Racial classifications of human populations are politically and socially determined. There is no biological or genetic basis for these racial classifications. Health behaviors may be influenced by culture and poverty. Disparities in health outcomes, sometimes resulting in higher mortality rates for African-Americans appear to influence end of life decision-making attitudes and behaviors. To improve the quality of end of life care in African-American communities, health care professionals must better understand and work to eliminate disparities in health care, increase their own skills, knowledge and confidence in palliative and hospice care, and improve awareness of the benefits and values of hospice and palliative care in their patients and families.
- A report by Wolf et al. (2004) observed that if differences in age-adjusted mortality between African Americans and whites were eliminated between 1990 and 2000, then approximately 890,000 African American lives would have been saved.
- In 2003, the age-adjusted death rate for the black population was still 30% higher (1.3 times greater) than the white population. (Hayert et al. 2006)
- There are many reasons for this persistent gap, including differences in rates of health insurance, which are critical to access to health care services; a greater likelihood of advanced stages of cancer and HIV-AIDS in blacks vs. whites at time of presentation for medical care; higher rates of tobacco and alcohol use in blacks vs. whites; and generally lower rates of utilization of health promoting lifestyles and use of preventive measures.
- The effects of racism and poverty and the associated marginalization compromise the attainment of quality caring in these domains of end-of life care. The challenge for clinicians and policy makers is to overcome this ultimate of inequalities in health care.