“A young man goes to the doctor complaining of severe pain in his back. He expects and trusts that a medical expert, his physician, will assess his pain and prescribe the appropriate treatment to reduce his suffering. After all, a primary goal of health care is to reduce pain and suffering. Whether he receives the standard of care that he expects, however, is likely contingent on his race/ethnicity. But research suggests that if he is black, then his pain will likely be underestimated and undertreated compared with if he is white”.
For those of us working to improve our health systems, current events should prompt critical questions about our own practices and beliefs. What role do our racial biases play in overall health outcomes for racial minorities across the healthcare system? How do they relate to other biases; rich versus poor, male versus female, young versus old, employed versus unemployed, thin versus obese, etc.?
Australians tend to overlook our own racial biases. We know there is a strong link between chronic pain and lower socio-economic status. We know Aboriginal and Torres Strait Islander communities are at higher risk of living with painful conditions. This may be related to difficulty accessing appropriate care for pain management, financial pressures, lack of education and low health literacy, or living in a rural or remote area. It may also reflect lower expectations or other biases.
Given the prevalence and costs of pain, the level of trust that the public places in health professionals and the fact that they see thousands of patients throughout their careers, there is a public health need for interventions that reduce disparities and improve pain care.
The National Strategic Action Plan for Pain Management recommends the establishment of clinical pain liaison roles that utilise the skills of GPs, nurses or allied health practitioners to identify chronic pain early in primary care, support education of local practitioners and smooth transitions and communications across services especially in priority population groups.
Inequality and discrimination should not be barriers to health care, but they are. We can’t always see our biases, but they are there. At Painaustralia, we are committed to ensuring people experiencing pain have access to the best possible treatment, regardless of their circumstances. We still have a long way to go to realise this goal.
What are your views, and suggestions on this complex issue? Please do leave a comment or write to us, we are very interested in your input.