Exhibition: Unequal - Health and Society

Not everyone receives the care they need, even under a universal healthcare system. This exhibition explores the history of health inequalities in the UK.

Oil painting by Sir Luke Fildes from 1874, portraying a line of destitute men, women, and children waiting outside a police station in Victorian London for admission to a workhouse's casual ward.

Banner image: Applicants for admission to a casual ward, Sir Luke Fildes, 1874. Wellcome Collection.

Working in a community, GPs may be the first to become aware of poor health outcomes. They can also be the first to challenge them. Social, economic and discriminatory barriers affect some more than others. Wealthier areas have better health centres, more GPs with smaller lists, and more hospital support. GP Julian Tudor Hart called this the ‘inverse care law’.

“In areas with most sickness and death, general practitioners have more work, larger lists, less hospital support, and inherit more clinically ineffective traditions of consultation, than in the healthiest areas; and hospital doctors shoulder heavier case-loads with less staff and equipment, more obsolete buildings, and suffer recurrent crises in the availability of beds and replacement staff. These trends can be summed up as the inverse care law: that the availability of good medical care tends to vary inversely with the need of the population served.” Julian Tudor Hart, ‘The Inverse Care Law’ 1971
A wealthy ignorant doctor recommending expensive foods and cures to a very poor woman for her sick child (Wellcome Collection, undated, 19th century)
A wealthy ignorant doctor recommending expensive foods and cures to a very poor woman for her sick child Wellcome Collection, undated, 19th century

Although poverty has long been a concern, no one spoke of health inequality until it became the subject of a research committee led by Sir Douglas Black in 1977. The Black Report was not accepted by the then Conservative government, and the College found it hard to get hold of copies. It wasn’t until 1997 that a new Labour government reignited interest in social inequality. This made the UK the first European country to systematically address inequalities in health.

Yet, just over twenty years later, the COVID-19 pandemic raised public awareness of ongoing injustices in illness prevention and treatment. And today, health inequalities remain a vital issue for primary care.

This exhibition explores how inequality emerged as an issue facing GPs long before the NHS, the impact of the National Health Service on health equity and the ongoing challenges for infant, family, and adult care across a range of backgrounds.

In focus: Missingness

Missingness is defined as the repeated tendency not to take up offers of care resulting in a negative impact on a person and their life chances. This video offers a patient perspective on Missingness, which is the result of complex interactions between patients’ circumstances and the ways in which services are designed and delivered. Many overlapping factors cause missingness, including patients feeling the service is not for them, practical things like availability of transport, and money being tight, mental health struggles and experiences of distrust, stigma and trauma. Applying a missingness lens directs services – not individual patients – to find the solutions.

Learn more about the research project and watch the video on the University of Glasgow website.

RCGP London Exhibition Experts. Produced by Brand Calibre Films.

Explore the exhibition

The Squalid City: Poverty and urban health

Find out how inner cities became the first focus for geographic inequalities.

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Historic map showing the living conditions of the poor in urban areas during the industrial revolution, highlighting issues of sanitation and public health.

A community view: Health centres and the NHS

Focus on healthcare in the community, and the impact of the NHS in 1948.

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Photograph from the 1980s showing Dr. Doreen Vernon measuring a patient's blood pressure during a World Health Day event, with Dr. Pro Torkington observing.

Intersectionality and adult health

Explore how health inequalities are intersectional, depending on class, race and gender.

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Image of Shiv Pande and his family. Shiv is holding a boy, the lady next to him a baby. There is a gentlemen wearing a suit with glasses and reading a book. Next to him is a woman wearing a red saree and next to her is a man sitting crossed legged. There are indian sweets in a tray on a white sheet covering the carpet, and there is a small holy ritual going on.

At the deep end: Today and tomorrow

Look to the future at what GPs are doing and can do to tackle health inequalities.

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A nurse writes notes at a table while examining a baby held by a woman; other women with infants sit in the background.

Listen to our podcast

GPs share their experiences around health equity in our RCGP oral history collection.

Contact us

These are just some of the stories from the RCGP archive and collections. Health inequality is a huge topic, and we could not possibly cover every theme. If you have memories or materials to share, we would love to hear from you. Please contact: [email protected].

Acknowledgements

  • Curatorial team: Sarah Chaney, Heather Heath, Antoinette Hoyte, Jonathan Bartho
  • Design and installation: Aura Creative
  • Digital support: Priya Dodhia
  • With thanks to: Richard Vautrey, Dominic Patterson, Katy Gardner, Patrick Hutt, Carey Lunan, Andrea Williamson, David Blane, Brian Jarman, Toni Hazell, Aaliya Goyal, Kevin McConville, Juliet Ash, Matt and Jess Turtle and the Museum of Homelessness, Peter Basham and the Royal College of Obstetricians and Gynaecologists, and members of the RCGP Health Equity, Heritage and Learning Disabilities Special Interest Groups.