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#PoliticalSpeak & #ThinkSpeak: access inequality has not caught up with knowledge access


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How can we democratise access to good quality healthcare? #PoliticalSpeak #ClinicSpeak

I am often asked why I dedicate so much time to blogging. One of the reasons is to help disseminate knowledge and to help curate knowledge, i.e. to highlight what is important to pwMS. By doing this I am participating in a 'healthcare revolution' that is leading rapidly to an era when people with a chronic disease will be able to self-manage their disease. Another important reason for blogging is to counteract 'fake knowledge', 'pseudoscience' and 'fake news'. Unfortunately, the latter often brings out the worst in some of our followers (aka trolls). 

A big issue with the democratisation of knowledge is that healthcare systems, such as the NHS, are stuck in the past and have yet to embrace the new era. As a result the NHS is the main stumbling block, or hurdle, for the self-management revolution to take-off. I therefore find the study below very upsetting. In short it shows widening health inequalities in England that seem to to coincide with a change of government, the financial crash or the resulting austerity. 

In an era where there is no barriers to access of information there are clearly barriers to accessing quality healthcare, i.e. the NHS. Why should the management of your MS be so dependent on our postcode? This research is another example of why health and politics are so intricately linked and that it is impossible to separate them. I sincerely hope that politicians and healthcare managers read this paper and ask themselves how can we reverse this trend given the current financial constraints we find ourselves in? A potential solution is democratise healthcare and the ask the crowd for ideas and solutions. 

Trends in life expectancy in the most deprived local authorities and the rest of England,
and the relative and absolute differences 1983-2015. (Source BMJ)

In response to some of these insights we are are changing the format of our group clinics to allow them to be run, and lead, by pwMS. We want pwMS to self-manage their condition and to only call on us when they need help, or access, to a specialist technology. The medical profession needs to wake-up to the 'power of the crowd' and join the crowd. The crowd will reshape the doctor-patient relationship and will change the way we work. I am sure this will be for the better, job satisfaction will improve and our patients will be happier with the service we provide. 

Is the medical community ready for a revolution or are they blinded by 'status quo bias'?

Barr et al. Investigating the impact of the English health inequalities strategy: time trend analysis. BMJ 2017;358:j3310.

Objective: To investigate whether the English health inequalities strategy was associated with a decline in geographical health inequalities, compared with trends before and after the strategy.

Design: Time trend analysis.

Setting: Two groups of lower tier local authorities in England. The most deprived, bottom fifth and the rest of England.

Intervention: The English health inequalities strategy—a cross government strategy implemented between 1997 and 2010 to reduce health inequalities in England. Trends in geographical health inequalities were assessed before (1983-2003), during (2004-12), and after (2013-15) the strategy using segmented linear regression.

Main outcome measure: Geographical health inequalities measured as the relative and absolute differences in male and female life expectancy at birth between the most deprived local authorities in England and the rest of the country.

Results: Before the strategy the gap in male and female life expectancy between the most deprived local authorities in England and the rest of the country increased at a rate of 0.57 months each year (95% confidence interval 0.40 to 0.74 months) and 0.30 months each year (0.12 to 0.48 months). During the strategy period this trend reversed and the gap in life expectancy for men reduced by 0.91 months each year (0.54 to 1.27 months) and for women by 0.50 months each year (0.15 to 0.86 months). Since the end of the strategy period the inequality gap has increased again at a rate of 0.68 months each year (−0.20 to 1.56 months) for men and 0.31 months each year (−0.26 to 0.88) for women. By 2012 the gap in male life expectancy was 1.2 years smaller (95% confidence interval 0.8 to 1.5 years smaller) and the gap in female life expectancy was 0.6 years smaller (0.3 to 1.0 years smaller) than it would have been if the trends in inequalities before the strategy had continued.

Conclusion: The English health inequalities strategy was associated with a decline in geographical inequalities in life expectancy, reversing a previously increasing trend. Since the strategy ended, inequalities have started to increase again. The strategy may have reduced geographical health inequalities in life expectancy, and future approaches should learn from this experience. The concerns are that current policies are reversing the achievements of the strategy.

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