Amanda Paust has an MSc in Public Health from Aarhus University. She is a PhD student at the Research Unit for General Practice in Aarhus and is enrolled at the Graduate School of Health, Aarhus University. She teaches courses on social inequality, e.g. for medical students. She is the initiator of a Danish research network on social inequality in general practice and serves as the coordinator between this national network and the Danish Alliance Against Social Inequality in Health.
What is your research area?
My research focuses on social inequality in medical treatment. Together with my colleagues, I explore the broad questions: Are some patients treated more often than others with inappropriate medication? Does this happen more often in specific types of clinics? Or in certain geographical areas? We also take a closer look at possible solutions in general practice. For example, we investigate what role the patient's social position may play in medical discussions with the GP. And we have developed a questionnaire that may help the patient prepare for taking part in medical decisions.
Why is it important?
Inequality in health is not necessarily an expression of social inequality. It can be caused by genes, gender, age or other factors. But when a citizen's health is determined by this individual's social position in society, it's an unfair difference. In the Danish society, we have chosen that all residents should have free and equal access to the healthcare system. So there shouldn't be such big differences. For example, many of the most socially disadvantaged patients die from diseases that could actually have been treated. It is often the well-educated residents who receive the most and best treatment. This is referred to as the inverse care law. This situation is unacceptable for the most disadvantaged people, but it is also costly for society. In the "Health for life" report by Danish Regions, it is estimated that up to 90 percent of early retirement costs could have been saved if all citizens aged 30-64 years had the same good health status as that of the well-educated population. The healthcare sector is partly responsible for this difference.
How can general practice help reduce inequality in health?
The general practitioner issues most prescriptions in Denmark and has an overview of the patient's overall treatment. Both the doctors and the practice staff have a unique knowledge of their patients and a long-standing relationship with them that is not seen anywhere else in the healthcare system. Knowledge and continuity are especially important for the vulnerable patients with multiple chronic diseases, who may find it difficult to navigate the healthcare system, or who may be in a difficult life situation. Here, general practice has a central role in helping to break down the structural and cultural barriers that some patients encounter in the healthcare system.
What measures does it require?
General practice already makes a great effort to reach out to all patients. Many clinics have special measures for vulnerable groups, because 'business as usual' is rarely enough if the disease picture is complex or the patient's life situation is challenging. But if we want to get closer to the goal of ensuring equal access to health care for all, the clinics should be allowed to arrange things in such a way that they can offer most support to those with the greatests needs. But it is not an easy task. I believe that research and practice must go hand in hand, so that we not only gain new knowledge, but also find some solutions that are applicable in the clinical setting. And that will require taking a closer look at both the organizational framework and the interaction between doctor and patient.
What is your most important message?
It is harmful for both the individual and for society that the social inequality in health is increasing. The healthcare system holds a responsibility for reducing it, and general practice is an important player. It requires both knowledge and special efforts to help the patients experiencing barriers. And those measures must be created in a collaboration between research and clinical practice. Everything from the organization of general practice to the relationship between the doctor and the patients must be considered if we really want to do something about it.
