Julian Tudor Hart

The originator of the Inverse Care Law, describing the unequal provision of healthcare where the most in need are helped the least.

Julian Tudor Hart was born in 1927 into a highly political family – his father, a staunch socialist, worked with the International Brigades in Republican field hospitals in the Spanish Civil War. Julian studied first at Queens’ College, Cambridge, in 1947 and then at St George’s Hospital in London, where he qualified as a doctor in 1952.

After a series of hospital jobs he became a GP in Notting Hill in London, where his patients comprised of many socially disadvantage migrants, and the occasional high profile left-wing activist who were in transit through the city.

By 1960 Julian moved to work with Archie Cochrane at the Medical Research Council Epidemiological Unit near Cardiff, Wales. From there he took up a practice in the mining village of Glyncorrwg in the Upper Afan Valley in 1961, where he met and later married Mary Thomas. She became a close partner personally, professionally and politically.

In 1971 his paper, The Inverse Care Law, was published in the Lancet. It describes how quality healthcare is inversely provided in relation to need – that those who would most benefit from care are least likely to receive it.

Julian explained how this mismatch becomes more evident with increased market involvement in health care delivery. This insight was following by a series of books and papers, including A New Kind of Doctor, The Political Economy of Health Care and Feasible Socialism, National Health Service Past, Present and Future.

Julian was very politically active, first with the Communist Party and later in the Labour Party, and he served on the local Glyncorrwg Urban District Council. He was a stalwart of the Social Health Association, eventually resigning from the organisation because of its rightward drift during the 1990s. He was also active in the Royal College of General Practitioners, serving on its Council and later becoming a Fellow of the College.

Julian retired from active clinical practice in 1987 but he continued to lecture internationally, and remained politically active in support of the NHS and socialist politics. As a person with a renaissance range of skills, he was also an active gardener and keen craftsman.

Julian died on 1st July 2018.

A presentation of the inverse care law 50 years after Julian articulated it can be found here.

Brian Gibbons