Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

A CALL TO ACTION: “Equity is a culture” - assessing perceptions of health (in)equity, the current landscape of health services for the development and the implementation of a Cancer Equity Framework. (#353)

Tilini Gunatillake 1 , Beverley Woon 1 2 , Vijaya Joshi 1 , Kalinda Griffiths 1 3 , Stephanie Best 1 2 , Jo Cockwill 1 , Jennifer Philip 1 4 5
  1. VCCC Alliance, Parkville, VICTORIA, Australia
  2. Peter MacCallum Cancer Centre, Parkville
  3. Flinders University, Poche SA + NT, Darwin
  4. Palliative Care, St Vincent's Hospital Melbourne, VICTORIA
  5. St Vincent's Hospital Melbourne, VICTORIA

Aim

To explore the current landscape and perceptions of health (in)equity across a cancer alliance health setting to enable successful development and implementation of a Cancer Equity Framework (CEF).

Methods

Thirty key stakeholders across metropolitan and regional Victoria were invited to partake in semi-structured interviews exploring: 1) perceptions of health (in)equity 2) enablers and barriers of implementing a CEF within hospitals. Participants’ roles included executive, middle-management, policy development, Aboriginal health and diversity managers and clinicians.

Results

Following qualitative analysis, four major themes were identified: 

1) ‘Responsibility’: All participants acknowledged the existence and impact of health inequity and majority believed it was the responsibility of health services to address inequities in service delivery.  

2) ‘Landscape’: Persistence of health inequity was attributed to several factors including ignorance, stigma, unconscious bias, lack of safety, lack of diversity within top tier leadership, and lack of frameworks to address health inequity.

3) ‘Culture change’: Overarching the well-established enablers and barriers for change (e.g., education, funding, and leadership buy-in) was the important need for a ‘culture change’ within the health services. This would allow consistent prioritisation of health equity at all levels, and overcome challenges consistently highlighted by participants.

4) ‘Business as usual’: successful framework implementation requires both the inclusion of change interventions in 'everyday core business' and the development of metrics to effectively measure their impact on health equity. 

Conclusions

This study provides important insights into the perceptions and impact of health (in)equity across health services. The importance of addressing inequities in service delivery through the development of a CEF was emphatic however there was recognition of well-established barriers that could prevent sustainable change. There is a clear call to action for health service leaders and workers to address these ongoing/persistent inequities by integrating equity into their core business and in turn start to promote a ‘culture change’ for prioritising equity across cancer care.