How to deliver equitable access to the best possible care

Healthcare services often fall short in their efforts to provide the best care possible to everyone they treat.

Sometimes this results from factors in individual health systems. In England, plans to remove national oversight of screening programmes risk undermining patient safety (doi:10.1136/bmj.q1117).1 And, across the UK, a cover up by the NHS and the government hid the truth for decades from tens of thousands of people infected by blood products or blood transfusions (doi:10.1136/bmj.q1139).2 “To save face and to save expense, there has been a hiding of much of the truth,” says Brian Langstaff, the retired High Court judge leading the infected blood inquiry. “The government repeatedly maintained that people received the best available treatment and that testing of blood donations began as soon as technology was available, and both claims were untrue.”

Some failures in healthcare concentrate in conditions that don’t receive the attention warranted by their impact on people’s wellbeing and quality of life. For instance, infertility affects one in six people in their lifetime, yet access to assisted reproductive technology remains inequitable globally (doi:10.1136/bmj-2023-077111).3

There are also cultural failings of healthcare as a collective enterprise, and these shortcomings more often affect women and children than they do men. Tessa Gooding (doi:10.1136/bmj.q1046) and Kirsten Furley (doi:10.1136/bmj.q1115) describe how women with pregnancy associated osteoporosis face misdiagnosis, delays to treatment, and additional psychological trauma associated with disbelief about their condition and dismissal of their pain.45

Yet it is heartening to note that we are already seeing movement on several fronts in tackling some of the health issues that affect women and children. Some of that progress is in the form of new policies and guidance for treatment. In the US, regulations have been issued expanding access to unpaid time off during pregnancy, for pregnancy termination, or after childbirth (doi:10.1136/bmj.q1050).6

In the UK, the National Institute for Health and Care Excellence has issued new guidance on identifying and managing familial and genetic risk of ovarian cancer (doi:10.1136/bmj.q807).7 And Kate King and colleagues provide an approach to assessing a child with suspected exposure to toxic household chemicals for those working in community settings (doi:10.1136/bmj-2023-077046).8

There are also advances in our understanding of how we can improve women’s health, maternity care, and outcomes for children. Kevin Cooper and his team show that, for women undergoing conservative surgery to treat endometriosis, postoperative prescription of a long acting progestogen could lower the risk of needing further surgery or second line medical treatments (doi:10.1136/bmj-2023-079006).9 Ahhyung Choi and colleagues find no association between maternal or infant antibiotic use and neurodevelopmental disorders, except for a modest association between exposure to antibiotics during infancy and epilepsy (doi:10.1136/bmj-2023-076885).10

Rachel Kearns and her team show that epidural analgesia during labour is linked to a reduction in severe maternal morbidity (doi:10.1136/bmj-2023-077190).11 The findings might “serve as a catalyst for initiatives aimed at improving equitable access to epidural analgesia during labour, potentially mitigating severe maternal morbidity and improving maternal health outcomes across diverse socioeconomic and ethnic backgrounds” (doi:10.1136/bmj.q1053).12

For all these issues, once the problem has been recognised, and a potential fix identified and shown to work, then efforts to implement that solution are the key to delivering equitable access. In the end, that is how healthcare services will be able to provide the best care possible to everyone they treat.