When I joined RePaDD in May 2021, I was privileged to be offered funding for a kickstart project. To gain an insight into the palliative care context and drawing on my background in public health, equity, and access to health care, I started a project to review the broader palliative care policy context and the extent to which Australian policies, initiatives and evaluations take equity issues into consideration.
Policy analysis is not novel as a research approach. Scholars often use research methodologies and theoretical frameworks to analyse policy contents in relation to their area of interest, examine policy making processes, investigate the use of evidence in policy and to explore ideologies and driving forces behind policy priorities [1,2]. Policy analysis can be useful both retrospectively and prospectively, to understand past policy failures and successes and to plan for future policy implementation.
This study used an equity lens to analyse palliative care policies. Supportive palliative care policy is one of the key elements of health promoting and public health models of palliative care as defined by the World Health Organisation in 1990  and Kellehear in 1999 . Consideration of equity in palliative care policies provides the supportive environment that is required to achieve equity in access to palliative care at the service level, build workforce capacity to address inequity, and ensure equity-oriented palliative care initiatives, research, and evaluation.
Countries such as the UK, Canada and Scotland have done some work around equity impact assessment of palliative care policies, and engagement of experts in policy development processes to improve equity in palliative care. In Australia, national and state/territory palliative care policies and strategies have been developed and updated over time. However, palliative care policies and the extent to which they incorporate equity has not been extensively examined.
In this study, we reviewed 25 national and South Australian documents relating to palliative and end of life care including national policies and strategic plans, reports of government-funded initiatives, evaluation reports and needs assessment reports published over the last 5 years. These documents were publicly available from the government websites. We developed a coding framework to facilitate the review process. Qualitative content analysis was used to look at the frequencies of equity related terms and concepts, and then more detailed inductive and deductive thematic analysis was undertaken. To advance health policy analysis, the use of theoretical or conceptual frameworks is highly recommended . Our study was informed by the equity action framework that focuses on different dimensions of equity in policy formulation and implementation .
Although this study was limited in scope, time, and resources, it provided great insight into opportunities and gaps for an equity-focused palliative care policies and programs and changes over time. Future studies to include policies and programs from other jurisdictions and exploring stakeholder perspectives about policy making processes will assist to better understand palliative care policy context in Australia and driving forces that enable or constrain the consideration of equity in policy formulation process and its implementation.
Findings from this study have been submitted to a peer-review journal so stay tuned if you are interested to learn more about the study findings!
I greatly acknowledge Professor Jennifer Tieman for her support and guidance in this study and Dr Julia Anaf for her assistance in policy review and analysis.
- Townsend B, Friel S, Freeman T, Schram A, Strazdins L, Labonte R, Mackean T, Baum F. Advancing a health equity agenda across multiple policy domains: a qualitative policy analysis of social, trade and welfare policy. BMJ Open. 2020 Nov 6;10(11):e040180. doi: 10.1136/bmjopen-2020-040180.
- Kayesa NK, Shun-King K. The role of document analysis in health policy analysis studies in low and middle-income countries: Lessons for HPA researchers from a qualitative systematic review. Science Direct 2021. https://doi.org/10.1016/j.hpopen.2020.100024
- World Health Organization. WHO Definition of Palliative Care. 2019.
- Kellehear A: Health-promoting palliative care. Melbourne: Oxford University Press; 1999.
- Walt G, Shiffman J, Schneider H, Murray SF, Brugha R, Gilson L. ‘Doing’ health policy analysis: methodological and conceptual reflections and challenges. Health Policy Plan. 2008 Sep;23(5):308-17. doi: 10.1093/heapol/czn024.
- Freeman T, Javanparast S, Baum F, Ziersch A, Mackean T. A framework for regional primary health care to organise actions to address health inequities. Int J Public Health. 2018 Jun;63(5):567-575. doi: 10.1007/s00038-018-1083-9. Epub 2018 Feb 16. PMID: 29453557.