Author: Dr Christa Maria Joel Module: Responding to Public Health Challenges Supervisor: Ms Helen Cockburn University of the West of Scotland

1. Can you identify how the inverse care law impacts on your area of practice and include a brief
example to support this?
Inverse care law states that the availability of good medical facilities varies inversely
with the needs of the vulnerable population (Hart, 1971).
This law is still prevalent globally even after 50 years. It describes the injustice faced by
the underprivileged communities in obtaining adequate healthcare facilities. This
inadequacy leads to irregularity in the healthcare system and is still prevalent in low and
middle-income countries. In addition, financial limitations and disintegrating insurance
systems contribute to inverse care law (Cookson et al., 2021).
The Alma Ata ‘Health for All’ declaration emphasizes the importance of primary health
care for reducing health inequalities in the vulnerable population (Bhan et
al., 2016). Many low and middle-income countries are trying to achieve universal
healthcare coverage according to the United Nations’ Sustainable Development
Goals. However, though they provide healthcare, it is mediocre due to financial
constraints (Moosa et al., 2014).
In my experience as a doctor in rural India, I saw a ubiquitous lack of quality
healthcare such as understaffed hospitals,
inadequate medications and vaccines, no facilities for surgery or
radiological examinations. There were instances when I could
not provide adequate care and empathy for my patients as the hospital was
understaffed and lacked proper facilities. According to the research conducted by
Anette Pedersen and Peter Vedsted, Poor treatment is given to the patient as the doctor
will be stressed and is at higher risk of burnout due to the increased number
of patients and the lack of facilities (Pedersen, AF, 2014). I have witnessed some
of these patients from rural areas traveling to the urban areas to
obtain improved healthcare facilities. However, they will not be able to afford the
treatment and resort to alternative options or sometimes ignore their

2. illness and eventually face lethal consequences. Even though many health
policies and programs introduced by the government are helpful for
these communities, it is challenging to implement and accomplish them due to
socioeconomic barriers.
The scene is quite different in tertiary hospitals in urban India. Provision of adequate
health care facilities such as doctors, nurses, medications, vaccines, surgeries, X-
rays, and scans are for people who can afford it and pay out of pocket. The patients
also receive adequate care and empathy from the doctors, and they are satisfied with
their care.
Inverse care law is very prominent in developing nations and needs to be addressed so
that the disadvantaged communities get the care they deserve.
REFERENCES FOR THE ASSIGNMENT- INVERSE CARE LAW
Hart, J.T (1971). The inverse care law. The Lancet, 297(7696), pp.405-412.
Cookson, R., Doran, T., Asaria, M., Gupta, I., Fiorella, Mujica, P. (2021). Inverse care
law reexamined: a global perspective. The Lancet, 397 (10276), pp.828-838.
Bhan, N., Rao, K.D., Kachwaha, S. (2016). Health inequalities research in India: a
review of trends and themes in the literature since the 1990s. International Journal for
Equity in Health, 15, 166.
Moosa, S., Wojczewski, S., Hoffmann, K., Poppe, A. (2014). The inverse primary care
law in Sub Saharan Africa: A qualitative study of the view of migrant health workers.
British Journal of General Practice, 64(623), pp.321-328.

3. Pedersen, A. F., Vedsted, P. (2014). Understanding the inverse care law: A register and
survey based study of patient deprivation and burnout in general practice. International
Journal for Equity in Health, 13, 121.