Skip to main content
The BMJ logoLink to The BMJ
. 1994 May 28;308(6941):1426–1429. doi: 10.1136/bmj.308.6941.1426

Equity in the NHS. Monitoring and promoting equity in primary and secondary care.

F A Majeed 1, N Chaturvedi 1, R Reading 1, Y Ben-Shlomo 1
PMCID: PMC2540364  PMID: 8019258

Abstract

Although need is often assumed to be the most important factor in determining the use of health services, there are many inequities in the provision and use of NHS services in both primary and secondary care. For example, existing data from district child health information services have been combined with census data for small areas to show wide variations in immunisation rates between affluent and deprived areas. Purchasers of health care are already responsible for assessing health needs and evaluating services, and the process of monitoring equity is a logical extension of these activities. Routine data sources used to collect activity data in both primary and secondary care can be used to assess needs for care and monitor how well these needs are met. Purchasers and providers should collaborate to improve the usefulness of these routine data and to develop a framework for monitoring and promoting equity more systematically.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ayanian J. Z., Epstein A. M. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med. 1991 Jul 25;325(4):221–225. doi: 10.1056/NEJM199107253250401. [DOI] [PubMed] [Google Scholar]
  2. Ayanian J. Z., Udvarhelyi I. S., Gatsonis C. A., Pashos C. L., Epstein A. M. Racial differences in the use of revascularization procedures after coronary angiography. JAMA. 1993 May 26;269(20):2642–2646. [PubMed] [Google Scholar]
  3. Baker D., Klein R. Explaining outputs of primary health care: population and practice factors. BMJ. 1991 Jul 27;303(6796):225–229. doi: 10.1136/bmj.303.6796.225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Baker R. General practice in Gloucestershire, Avon and Somerset: explaining variations in standards. Br J Gen Pract. 1992 Oct;42(363):415–418. [PMC free article] [PubMed] [Google Scholar]
  5. Balarajan R., Yuen P., Soni Raleigh V. Ethnic differences in general practitioner consultations. BMJ. 1989 Oct 14;299(6705):958–960. doi: 10.1136/bmj.299.6705.958. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Ben-Shlomo Y., White I., McKeigue P. M. Prediction of general practice workload from census based social deprivation scores. J Epidemiol Community Health. 1992 Oct;46(5):532–536. doi: 10.1136/jech.46.5.532. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bombardier C., Fuchs V. R., Lillard L. A., Warner K. E. Socioeconomic factors affecting the utilization of surgical operations. N Engl J Med. 1977 Sep 29;297(13):699–705. doi: 10.1056/NEJM197709292971305. [DOI] [PubMed] [Google Scholar]
  8. Braveman P., Bennett T., Lewis C., Egerter S., Showstack J. Access to prenatal care following major Medicaid eligibility expansions. JAMA. 1993 Mar 10;269(10):1285–1289. [PubMed] [Google Scholar]
  9. Carr-Hill R. A., Sheldon T. Designing a deprivation payment for general practitioners: the UPA(8) wonderland. BMJ. 1991 Feb 16;302(6773):393–396. doi: 10.1136/bmj.302.6773.393. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Carstairs V. Multiple deprivation and health state. Community Med. 1981 Feb;3(1):4–13. [PubMed] [Google Scholar]
  11. Davis K., Gold M., Makuc D. Access to health care for the poor: does the gap remain? Annu Rev Public Health. 1981;2:159–182. doi: 10.1146/annurev.pu.02.050181.001111. [DOI] [PubMed] [Google Scholar]
  12. Dudley N. J., Burns E. The influence of age on policies for admission and thrombolysis in coronary care units in the United Kingdom. Age Ageing. 1992 Mar;21(2):95–98. doi: 10.1093/ageing/21.2.95. [DOI] [PubMed] [Google Scholar]
  13. Elder A. T., Shaw T. R., Turnbull C. M., Starkey I. R. Elderly and younger patients selected to undergo coronary angiography. BMJ. 1991 Oct 19;303(6808):950–953. doi: 10.1136/bmj.303.6808.950. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Freeman H. E., Corey C. R. Insurance status and access to health services among poor persons. Health Serv Res. 1993 Dec;28(5):531–541. [PMC free article] [PubMed] [Google Scholar]
  15. Freeman H. P. The impact of clinical trial protocols on patient care systems in a large city hospital. Access for the socially disadvantaged. Cancer. 1993 Nov 1;72(9 Suppl):2834–2838. doi: 10.1002/1097-0142(19931101)72:9+<2834::aid-cncr2820721512>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  16. Gillam S. J., Jarman B., White P., Law R. Ethnic differences in consultation rates in urban general practice. BMJ. 1989 Oct 14;299(6705):953–957. doi: 10.1136/bmj.299.6705.953. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Gillam S. J. Provision of health promotion clinics in relation to population need: another example of the inverse care law? Br J Gen Pract. 1992 Feb;42(355):54–56. [PMC free article] [PubMed] [Google Scholar]
  18. Goldberg K. C., Hartz A. J., Jacobsen S. J., Krakauer H., Rimm A. A. Racial and community factors influencing coronary artery bypass graft surgery rates for all 1986 Medicare patients. JAMA. 1992 Mar 18;267(11):1473–1477. [PubMed] [Google Scholar]
  19. Gordon A., Collin J. Save the normal foreskin. BMJ. 1993 Jan 2;306(6869):1–2. doi: 10.1136/bmj.306.6869.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Halfon N., Newacheck P. W. Childhood asthma and poverty: differential impacts and utilization of health services. Pediatrics. 1993 Jan;91(1):56–61. [PubMed] [Google Scholar]
  21. Hobbs R. Deprivation payments. BMJ. 1993 Feb 27;306(6877):534–535. doi: 10.1136/bmj.306.6877.534. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Kee F., Gaffney B., Currie S., O'Reilly D. Access to coronary catheterisation: fair shares for all? BMJ. 1993 Nov 20;307(6915):1305–1307. doi: 10.1136/bmj.307.6915.1305. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Kjellstrand C. M. Age, sex, and race inequality in renal transplantation. Arch Intern Med. 1988 Jun;148(6):1305–1309. [PubMed] [Google Scholar]
  24. Kogevinas M., Marmot M. G., Fox A. J., Goldblatt P. O. Socioeconomic differences in cancer survival. J Epidemiol Community Health. 1991 Sep;45(3):216–219. doi: 10.1136/jech.45.3.216. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Lachmann P. The use of animals in research. BMJ. 1992 Jul 4;305(6844):1–1. doi: 10.1136/bmj.305.6844.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Lear J. T., Lawrence I. G., Pohl J. E., Burden A. C. Myocardial infarction and thrombolysis: a comparison of the Indian and European populations on a coronary care unit. J R Coll Physicians Lond. 1994 Mar-Apr;28(2):143–147. [PMC free article] [PubMed] [Google Scholar]
  27. Majeed A., Pollock A. M. Women and coronary artery surgery. Health authorities should monitor equity of service. BMJ. 1993 Jun 19;306(6893):1689–1689. doi: 10.1136/bmj.306.6893.1689-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Majeed F. A., Cook D. G., Anderson H. R., Hilton S., Bunn S., Stones C. Using patient and general practice characteristics to explain variations in cervical smear uptake rates. BMJ. 1994 May 14;308(6939):1272–1276. doi: 10.1136/bmj.308.6939.1272. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Marsh G. N., Channing D. M. Narrowing the health gap between a deprived and an endowed community. Br Med J (Clin Res Ed) 1988 Jan 16;296(6616):173–176. doi: 10.1136/bmj.296.6616.173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Murray S. A., Tapson J., Turnbull L., McCallum J., Little A. Listening to local voices: adapting rapid appraisal to assess health and social needs in general practice. BMJ. 1994 Mar 12;308(6930):698–700. doi: 10.1136/bmj.308.6930.698. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Old P., Voss S., Davidge M. Primary care. Performing arts. Health Serv J. 1994 Apr 21;104(5399):28–29. [PubMed] [Google Scholar]
  32. Reading R., Colver A., Openshaw S., Jarvis S. Do interventions that improve immunisation uptake also reduce social inequalities in uptake? BMJ. 1994 Apr 30;308(6937):1142–1144. doi: 10.1136/bmj.308.6937.1142. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Reading R. Equity and community child health. Arch Dis Child. 1993 May;68(5):686–690. doi: 10.1136/adc.68.5.686. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Reading R., Jarvis S., Openshaw S. Measurement of social inequalities in health and use of health services among children in Northumberland. Arch Dis Child. 1993 May;68(5):626–631. doi: 10.1136/adc.68.5.626. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Shaukat N., de Bono D. P., Cruickshank J. K. Clinical features, risk factors, and referral delay in British patients of Indian and European origin with angina matched for age and extent of coronary atheroma. BMJ. 1993 Sep 18;307(6906):717–718. doi: 10.1136/bmj.307.6906.717. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Smith T. Influence of socioeconomic factors on attaining targets for reducing teenage pregnancies. BMJ. 1993 May 8;306(6887):1232–1235. doi: 10.1136/bmj.306.6887.1232. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Talbot R. J. Underprivileged areas and health care planning: implications of use of Jarman indicators of urban deprivation. BMJ. 1991 Feb 16;302(6773):383–386. doi: 10.1136/bmj.302.6773.383. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Walsh S. S., Jarvis S. N. Measuring the frequency of "severe" accidental injury in childhood. J Epidemiol Community Health. 1992 Feb;46(1):26–32. doi: 10.1136/jech.46.1.26. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Whitehead M. Who cares about equity in the NHS? BMJ. 1994 May 14;308(6939):1284–1287. doi: 10.1136/bmj.308.6939.1284. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Womersley J., McCauley D. Tailoring health services to the needs of individual communities. J Epidemiol Community Health. 1987 Sep;41(3):190–195. doi: 10.1136/jech.41.3.190. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES