Public Health Perspective on End of Life Care

There is an urgent need for public health
to adopt dying and palliative care as a major public health priority, for
instance in national health strategies, and for palliative care to adopt a
public health perspective to improve circumstances of dying at a population
level.

Worldwide, more than 50 million people die each year
and it is estimated on the basis of the conditions leading to death that up to
60% of them could benefit from some form of palliative care.  It is a public health challenge to ensure that
these people can access good palliative or end-of-life care.  Pursuing good population health essentially
also implies striving for a 'good enough death' and a good quality of care at
the end of life.  Safeguarding a good
quality of the end of life for patient populations for whom it is appropriate
requires a public health approach. 

In
most developed countries ageing populations that increasingly die from chronic
diseases after a prolonged -often degenerative- dying trajectory make up the
public health challenges for palliative care. The very large baby boom
generation will soon reach old age and can be expected to pose strong demands
regarding the circumstances and care at their end of life. Only by applying a
public health approach to palliative care (instead of individual patient
perspectives), can societies successfully help to organize and plan end-of-life
care in accordance with these aspirations.

A
Public Health Perspective on End of Life Care (Oxford University Press) presents a synthesis and
overview of relevant research and empirical data on the end of life that can
bear a basis for a more systematic 'public health of the end of life'. The book
focuses on population health, rather than clinical interventions or other
aspects of individual health, and discusses studies using different
methodologies (not only epidemiological research). The focus is on the quality
of the end-of-life of populations, in particular from social sciences,
environmental sciences, and humanities perspectives.

PART I:
INTRODUCTION

1: J Cohen & L
Deliens: Applying a public health perspective in end-of-life care

PART II: CLINICAL AND SOCIAL CONTEXT OF
DEATH AND DYING

2: ST Tang &
C-H Chen: Place of death and end-of-life care

3: I Higginson:
Circumstances of death and dying

4: A Van der Heide
& J Rietjens: End-of-life decisions

5: K Fassbender:
Economic and health related consequences of individuals caring for terminally
ill cancer patients in Canada

PART III: END-OF-LIFE CARE: PROVISION,
ACCESS, AND CHARACTERISTICS

6: Wentlandt K
& C Zimmerman: Aggressive treatment and palliative care at the end of life

7: G Grande:
Access to palliative care

8: L Emanuel:
Communication between patient and caregiver

PART IV: END-OF-LIFE CARE SETTINGS

9: L Van den
Block: Palliative care in primary care

10: JT Van der
Steen, MR Helton, PD Sloane & MW Ribbe: Palliative care in institutional
long-term care settings

11: AS Kelley, DJ
Fischberg & RS Morrison: Palliative care in hospitals

PART V: INEQUALITIES AT THE END OF LIFE:
UNDERSERVED GROUPS

12: J
Addington-Hall & K Hunt: Non-cancer patients

13: K Brazil:
Palliative care for the older adult

14: K Hexem &
K Feudtner: A public health framework for pediatric palliative and hospice care

15: I
Tuffrey-Wijne, A Wagemans & L Curfs: End-of-life care for patients with
intellectual disabilities

16: D Wilson &
D Mohankumar: End-of-life care for people who live in rural or remote areas
versus those who live in urban areas

17: J Koffman:
Social inequalities at the end of life

PART VI: END-OF-LIFE CARE POLICIES

18: X
Gómez-Batiste, J Espinosa, MP Gonzalez Olmedo, M Martínez-Muñoz, C Lasmarias, A
Novellas, E Beas, J Porta, J Trelis, C Calle & J Stjernsward: Design,
implementation, and evaluation of palliative care programs and services with a
public health who perspective

19: J Downing
& R Harding: Public health policy regarding end-of-life care in sub-Saharan
Africa

20: D Clark:
Palliative care in the global context: understanding policies to support
end-of-life care

21: A Kellehear:
The importance of family carers in end-of-life care: a public health approach

PART VII: Conclusion

22: L Deliens
& J Cohen: Conclusions