The inverse response law: Theory and relevance to the aftermath of disasters

The inverse care law is principally concerned with the effect of market forces on health care which create inequities in access to health services through privileging individuals who possess the forms of social capital that are valued within health care settings. The fields of disaster risk reduction need to consider the ways in which inequities, driven by economic and social policy as well as institutional decision-making, create vulnerabilities prior to a disaster, which are then magnified post disaster through entrenched structural differences in access to resources.

Drawing on key principles within the inverse care law, the inverse response law refers to the idea that people in lower socio-economic groups are more likely to be impacted and to experience disparities in service provision during the disaster response and recovery phase. In a market model of recovery, vulnerable groups struggle to compete for necessary services creating inequities in adaptive capacity as well as in social and wellbeing outcomes over time. Both the inverse care law and the inverse response law focus on the structural organisation of services at a macro level.

In this article, the inverse care law is outlined, its application to medical treatment following disasters considered and an explanation of the inverse response law provided. Case studies from recent disasters, in London, New Zealand, Puerto Rico and Mexico City are examined in order to illustrate themes at work relating to the inverse response law.