重要性。简单地说，都铎·哈特观察到，弱势群体比优势群体需要更多的医疗保健，但得到的更少。都铎·哈特的生活和职业生涯使他从伦敦和剑桥的特权出身，到在贫困和社会主义程度极高的威尔士山谷度过了几十年。他的经历和工作激励了一代有影响力的医疗保健领袖，包括安德鲁·海恩斯、艾利森·波洛克、塞萨尔·维克托拉和格雷厄姆·瓦特。今天出版的《柳叶刀》周年刊探讨了反向医保法的全球影响，以及英国贫困地区的初级保健倡议。尽管人们广泛了解医疗不平等及其诸多原因，但医疗服务提供的不平等是持久和根本的：这是一个位于反向医疗法核心的棘手概念。反向保健法主要是关于导致健康方面不公平的社会不平等(不平衡)的保健方面的不公平(不公正)。自从反向医保法公布以来，英国国家医疗服务体系(NHS)一直在努力减少不平等，但成功与否参差不齐。值得注意的是，通过1970年代的资源分配公式取得了持久的进展，减少了医院和机构支出的地域不平等。在本世纪初，NHS加强了贫困地区的初级保健服务，导致社会不平等的暂时减少，尽管随着资金转移、支出放缓和多年的紧缩生活，这一进展已经逆转。在全球范围内，让市场力量决定医疗保健仍然是造成不公平的主要因素--只有那些负担得起费用的人才能获得私人医疗保健。在许多国家，社会护理和长期护理是
These understated opening lines of Julian Tudor Hart’s paper, The Inverse Care Law, are as relevant now (50 years to the day since publication) as in 1971. The paper is one of the landmark publications in The Lancet’s near 200-year history, and the resonance of Tudor Hart’s definition of the inverse care law has global and timeless importance. Simply expressed, Tudor Hart observed that disadvantaged populations need more health care than advantaged populations, but receive less. Tudor Hart’s life and career took him from highly privileged beginnings in London and Cambridge to decades spent in the deprived and deeply socialist Welsh valleys. His experience and work has inspired a generation of influential health-care leaders including Andrew Haines, Allyson Pollock, Cesar Victora, and Graham Watt. Today’s anniversary issue of The Lancet explores both the global reach of the inverse care law and primary care initiatives in deprived areas around the UK.Although inequality in health and its many causes are widely understood, inequity in health-care service provision is enduring and fundamental: an intractable concept that lies at the heart of the inverse care law. The inverse care law is primarily about inequity (injustice) in health care that results in unfair social inequalities (imbalances) in health. Since the inverse care law was published, the UK’s National Health Service (NHS) has strived to reduce inequity with mixed success. Notably, long-lasting progress was achieved through the 1970s resource allocation formula, which reduced geographical inequality in hospital and institutional expenditure. In the early 2000s, the NHS strengthened primary care provision in disadvantaged areas, leading to a temporary reduction in social inequality, although this progress has reversed following shifts in funding, a slowing of spending, and years of living with austerity. Globally, letting market forces dictate health care is still a major contributor to inequity—private health care can only be accessed by those who can afford to pay. In many countries, social care and long-term care are