How does the General Practice curriculum understand health inequality?

Problem

Reducing health inequalities (differential health outcomes and experiences based on social determinants) has long been a public health priority. General Practitioners (GPs) are generally understood to have an important role in improving health disparities between social groups through not only their medical practice but also their influence on national and local policy agendas. GPs are in a unique position as the effects of the social determinants of health are something they can both observe directly and are confronted with daily. Perhaps because of this, there is a drive towards including teaching on health inequalities and the social determinants of health in undergraduate medicine and in GP specialist training.The aim of this whole study was to conduct a critical analysis of the curriculum relating to health inequalities and to examine the narratives and assumption contained within undergraduate and GP training on health inequalities. This particular part of the study is focused on curriculum and practice documents. Future work will involve semi-structured interviews with GPs in training and in practice.

Approach

Through a search of key sources (General Medical Council, Royal College of General Practitioners, British Medical Association, Society for Academic Primary Care, Royal College of Physicians, British medical schools, gov.uk) a number of curriculum documents, practice guides and textbooks which relate to health inequalities were identified. The data was analysed using a dialectical materialist method drawing on Marxist and feminist theories which aim to find connections and patterns in the data with specific reference to the wider political, societal and economic context.

Findings

Early findings show that although the social determinants of health framework has the potential to extend inquiry towards the fundamental political economy of contemporary Britain, it tends to stop short of this and understands the determinants as disarticulated risk factors. This leads to a tendency towards an understanding of health inequalities as being largely or wholly a matter of individual behaviour. Where structural forces are mentioned these are often presented abstractly, without cause.

Consequences

Future teaching on health inequalities should include a thorough theoretical understanding of why and how health inequalities persist in Britain including explanations for how individual behaviour is sometimes constrained. This analysis will also highlight the ways in which primary care practice could be meaningfully adjusted and to lessen the focus on individual change. Future work can move beyond documenting and analysing the effects of the social determinants of health and GPs can direct their policy influence towards the fundamental drivers of inequality.