Social inequality and access to care

The purpose of the National Service Framework for Diabetes is to establish national standards for the care of people with diabetes to improve care for all and to reduce inequalities. The harmful effect of social deprivation on health is well recognised¹ and is mirrored in diabetes where “wealthy means healthy”.² In patients with diabetes increased social deprivation has been shown to be related to higher hospital admission rates,³ poorer diabetes control, increased complications, and increased mortality.⁴ However, the reasons for these inequalities and the relative contributions of differences in individual behaviour and access to high quality health care are unclear. Goyder and colleagues⁵ in this issue of Quality in Health Care have elucidated how social factors might influence access to diabetes care. In a cohort of individuals with diabetes identified from general practice, they examined which factors predict attendance for diabetes review at both hospital clinics and general practices. The predictors of hospital attendance were younger age, longer duration of diabetes and treatment with insulin, access to a …