Challenging the inverse care law: can parenting support be fair to everyone?

Julian Tudor Hart coined the phrase 'inverse care law' 45 years ago to describe the sad truth that healthcare tends to be taken up in inverse proportion to the need for that care. How do we ensure that parenting support is offered and taken up in proportion to need? Can we create a happy marriage of universal and targeted provision when resources are limited? In this talk, Phil Wilson illustrated the issues through examples of different approaches tried in Glasgow.  He made the following points:

  • The strongest determinants for how long you will live and how your life will be are rooted in early childhood
  • Before 2005, uptake of child health screening was around 80%: most of the remaining 20% was in the most deprived areas.  Growing Up in Scotland (GUS) research has shown that more affluent families are more likely to seek advice from health visitors and GPs about their children's health
  • Getting access to the parents who do not turn up for appointments is very difficult
  • There are significant variations between the most and the least affluent across Scotland including life expectancy.  It also includes big differentials in child wellbeing in the pre-school years.  Chillingly, research is showing that these amplify in the first three years of primary school
  • Given this, should we be providing universal, services, targeted services or a bit of both?
  • Evidence shows that using parenting programmes as a universal approach does not work efficiently enough, which means this is not an effective way to spend public money
  • Targeted parenting support can be very effective, such as Family Nurse Partnership and Incredible Years, but they are still limited and there are questions about whether these are getting to the people who would benefit most
  • We got it wrong with Hall4.[1] Reducing the number of contacts with children meant that health professionals relied on parents reporting problems. But parents do not always know that they or their children need help; and also it is difficult to predict who will need help

He concluded that:

  • There are big variations in need for parenting support
  • Economic factors are part of the picture, but not the whole picture
  • Providing good parenting programmes is not enough. We need to provide universal support which identifies additional need and addresses this with more targeted support
  • We need to find a way to identify needs and offer support proportionately
  • Good health visiting can do this. The Scottish Government's new health visiting core programme is a major step in the right directing in re-establishing good relationships between universal services and parents/children.  The changes proposed are revolutionary and would take us to something better than how things were before 2005.  This is a cause for celebration

The main learning I will take from this conference is: the negative impact our social policy has on the wellbeing, development and care of our children. (participant)

 [1] Hall4 (Health for All Scotland's Children) set out new guidelines for the core programme of screening, surveillance and health promotion contacts for children. This resulted in fewer health contacts with children