As part of an ongoing series about equity oriented palliative care, Te Ārai Research Group recently published a paper looking at the disproportionate impact poverty and deprivation has on how, when and where we die. As the WHO Commission on Social Determinants of Health, & World Health Organization puts it:
“The poorest people have high levels of illness and premature mortality – but poor health is not confined to those who are worst off. At all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health” (2008).
Interestingly, the paper suggests that people experiencing poverty and deprivation are more likely to experience pain prior to the onset of a life-limiting condition (which is then likely to shape how pain is experienced at end of life). Evidence also suggests that people experiencing poverty can struggle to access sufficient pain medication due to health professional prejudice regarding drug-seeking behaviour, including in a palliative care context. The paper also raises the point that choice is often linked to opportunity and environment; therefore, someone who has limited opportunity to choose where they live, what they eat and how they make money may find it difficult to even begin making a choice about how they want to spend their end of life. This is a particularly interesting point given that the End of Life Choice Act 2019 comes into law on 7 November.
Director of Te Ārai Group Professor Merryn Gott hopes that the findings from this study “provides a good foundation for setting a future research direction for deprivation and palliative care – an issue made even more critical by the negative economic impacts of the Covid-19 pandemic upon those already experiencing poverty.” The paper provided some suggestions to help shape future research into the topic including:
- to better understand the end-of-life choices of people experiencing poverty and deprivation and how these can be realised;
- to examine attitudes towards Advance Care Planning for people experiencing poverty and deprivation and mechanisms to support conversations about end-of-life preferences where these are desired;
- to examine the role of institutional settings such as acute hospitals and Aged Residential Care facilities in supporting people who are experiencing poverty and deprivation at end of life – what experiences or innovations can they share?
- increase the representation of people who have lived experience of poverty and deprivation in the health and social care sector, particularly in fields in which they are traditionally under-represented, notably medicine;
- to empower people living in poverty and their organisations, and to involve them fully in the setting of targets, and in the design, implementation, monitoring and assessment of national strategies and programmes for poverty eradication and community-based development
Read the full paper ‘The impact of poverty and deprivation at the end of life: a critical review’.