1) Given that a cure for death has yet to be found, death remains an inevitability for everyone. Despite the majority of healthcare dollars being spent in the last years of life, there remains wide variation in the quality of palliative care received by those with serious illnesses and/or normal progression of aging. The focus on quality of life is tantamount in palliative care and like all health care outcomes, quality of life (and death) is not an objective measure, rather it is subject to multiple structural determinants.
Income and education are two structural stratifiers that may influence an individual's access to appropriate and comprehensive palliative care services, including pain and symptom management, social and psychological support, and advance care planning. Palliative care should be integrated into routine medical care for those living with serious illness such as cancer, as well as those living with chronic disease and complex morbidity. Comprehensive palliative care services is already limited in most health care settings. Since disparities in even basic health care exists for those with lower incomes and education levels, these same disparities will be exacerbated for those in need of palliative care. Palliative care research is a burgeoning field and more research and attention is being paid to the fact that aggressive medical care isn't necessarily better care. But for those with limited education levels, it may be easier to be caught up in the medical industrial complex and not advocate/demand an individualized plan of care for themselves or loved ones.
An intermediary determinant of health disparities in palliative care is the social-environmental and psychosocial circumstances that may exist for different individuals/families. Being sick is stressful for both the individual and their families and can cause significant strain on relationships and psychosocial well-being. The ability or inability to cope and adapt to morbidity will vary and may be dependent or independent of SES.
2) Socioeconomic factors earlier in the life course can also affect palliative care access and outcomes. Caregiving needs can be extensive with serious illness and are often dependent on housing, family structure, and financial resources. Caregiving for aging parents tends to fall on their children so those with traditional family structures or strong family ties may be able to rely on family caregivers more than those without that earlier foundation. Caregiving tends to fall on family members but can be fulfilled by strong social and neighborhood ties as well. Safe and accessible housing is needed for those with physical needs or disabilities, and hospice services are almost always provided in the home (there are few inpatient residential hospices) so an actual home is necessarily to access hospice care in most cases.