Palliative care and end-of-life care has come a long way in the past twenty years. We have seen a number of strategic shifts in thinking about what PC is, what it should deliver and to whom. From being a service historically designed to address the needs of advanced cancer patients in the last days or weeks of life, research evidence and best practice models of PC now suggest that there is an urgent need for early intervention across a spectrum of chronic life-threatening illnesses and that PC has the potential to contribute to the quality of dying and the quality of life in advanced illness and at the end of life. There is also an increasing awareness that in order to improve the circumstances surrounding dying we require public health approaches next to health service approaches. These need to look at aspects of health beyond those within the mandate of healthcare services and also engage the different actors other than health professionals involved in palliative care and end-of-life care.
Palliative care began and continues to emphasise tertiary level interventions that emphasise inpatient facilities and specialist service providers. A primary health care approach is in evidence in some parts of the world with extensive use of general practitioners or community nurses providing initial assessment and sharing responsibilities with specialists in providing adequate interventions. A population health approach to palliative care is the most under-developed at this stage of palliative care service development. Yet, it is the approach that has the most potential to enhance the quality of life and sense of well being to the widest number of people in sickness and in health, in dying and in loss, and in all caring experiences toward one another. Interest in a public health approach to palliative care has been growing worldwide and this is evidenced in the international literature in the field, and in the establishment of conferences and a professional association (IAPHPC).
Public health approaches involves:
- strategies for the planning and development of appropriate service provision in palliative care;
- strategies for the monitoring of the needs assessment, quality of palliative care and social equity on population level;
- strategies for community involvement in health and wellbeing, including multiple experiences of death, dying, loss and care. This 'new' public health in palliative care is also known as health promoting palliative care;
organise public health actions in palliative care and evaluate the outcomes of it.