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Inequities exist in our society in a variety of forms. Palliative care is widely recognized as a public health concern, with both structural and social determinants of health inequalities affecting health for disadvantaged populations across both high- and low-income countries[1].
Racial and ethnic equity would imply that people of all races and ethnicities in society receive equal treatment, access, opportunity, and achievement[2]. The first step to achieving racial and ethnic equity is identifying the core causes of the disparities.
A review of hospice-patient care in the United Kingdom, Australia, New Zealand, and Canada found that older people (equal to or over the age of 85), ethnic minorities, and people living in rural areas had unequal access to palliative care[3]. These findings confirm the reality that palliative care service provision only reaches a minority of those who need palliative care. Furthermore, these inequities of access significantly affect those from diverse cultural backgrounds.
Semlali et al. conducted research that supports the need for cross-cultural concerns training for end-of-life care practitioners[4]. The focus groups stressed the importance of incorporating such material into existing training options and ensuring that basic knowledge is developed throughout undergraduate study, even before individuals choose to specialize in end-of-life-related professions. In postgraduate and continuing education, collaborative learning among different professions is encouraged.
In order to address race and ethnicity in palliative care, there needs to be changes made. One of the first steps toward equity in access is identifying and valuing existing community strengths. The next stage is to work together to identify and provide the types of support that members of various groups would like to complement their strengths[5]. Structural racism should be addressed, which includes calling it out by name and identifying the form it takes. Furthermore, the role structural racism has on individuals feeling a lack of trust must be explored to determine the impact it may have on inequities. These changes are necessary, but not sufficient. There needs to be an ongoing discussion on race and racism in the care of palliative patients and families, along with creating and strengthening supportive environments.
[1] Mills J, Abel J, Kellehear A, Patel M. Access to palliative care: the primacy of public health partnerships and community participation. The Lancet Public Health. 2021;6(11): https://doi.org/10.1016/S2468-2667(21)00213-9
[2] Quest T, Periyakoil V, Quill T, Casarett D. Racial Equity in Palliative Care. Journal of Pain and Symptom Management. 2021;61(3):435-437. https://doi.org/10.1016/j.jpainsymman.2020.12.005
[3] Mills J, Abel J, Kellehear A, Patel M. Access to palliative care: the primacy of public health partnerships and community participation. The Lancet Public Health. 2021;6(11): https://doi.org/10.1016/S2468-2667(21)00213-9
[4] Semlali, I., Tamches, E., Singy, P., & Weber, O. Introducing cross-cultural education in palliative care: focus groups with experts on practical strategies. BMC palliative care. (2020);19(1), 171. https://doi.org/10.1186/s12904-020-00678-y
[5] Mills J, Abel J, Kellehear A, Patel M. Access to palliative care: the primacy of public health partnerships and community participation. The Lancet Public Health. 2021;6(11): https://doi.org/10.1016/S2468-2667(21)00213-9
