Territorial justice and primary health care: An example from London

The research reported here is concerned with empirically testing the 'inverse care law' at the DHA level, and the often held assumption of a simple dichotomy of relatively underprovided inner DHAs and overprovided outer DHAs is shown not to be tenable.

Abstract

This paper is part of a larger piece of research which examines the spatial relationship between need for and provision of primary health care in London. The research reported here is concerned with empirically testing the 'inverse care law' at the DHA level. One concept that may be used to guide this analysis is 'territorial justice'. Several conceptual problems associated with the use of territorial justice are outlined. These include inadequate conceptualisation of the form of social justice assumed, of the problem of deriving need indices and of the nature of resources. A final problem is concerned with the spatial scale of the analysis. The concept of territorial justice is made operational so as to identify relatively under and overprovided DHAs. The result is that the often held assumption of a simple dichotomy of relatively underprovided inner DHAs and overprovided outer DHAs is shown not to be tenable. However, this research concentrates on the quantity of care, and does not focus on the important aspect of its quality. This preliminary analysis reveals the need for further research on this important topic.