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Abstract
Hart's original paper, introducing the inverse care law, was not a systematic review of evidence but a polemic describing the effect of market forces on health care. Then, as now, there was less evidence than one might expect. Although commercial solutions to health-care problems are still a threat to public-health equity, this is no longer the most important formulation of the inverse care law in the UK. As affluent groups accrue the public-health benefits of effective clinical interventions, the perverse effect of evidence-based medicine will be to increase inequalities in health. A major stumbling block to progress is the absence of routine and research data quantifying the added costs of clinical effectiveness in deprived areas. Until this work is done, deprived areas will continue to lose out in NHS resource distribution formulas.