“Rich people get lots of it. Poor people don’t get any of it!”: Fifty years of tackling the Inverse Care Law

I was fortunate to have the opportunity to speak at the South Western Sydney Local Health District Primary & Community Health Research & Innovation Showcase on 6 September 2023 about 50 years of the inverse care law. My slides and references are below.


  • “Rich people get lots of it. Poor people don’t get any of it!” Fifty years of tackling the Inverse Care Law
  • “The availability of good medical care tends to vary inversely with the need of the population served… This inverse care law operates more completely where medical care is most exposed to market forces and less so when such exposure is reduced” Tudor Hart, 1971
  • “To the extent that health care becomes a commodity it becomes distributed just like champagne. That is rich people get lots of it. Poor people don’t get any of it.” Tudor Hart, 1973
  • Effect of different approaches to reduce health inequalities. Shows that proportionate universalism has an important role to play in achieving gains in life expectancy.
  • The inverse care law persists in Australia
  • Provision and use of health care in the lowest and highest SES areas
  • There are multiple causes of, and forms of, disadvantage… …but income inequality is a manifestation that cuts across all of them.


ABS. (2019, April 29). 4364.0.55.014—National Health Survey: Health Literacy, 2018. Australian Bureau of Statistics. https://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.014

AIHW. (2021). Health Expenditure Australia 2019-20., AIHW, Australian Government. Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditure-australia-2019-20/report-editions

AIHW. (2023). Mortality Over Regions and Time (MORT) books. Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/life-expectancy-deaths/mort-books/contents/mort-books

Bates, S., Harris-Roxas, B., & Wright, M. (2023). Understanding the costs of co-commissioning: Early experiences with co-commissioning in Australia. Australian Journal of Public Administration, online first. https://doi.org/10.1111/1467-8500.12599

Furler, J. S., Chondros, P., Young, D. Y., Harris, E., Powell Davies, P. G., & Harris, M. F. (2002). The inverse care law revisited: Impact of disadvantaged location on accessing longer GP consultation times. Medical Journal of Australia, 177(2), 80–83.

Harris, E., & Harris, M. F. (2022). An exploration of the inverse care law and market forces in Australian primary health care. Australian Journal of Primary Health. https://doi.org/10.1071/PY22160

Harris-Roxas, B., & Sturgiss, E. (2023). Equity in primary health care provision: More than 50 years of the inverse care law. Australian Journal of Primary Health, 29(2), i–ii. https://doi.org/10.1071/PY23062

Lewis, V. J., Macmillan, J., & Harris-Roxas, B. (2022). Defining community health services in Australia: A qualitative exploration. Australian Journal of Primary Health. https://doi.org/10.1071/PY21265

NCCDOH. (2013). Let’s talk: Universal and targeted approaches to health equity. National Collaborating Centre for Determinants of Health.

Tudor Hart, J. (1971). The inverse care law. The Lancet, 7696, 405–412.

Turrell G, Stanley L, de Looper M, & Oldenburg B. (2004). Health Inequalities in Australia: Morbidity, health behaviours, risk factors and health service use (Health Inequalities Monitoring Series No. 2). Queensland University: AIHW.

University of Glasgow. (2023). The Scottish Deep End Project. https://www.gla.ac.uk/schools/healthwellbeing/research/generalpractice/deepend/

Watt, G. (1998). Not Only Scientists, but Also Responsible Citizens. Journal of the Royal College of Physicians of London, 32(5), 460–465.

Watt, G., Brown, G., Budd, J., Cawston, P., Craig, M., Jamieson, R., Langridge, S., Lyon, A., Mercer, S., Morton, C., Mullin, A., O’Neil, J., Paterson, E., Sambale, P., Watt, G., & Williamson, A. (2012). General Practitioners at the Deep End. Occasional Paper (Royal College of General Practitioners), 89, i–40.