Editor's Choice

Healthcare for the many

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j3122 (Published 29 June 2017) Cite this as: BMJ 2017;357:j3122
  1. Theodora Bloom, executive editor
  1. The BMJ
  1. tbloom{at}bmj.com

Do clever people live longer? Numerous studies linking IQ to health outcomes indicate that they might, and now a large longitudinal study reaches a similar conclusion (doi:10.1136/bmj.j2708). In their long term study Catherine Calvin and colleagues followed tens of thousands of people born in Scotland in 1936 and found that higher IQ at school age correlated with lower death rates from many causes, in women and men. The association was strongest for respiratory disease, coronary heart disease, and stroke. In their linked editorial (doi:10.1136/bmj.j2708) Daniel Falkstedt and Anton Lager point out that, given the strong link between these conditions and smoking, socioeconomic status may underpin much of the finding, but it remains to be seen whether this is the whole story.

WHO defines four main dimensions to the social determinants of health: economic, political, social, and cultural. Inequality in any of these can lead to social exclusion and health inequity. The 0.6% of the UK population that identifies as transgender (according to healthcare records) may experience just such exclusion and inequity. Clinicians’ feelings of inexperience in this area should prompt them to learn more, rather than avoiding the issue, says James Barrett (doi:10.1136/bmj.j2866). A group of transgender patients remind their healthcare providers that “how trans affirming you are has a direct impact on my health outcomes” (doi:10.1136/bmj.j2963). Sometimes patients will see their GP for referral to a specialist clinic for gender dysphoria, which should be done promptly and respectfully. But transgender people consult GPs and specialists about unrelated problems, and “a person’s change of gender role is rarely clinically relevant and does not need to be mentioned unless it is,” says Barrett.

All four of WHO’s dimensions affect the more than five million refugees from the war in Syria now living in neighbouring countries, including more than three million in Turkey. Providing healthcare for such a huge displaced population requires creativity. Abbreviated localised training for Syrian doctors and nurses in southern Turkey is one approach. It could provide healthcare workers who can break down language barriers and are familiar with diseases prevalent in refugee populations. Scaling up from a pilot study might yield hundreds of willing healthcare workers in the many Turkish cities with large refugee populations. But what will be the effect on refugees’ health and on the host country’s health services? And how will the host country’s professionals respond to their new colleagues? Despite such uncertainties, Vural Özdemir and colleagues argue (doi:10.1136/bmj.j2710) that we must explore all options, because huge numbers of refugees are likely to remain displaced for many years. Meeting the needs of society’s most vulnerable people will test the political will of all nations.

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