As a GP with an interest in palliative care my eye was drawn to your January 2017 briefing entitled ‘Dead unequal’.1 Referring to Graham Watt’s ‘Deep End’ work in Scotland, you highlighted the economic differences between rich and poor that contribute to differential morbidity and mortality.
Just as in life there are postcode inequalities, in death there are equally significant inequalities. As well as a postcode lottery, there is a diagnostic lottery. Much better to have cancer than a non-malignant condition. Support to help people with cancer at the end of life is better resources and is more accessible than other conditions.
Despite the Scottish End of Life Strategy 6 years ago highlighting this diagnostic iniquity as a key target, there is still so much to do. Indeed, the 2016 Scottish strategy again has this as the number one priority: to identify more people with non-malignant disease for end-of-life care. Charities, such as Marie Curie, have now doubled their non-malignant effort, but the differential is still great as care models are so cancer-centric. So, in the end, you would probably benefit more from the right diagnosis even more than the right postcode.
- © British Journal of General Practice 2017
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