Audit Scotland's report on health inequalities clearly shows the value and need for independent assessment of policy in this area ("Health inequalities persist despite £2bn investment", The Herald, December 13).
In general, talk has been cheap, but progress difficult. There has been ample political will, but less political understanding. When shown the maldistribution of GPs, politicians' jaws invariably drop. It is remarkable how little this issue has featured in successive policy documents. The original Equally Well policy document (the Government's flagship policy on health inequalities) made no reference to general practice.
The Government is correct to focus on the causes of health inequalities, but one cause it has neglected is the role of the NHS in widening the social gap.
As health care has become more effective, not just via the delivery of evidence-based medicine, but also by unconditional continuity of personalised care for patients with multiple problems, the distribution and uptake of such care becomes crucial. Put simply, if the NHS is not at its best where it is needed most, health inequalities will widen.
This is a challenge for the future. As health systems struggle to find efficient ways of addressing increasing multimorbidity, service fragmentation, resource constraints and widening inequality, solutions are needed especially in deprived areas.
The good news is that Scotland has a high quality workforce in these areas. With proper resourcing and support, it could show the world what needs-based universal coverage can achieve.
The challenge for politicians is this: will they bring primary care in deprived areas out of the shadows, and put it centre stage?
Professor Graham CM Watt,
Norie Miller Professor of General Practice,
General Practice and Primary Care,
University of Glasgow,
1 Horselethill Road,
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