title: Addressing the inverse care law: the role of community paediatric services.
abstract: BACKGROUND
  Children's health suffers disproportionately from the effects of poverty. The inverse care law states that those who need care the most are the least likely to receive it. Community paediatricians are well placed to address health inequalities in children.
  
  
  OBJECTIVE
  To explore, using routinely collected data, whether we address health inequalities and the inverse care law, particularly for certain conditions targeted by our specialty.
  
  
  METHODS
  Five years of data were analysed, during which health equity audits have led to service changes in order to tackle inequities. The data include postcodes, allowing each child to be assigned to a deprivation quintile, and a range of diagnoses, including five sentinel conditions: attention deficit hyperactivity disorder (ADHD) on medication, autistic spectrum disorder (ASD), epilepsy, cerebral palsy and Down's syndrome. This allowed analysis of the caseload by deprivation index for these conditions, comparison with the background population and exploration of time trends.
  
  
  RESULTS
  The number of children on the caseload and their distribution across the quintiles remained stable. The proportion of deprived children (i.e. in the lowest two quintiles) on the caseload over the last five years taken together is 56%, compared to 44% in the background population. The numbers of children with ADHD on medication has almost quadrupled in deprived quintiles and doubled in the least deprived quintile, while the numbers of children with this diagnosis in the most deprived is four times that in the least deprived. Numbers of children with ASD have also increased in each quintile. In contrast, the number of children with epilepsy and cerebral palsy did not show much variation, but those from deprived quintiles made up a greater proportion of the caseload.
  
  
  CONCLUSIONS
  Routine data collection demonstrates that inequalities are addressed using all four quality domains of service provision and sentinel conditions more likely to affect deprived children are targeted. We believe it is possible for all services to collect and analyse data thus with minimal effort, thereby providing a foundation from which to address the inverse care law.
authors.affiliation: Derbyshire Healthcare NHS Foundation Trust, Derby, UK.
authors.forename: Fawzia R
authors.initials: FR
authors.lastname: Rahman
authors.forename: Veena
authors.initials: V
authors.lastname: Maharaj
authors.forename: Rowena
authors.initials: R
authors.lastname: Yates
authors.forename: Chris
authors.initials: C
authors.lastname: Beeley
authors.forename: Ian
authors.initials: I
authors.lastname: Moore
authors.forename: Alex
authors.initials: A
authors.lastname: Rose
authors.forename: Andy
authors.initials: A
authors.lastname: Counsell
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000453:epidemiology; D002547:Cerebral Palsy / Q000453:epidemiology / Q000628:therapy; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000453:epidemiology / Q000628:therapy; D002662:Child Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004314:Down Syndrome / Q000453:epidemiology / Q000628:therapy; D004827:Epilepsy / Q000188:drug therapy / Q000453:epidemiology; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008511:Medicine; D011204:Poverty Areas; D013222:State Medicine / Q000706:statistics & numerical data; D006113:United Kingdom
keywords: child health; community paediatrics; deprivation; health inequalities; inverse care law; sentinel conditions