Last month, an article titled Palliative Care In The Face Of Racism: A Call To Transform Clinical Practice, Research, Policy, And Leadership was published in Health Affairs as part of a Forefront series on Racism and Health. Written by field leaders and palliative care experts, the article calls attention to three areas in palliative care where strategies to mitigate the impact of structural and systemic racism are needed: clinical practice, research, and policy. As C-TAC strives to strengthen its focus on health equity by engaging in community-based partnerships, influencing clinical practice, and advocating for transformative policy, the insights and strategies provided in this article are of importance to our movement.Racial disparities in palliative care access and delivery are apparent. We recognize that such differences in how people in marginalized communities, especially people of color, experience health care stem from a long history of racist and discriminatory policy implementation that has negatively impacted the capability to be healthy for these groups[MG1] . As we continue to act on our commitment to advancing health equity, addressing structurally derived disparities in palliative care is essential to transforming healthcare into a system that works for all people living with serious illness.
The authors point out ways that clinical practice can be improved to make progress in delivering equitable palliative care and underscores the importance of ensuring palliative care providers are equipped to combat all forms of racism in their practice – first by being able to acknowledge it in the context of serious illness. If we are to truly create a healthcare system that ensures all people living with serious illness receive the quality care they want and need, regardless of their background, we must be willing and able to call out all forms of racism and discrimination where they persist. Our Core Principles for Care Models include equity as an essential component of any care model for serious illness, exemplifying the need for omnipresent recognition of racism’s impact on healthcare experiences.
“Care is inclusive – reducing inequities and disparities, and removing barriers to access and to quality care.”
C-TAC Core Principles for Care Models
This core principle calls for the implementation of strategies in care that remove barriers derived from generations of racist and discriminatory policy. The authors of the Health Affairs article outline strategies that align with this prioritization of equity throughout all levels of care delivery.
Efforts to advance equity across marginalized communities require strategies to maintain shared power to ensure that agency remains with the individuals being impacted. This can be accomplished with the delivery of care that recognizes community-trauma, cultural humility, and in partnership with community organizations. Community-based partnerships are an essential part of how our efforts to advance equity have progressed. For example, the Louisville, KY Pilot Project and our collaboration with the DC Coalition to Support Caregivers exemplify community-based action that elevates the voice of community members and is done with shared ownership between community members and health-related organizations.
Our community-based efforts have created opportunities to inform policy and improve the lives of people affected by serious illness. As the paradigm around health policy continues to shift toward a wider recognition of the social determinants of health (SDoH) and the structural drivers influencing them, especially among marginalized communities, the need to effectively assess their impact is increasingly prioritized. Several tools to screen for SDoH are referenced in the Health Affairs article and the authors provide insights on the policy needed to ensure support beyond screening. Citing the impact of financial toxicity on people in racially minoritized groups living with serious illness, the authors underscore the importance of continued attention to policies that decrease financial barriers to healthcare access, including those related to Medicaid expansion, reducing cost-sharing, investing in holistic care models, and strengthening the US safety net. C-TAC consistently advocates in policies for comprehensive screening of social risk factors and for programs that then address any identified needs.
The healthcare workforce is another area of opportunity for policymakers to address systemic racism in palliative care. Federal legislation, such as the Palliative Care and Hospice Education and Training Act (PCHETA) and the Resident Physicians Shortage Reduction Act, are pointed out in the article as a means to remove barriers to medical education and ameliorate the lack of diversity and representation in medicine. Our team of policy experts monitor and advocate for congressional actions around legislation related to serious illness, including these two bills. The Resident Physician Shortage Reduction Act was introduced in the current Senate in 2021. PCHETA was introduced in the House in 2017 and again 2019; and its key elements are included in the Build Back Better bill now before Congress.
A multilevel approach to addressing racism in healthcare is required to develop care models that effectively deliver equitable care. C-TAC members can benefit from exploring the insights and strategies outlined in the Health Affairs article to identify areas of intersection between their work and efforts to dismantle all forms of racism in palliative care and the entirety of the healthcare system.
We applaud the authors of this Health Affairs article and are encouraged by the many pieces of work published through the Forefront series on Health and Racism. Exchanging this sort of information with our individual and organizational spheres of enables us to better mobilize and organize efforts to transform healthcare into a system that works for every person living with serious illness.
To read the Health Affairs article click here and be sure to visit our website to learn more about how we are taking action to center health equity in all aspects of our work.
Written by: Andrew Lozano, C-TAC Communications Specialist
