GPs must play wider role in cutting health inequality, says public health professor

Reducing health inequality should be a focus for primary care, says a public health expert who published a government report on GPs' role in boosting living conditions within their communities.

Professor Sir Michael Marmot: health inequality warning
Professor Sir Michael Marmot: health inequality warning

Professor Sir Michael Marmot told GP that there has been progress since the Marmot Review in 2010 recommended that primary care should be a ‘focus hub’ to reduce health inequality, but GPs have much more to contribute.

‘There have been some encouraging signs,’ he told GP. ‘But it’s clear there is a wider role for GPs to play in public health. Health equity ought to be absolutely key.

‘Some GPs have said to me: "I’m a clinician, I’m not a public health doctor". That’s fine - they just have to realise they can have an impact on the health of the populations that they serve.’

Holistic approach

With recent NICE guidelines recommending that doctors should help patients living in cold homes by putting them in touch with the local council and energy companies, Sir Michael believes that the NHS is beginning to shift its focus to the right area.

‘I think preventative medicine is a priority for the NHS,’ he said. ‘Simon Stevens, NHS England’s chief executive, has made it clear that we can’t afford not to do prevention, but I’ve always argued that we should be involved in prevention not for economic reasons but because it’s the right thing to do.'

Sir Michael cites the award-winning Bromley-by-Bow centre as a bastion of community engagement, and applauds GP services that aim to help homeless people.

‘At the same time as treating their diabetes or liver disease, or pneumonia, they’re trying to deal with the fact of their homelessness, by working with social housing and housing associations,’ he said.

‘There’s a great deal that GPs can do and we [the Institute of Health Equity at University College London] are trying to develop the guidance with CCGs to show what can be done.’

Global health

Sir Michael says that GPs in the UK should take note from doctors in Gujarat, India, which he recently visited in his new role as president of the World Medical Association.

Doctors running health camps in tribal areas there have been working to improve the living situation of their patients by helping to build dams to improve agriculture, and setting up education and training schemes.

‘The doctors said, this needs to be part of our role as caring physicians,’ said Sir Michael. ‘They started treating underserved, sick people, and now they’ve been trying to improve the conditions in which people live.

‘Given how difficult conditions in rural Gujarat are, if it can be done there, we can do those things in Britain,’ he said.

‘Housing may be immeasurably better here, but there’s still much that can be done - improving neighbourhoods, coordinating with social care, creating work opportunities and so on,' he added.

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