Dear James and colleagues:
In reply --
>As far as I can see equality in outcomes is clearly
> not possible and not really desirable.
Are you sure that you mean this? Is it okay for people
with the same disease but different economic
situations to have different outcomes (length of
survival etc)? I hardly think so, and we need to be
careful to distinguish 'health outcomes' from
'social outcomes'. It is a great frustration for
clinical staff that they can and do provide equally
painstaking treatment for people, only to find that
those who are less well off heal up more slowly,
are more likely to get worse or to relapse. This is
one of the starting points for a debate on *health*
inequality, namely, that the best intentions of
health workers are frustrated by social reality.
And indeed, on the economic front, the great
expense of health care yeilds less 'returns'
than it otherwise might.
Mel B
Mel Bartley
Dept of Epidemiology and Public Health
University College London Medical School
1-19 Torrington Place
London WC1E 6BT
tel: 0171 391 1707
fax: 0171 813 0242
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