Almost 25 years ago Margaret Thatcher declined to publish the Black
Report as she was not very partial to its message “All the major
killer diseases now affect the poor more than the rich.”
Two decades later, we learn that up to 3,000 people are dying from
cancer annually because of huge differences in the way the richest
and poorest patients are diagnosed and treated, according to a
report published in the British Journal of Cancer.
Men from the richest fifth of society now have a survival rate 9.4
per cent higher than similar patients from the poorest fifth.
Among women with breast cancer, those on a low income have a 5 per
cent reduced rate of survival compared with the richest
The study’s author, professor Michael Coleman says:”There is
evidence that more deprived patients are less likely to take up
screening, less likely to see their GP when they have early
symptoms and are less assertive about treatment.”
In other words, premature death is a result not of the consequences
of too little money, diet or occupation – but because the poor are
less able to extract the best deal for themselves in the market
place of the NHS.
Perhaps, he is wrong. Perhaps the fault lies not with patients but
practitioners. Many at the bottom of the pile medicalise the
practical difficulties in their lives – rotten pay, bad housing and
poor social skills. Cash, and a fresh network of support, would
probably “cure” many ailments but since they are unlikely to
materialise, the GP and antidepressants will have to do.
Arguably it’s not, as professor Coleman attests, that the more
deprived are less likely to see their GP, but that some doctors
believe that they visit the surgery too frequently. Familiarity
breeds contempt – and genuine symptoms are possibly overlooked. We
must remember that while we cannot expect GPs to have equal
knowledge, patience and positive outlook.
Research into the attitudes of medical practitioners towards
patients – rich and poor – might be enlightening. It would also
flag up what may be a hurdle ahead for greater integration between
social services, health and education.
While there are progressives (perhaps even socialists!) working in
all the professions, one suspects that social services are far more
at ease with the democratic idea that it’s not income and eloquence
that should dictate access to a premier service – it’s need.