Press releases Saturday 26 June 2004

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(1) MASSIVE DISPARITIES IN MEDICAL SCHOOL ADMISSION BY SOCIAL CLASS

(2) TOBACCO CONTROL STYLE TACTICS NEEDED TO FIGHT OBESITY EPIDEMIC

(1) MASSIVE DISPARITIES IN MEDICAL SCHOOL ADMISSION BY SOCIAL CLASS

("Not a university type": focus group study of social class, ethnic, and sex differences in school pupils' perceptions about medical school)
http://bmj.com/cgi/content/full/328/7455/1541

(The standardised admission ratio for measuring widening participation in medical schools: analysis of UK medical school admissions by ethnicity, socioeconomic status, and sex)
http://bmj.com/cgi/content/full/328/7455/1545

(Editorial: Opening doors to medicine)
http://bmj.com/cgi/content/full/328/7455/1508

There are massive disparities in medical school admissions by social class, mainly because pupils from working class backgrounds see medical school as distant, unreal, and culturally alien, according to two studies in this week's BMJ.

These findings question the impact of the government's commitment to widening participation in higher education.

In the first study, researchers used data on UK medical school admissions from 1996 to 2000 to calculate the proportion of admissions from various subgroups of the population (standardised admission ratios).

They found that white and black pupils from the highest social class (social class I) were between 30 and 100 times more likely to gain a place at medical school than those from the poorest social classes (social classes IV and V).

Asian pupils seemed to compensate better for poor origins, but those from social class I were still 6-10 times more likely to gain a place than those from classes IV or V.

When they calculated the ratios by ethnicity and social class, they found a 600-fold difference between the most over-represented group (Asians from social class I) and the most under-represented group (blacks from social class IV).

Standardised admission ratios for males were lower than those for females, with around 60 percent of medical school places now going to women. These sex differences did not vary by social class, but they did vary by ethnicity, with Asians having similar ratios for men and women, but black and white men were significantly under-represented compared with women.

Equal representation at medical school across all social and ethnic subgroups is probably an inappropriate goal, but the findings of this study suggest that many able and ambitious pupils from poor backgrounds are not achieving their potential.

A second study looked at the reasons for these differences. Focus groups were conducted with 68 high ability pupils aged 14-16 years from different backgrounds in six secondary schools in London, ranging from inner city comprehensives to a selective private school. Discussions explored the pupils' perceptions and aspirations about medical school.

There were few differences by sex or ethnicity, but striking differences by socioeconomic status.

Pupils from lower socioeconomic groups held stereotyped and superficial perceptions of doctors, saw medical school as culturally alien and geared towards "posh" students. They greatly underestimated their own chances of gaining a place and staying the course.

Whilst they saw medicine as having potential financial rewards in the distant future, they perceived prohibitive personal risk in the more immediate term. They viewed medical school as high-pressure and boring ? a necessary sacrifice for the chance of affluence later in life.

In contrast, pupils from affluent backgrounds viewed medicine as one of a menu of challenging career options with intrinsic rewards such as personal fulfilment and achievement.

All pupils interviewed had some concerns about the costs of study, but only those from poor backgrounds saw costs as constraining their choices.

The authors conclude that policies to widen participation in medical education must go beyond "topping up knowledge" and address the complex social and cultural environment within which individual life choices are embedded.

If the NHS is to understand and serve the community, the make-up of its workforce should reflect that community, write experts in an accompanying editorial.

Although the relationship between top up fees and widening participation is problematic, the need for widening participation in medicine is essential and is one that we must embrace. "We have much to gain from taking part and a wealth of wasted potential if we do not," they conclude.

Contacts:

Papers: Professor Trisha Greenhalgh, Department of Primary Health Care, University College London, UK
Email: p.greenhalgh@pcps.ucl.ac.uk
or
Judith Moore, Media Relations Manager, University College London, UK

Editorial: Sean Hilton, Professor of Primary Care, St George's Hospital Medical School, London, UK
Email: shilton@sghms.ac.uk

(2) TOBACCO CONTROL STYLE TACTICS NEEDED TO FIGHT OBESITY EPIDEMIC

(Tobacco and obesity epidemics: not so different after all?)
http://bmj.com/cgi/content/full/328/7455/1558

Global strategies similar to those used against the tobacco industry are needed to tackle the obesity epidemic, argue researchers in this week's BMJ.

Diets across the globe are being shaped by a concentrated and global food industry that is fiercely resisting public health attempts to promote healthy eating, write the authors.

The food industry tactics are similar to those used by the tobacco industry ? supplying misinformation, use of supposedly conflicting evidence, and hiding negative data.

Firstly, there is the half true contention that there is no such thing as an unhealthy food, only unhealthy diets. Secondly, the industry contends that the problem is not the excessive diet but the reduction in physical activity.

Thirdly, the industry uses a smoke screen of apparently conflicting scientific data about sugars and different types of fat. "Although scientific knowledge is still incomplete, it is less divided than the industry would have the public believe," say the authors.

Advocates for tobacco control have used a variety of tactics in their campaign that could have relevance for the fight against unhealthy diets, suggest the authors.

"It will be much more difficult to establish internationally binding instruments or conventions like those achieved in tobacco control. Nevertheless, their importance in bringing about changes in national behaviour should not be under-rated," they say.

Potential international standards might cover issues such as marketing restrictions for unhealthy food products, restrictions on the advertising and availability of unhealthy products in schools, or potential price or tax measures to reduce the demand for unhealthy products.

"The public attention generated by the discussion and formulation of such standards may set general standards for corporate conduct without being potentially unacceptable and even generate enough political capital for national legislation," they conclude.

Contact:

Mickey Chopra, Senior Lecturer, School of Public Health, University of the Western Cape, South Africa
Email: mchopra@uwc.ac.za

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