It is well recognised that socioeconomic disadvantage has a profound impact on people’s health, and GPs are often in a good position to confront this.48
However, poverty is not evenly spread across Australia, and it is likely that GPs who see some patients with socioeconomic disadvantage will see many. Similarly, GPs are not evenly spread with respect to poverty. The Australian Bureau of Statistics (ABS) have shown that, in 2006, 11% of GPs worked in the most disadvantaged areas, while 24% worked in the least disadvantaged.49
Healthcare in communities that are socioeconomically deprived is often complex. As well as having more chronic health conditions, and more health behaviours leading to increased risk, there may be a lack of local support and infrastructure to improve the situation. General practices are often one of the few resources patients have to call on. There are often significant personal and social barriers to achieving change. As well as good communication skills, GPs may need to help patients navigate health, housing, welfare and legal systems. This often makes for more-frequent, longer, more-complex consultations. However, the long-term relationships GPs develop with patients are significant enablers for patients who are socioeconomically deprived to be able to make changes.
Health equity issues are more complex than just socioeconomic factors. There are specific issues for Aboriginal and Torres Strait Islander peoples, where an ongoing history of colonisation, dispossession and racism interact with a lack of economic opportunity. The National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people, 2nd edn50 provides extensive detail on specific preventive care issues facing Aboriginal and Torres Strait Islander peoples, and the health equity material canvassed here should be read in conjunction with those guidelines. They provide much more in-depth and important guidance on preventive healthcare strategies that are recommended for practitioners working with Aboriginal and Torres Strait Islander peoples and communities. In addition, GPs should optimise their use of Medicare Benefits Schedule (MBS) Item 715 that supports health checks in Aboriginal and Torres Strait Islander peoples and their use of Close the Gap provisions in ensuring affordable access to medicines. GPs should also proactively address cost barriers to referral to other services faced by Aboriginal and Torres Strait Islander peoples.