Doctors can promote fairness and equality in health through education

By The Royal College of Physicians, including comments from:

  • Professor Ian Gilmore, President of the Royal College of Physicians
  • Professor Alan Maryon-Davis, President of the Faculty of Public Health
  • Paul Lincoln, Chief Executive of the National Heart Forum
  • Professor Steve Field, Chairman of the Royal College of General Practitioners
  • Dr Max Henderson, representing the Royal College of Psychiatrists
  • Dr David Pencheon, Director of the NHS Sustainable Development Unit

In the UK today social disadvantage results in vast gaps in health and mortality, but these inequalities are not inevitable.  A new report from the Royal College of Physicians (RCP) in partnership with leading health organisations and the NHS calls on all doctors to make addressing the social determinants of health part of their everyday medical practice, reducing where they can the inequitable burden of disease.

The report ‘How doctors can close the gap: tackling the social determinants of health through culture change, advocacy and education’ is the synthesis of the ideas and proposals to emerge from a series of policy dialogues held at the Royal College of Physicians.  The dialogues and report have been organised in partnership with the Royal College of General Practitioners, Royal College of Psychiatrists, Faculty of Public Health, National Heart Forum, and the NHS Sustainable Development Unit.

The report identifies how doctors can take account of social inequalities in every area of their work, calling for changes to medical practice and consultations and encouraging doctors to use their powerful voices to advocate health equality. The links between climate change and health inequalities and the fact that what is good for climate change is good for health are also highlighted. The principal recommendations include:

  • Refocusing of attitudes and resources in healthcare towards prevention rather than treatment of ill-health
  • Doctors ensuring they identify opportunities to help patients from disadvantaged backgrounds to manage their health, taking into account their social and physical environment and to encourage patients from marginalised groups to access health information, screening and health promotion services
  • Encouraging patients to undertake healthy activities such as cycling which have co-benefits for both the patient and the environment. Doctors can also persuade local authorities to supply the resources and green spaces to support more active lifestyles
  • Urging doctors to join forces to advocate health equality at all levels – from impassioned medical students to influential deans and directors. The entire profession can use its powerful voice to promote action on the social determinants of health
  • Restructuring the undergraduate and postgraduate education of doctors to make the public health and social aspects of the courses more engaging. Also, giving doctors in training the opportunities to be involved in issues around social determinants of health through innovative continuing professional development and certification
  • Better targeting of user-friendly and accessible information for socially disadvantaged groups and young people, and more information-sharing between doctors, public health teams and researchers on best practice in reducing inequalities

Professor Ian Gilmore, President of the Royal College of Physicians, said:

“At present, many doctors and other health professionals do their best to treat the patient in front of them, but they do not always look beyond the symptoms presented, and address the patients’ social and economic background. This becomes a vicious cycle, where people are treated for an illness, go back into the community and fall ill again, because doctors have not been able to address the reason they were unwell in the first place.”

Professor Alan Maryon-Davis, President of the Faculty of Public Health, said:

“Doing what we can to remove some of the unfair barriers to better health and wellbeing is not just the province of public health specialists. All doctors can help to reduce the 'health divide' in various ways. I hope this report will stimulate not just reflection and discussion, but also action.”

Paul Lincoln, Chief Executive of the National Heart Forum, said:

“Doctors are key agents for progressive social change if they lead advocacy at a patient and population level on effective and sustainable action on tackling the root causes of disease and promote good health and wellbeing. Doctors should increasingly become much more engaged in early intervention and prevention and thus reduce and shape the demand for avoidable conditions on the NHS”

Professor Steve Field, Chairman of the Royal College of General Practitioners, said:

“It’s shocking that we are in 2010, yet the health and life expectancy of our population are still largely determined by whether we are rich or poor - and that the divide between the two seems to be getting wider.  GPs, more than any other health professionals, are in the privileged position of working at the heart of communities and being able to provide care to patients throughout their lifetime. We have a unique insight into the lives of our patients and are already making good progress in helping people live healthier lives and preventing them becoming ill, rather than trying to patch them up once they are ill.  But we can all do more and this report ups the ante. By working together, the medical professions can be a force for change and do much to improve the health outcomes for all our patients, wherever they fall in the socio-economic divide.  I am particularly pleased to see sustainability at the heart of this work. I am convinced that with the influence and support of the medical world driving it forward, this agenda can become as powerful as the anti-smoking movement started and led by doctors three generations ago.”

Dr Max Henderson, representing the Royal College of Psychiatrists, said:

“Psychiatrists know that poor mental health can have a significant adverse impact on many aspects of a person's life. I very much hope that this document persuades psychiatrists to advocate for a wider awareness of the role played by mental ill health, while at the same time joining forces with other doctors to address the range of health inequalities that exist in society.”

Dr David Pencheon, Director of the NHS Sustainable Development Unit, said:

“Doctors have a duty of care to address not only the illnesses of the patients that present themselves, but also the wider cause of disease and health inequalities that cause such unfair variations in health and opportunity.  These inequalities are not just between different parts of society today, but between society today and society tomorrow; here in the UK and in even more vulnerable parts of the world.  The increasing inequalities that we are storing up for our children and grandchildren are simply wrong, and are largely preventable with knowledge we already have - if we chose to use it.  We have no right to use resources so profligately today that we endanger the fundamental bases of health and justice for people today or tomorrow.  Doctors need to use their voice and influence to ensure that, on our watch, we leave a legacy we can be proud of.”

The report is free to download from the RCP website.

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