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-W. Bradford Wilcox
Associate Professor of Sociology, University of Virginia
As public-health officials grow increasingly worried over runaway medical costs, they pin ever more hope on timely preventive care as a brake on such costs. However, in a new study conducted at the Universities of Stirling and Dundee in the United Kingdom, researchers have learned that married men and women are significantly more likely to receive this much-needed care than are their unmarried peers.
The evidence that marriage confers an advantage in preventive medical care emerges in a broader survey of empirical data. To identify the characteristics of those who regularly receive general and preventive health checks, the Stirling and Dundee scholars pored over a very large set of databases and earlier analyses, finally focusing on 39 analyses (13 from North America, 24 from Europe, one from Taiwan, and one from Israel).
These analyses highlight a number of important predictors of regular preventive medical care. The researchers emphasize marital status as one of these predictors: “An individual’s marital status,” they remark, “was found to affect attendance rates, with non-attenders more likely to be single.” In explaining this pattern, the researchers note an earlier study concluding that “the decision to attend a [medical] screening is often made by the [marital] partner, with this initiation behaviour prevalent across a number of socio-demographic factors.” Marital status makes a difference for preventive care among both men and women; however, the data indicate that “being married appears to have a stronger effect on [preventive medical care] uptake in men.”
Disproportionately unmarried, the men and women who fail to receive anticipatory medical care tend to manifest a number of medical disadvantages. The Stirling and Dundee researchers note that, compared to those who receive regular preventive medical care, those who do not receive such care suffer from “a greater proportion of cardiovascular risk factors.” More generally, the researchers discern a pattern of “unhealthy lifestyle factors” among those who do not receive regular preventive medical care. Compared to those who receive regular preventive medical care, men and women who do not receive such care manifest “odds ratios higher for smokers, heavy drinkers, and those with unhealthy diets and the obese.”
The Stirling and Dundee researchers believe their findings confirm what they call the “inverse care law”—a law predicting that “the availability of good medical care . . . [will] vary inversely with the need for the population served.” This law troubles the researchers as they contemplate its implications at a time when measures fostering “general and preventive health checks are a key feature of contemporary policies” for containing medical costs through “early identification of risk factors for conditions such as heart disease, diabetes and stroke.”
Public-health officials may believe that “anticipatory care . . . [is] a means by which the increasing demands of an aging population, growing numbers of people living with long term conditions, and persisting inequalities in health may be addressed.” But the Stirling and Dundee researchers fear that because of the “inverse care law,” those relying on preventive or anticipatory medical care, “like [those relying on] other contemporary public health policies, risk exacerbating rather than narrowing health inequalities.” This new study makes it clear that the growing number of unmarried men and women are particularly likely to find themselves on the wrong side of the inequities generated by the “inverse care law.”
(Ruth Dryden et al., “What Do We Know About Who Does and Does Not Attend General Health Checks? Findings from a Narrative Scoping Review,” BMC Public Health 12 : 723.)