Equity and Social Determinants in Palliative Care


Written by Dr Sara Javanparast, Research Fellow, RePaDD

Traditionally, palliative care had a focus on medical services primarily provided by health professionals to manage clinical symptoms in patients suffering from life limiting illnesses. In recent years, there has been a growing recognition of ‘public health model of palliative care’. A public health approach conceptualises palliative care in social and political terms rather than solely clinical care and highlights concepts around ‘control’, ‘health and death literacy’ and ‘informed consent’. This approach is well recognised by the World Health Organisation and other scholars in the field [1,2]. The common ground underpinning public health approach in palliative care is the social view of health including equity and inclusion, community engagement and empowerment, supportive policy environment, public advocacy and social determinants of health i.e. conditions in which people are born, grow, work, live, age and die [3].

Inequity in access to palliative care is reported in Australia. The 2018 National Palliative Care Strategy identified people who are Aboriginal and Torres Strait Islander, culturally and linguistically diverse particularly new migrants, LGBTIs, living in rural and remote areas, living with disability and experiencing homelessness and incarcerated as groups who face structural or system barriers to access to quality palliative care [4]. An exploratory analysis report commissioned by the Australian Government in 2018 has an extensive focus on equity and presents a wide range of social determinants that hinder access to palliative care amongst nine underserved population groups in Australia [5].

To achieve the goal of high-quality palliative care for ALL Australians who are affected by life-limiting illnesses, equity and social determinants lens is to be used in Australian palliative care policies and initiatives. Political context supporting of equity, accountability for equity, gathering equity knowledge and evidence to inform policy, meaningful collaboration and engagement in policy formulation and implementation are critical. Two key questions to be always asked are ‘who benefit from the policy?’ and ‘Does it decrease or increase inequity?’

More critical, is the enactment of equity and public health approach in palliative care and the extent to which equity visions and goals are translated into actual actions and investment opportunities. These actions are to improve equity knowledge and capacity building, accessing equity related data, engagement with community groups in the design and implementation of palliative care services, and vertical and horizontal collaborations with health and non-health sectors to address social determinants of health.

The last but not the least is the key role research and evaluation play to generate evidence and to assess short-, medium- and long-term equity impacts of policies and initiatives. Research on regulatory environment and organisational factors that drive the consideration of equity in palliative care provides valuable insights on system level challenges and enablers. To meet the needs of diverse Australian population, development, implementation and evaluation of innovation models of palliative care that are community-supported, culturally appropriate and sustainable are needed. This, of course, requires funding support and commitment from government and non-government organisations as well as research funding bodies.

Dr Sara Javanparast
Dr Sara Javanparast, Research Centre for Palliative Care, Death, and Dying

Research Centre for Palliative Care, Death and Dying with its extensive experience in the field, multidisciplinary team, and strong networks and relationships nationally and internationally is in an excellent position to lead equity-focused research to inform future palliative care policies and practices.


1. WHO. WHO Definition of Palliative Care. 2019.
2. Kellehear, A. Health-promoting palliative care. 1999, Melbourne: Oxford University Press.
3. Kellehear, A. Health-promoting palliative care: developing a social model for practice. Mortality, 1999. 4(1): p. 75-82.
4. Australian Government, National Palliative Care Strategy 2018, D.o. Health, Editor. 2018: Canberra.

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