Palliative care for older people - World Health Organization ...

5National awareness“You matter because you are you, and youmatter to the end of your life.We will do all we can not only to help youdie peacefully, but also to live until you die.”Cicely Saunders (1)Founder of the modern hospice movementHealth promotion and public awareness have a keyrole to play in end-of-life care for older people (2).Health promotion and palliative care are frequentlythought to be unrelated concepts (3) but havemuch in common. Health promotion aims to buildpublic policies that sustain health, create supportiveenvironments, strengthen community action,develop personal skills and reorient health services,especially toward partnerships with the community.This approach enhances collaboration andparticipatory relationships; recognizes the socialcharacter of health, illness and dying; emphasizeseducation and information-sharing; and requiresthe understanding that all health policies must bedesigned for ill and well individuals and that healthis everyone’s responsibility. These principles underpinthe WHO public health strategy to integratepalliative care into existing health care systems andat all levels throughout the society.Palliative care health promotion activities involveeducational programmes in partnerships withcommunities to foster understanding of their healthcare needs, the acceptance of loss and dying andencouraging personal and social support at theend of life. Other aspects include recognizing thesocial character at the core of care and loss; andreorienting health services (such as palliative care,care for older people or bereavement care) towardscommunity partnerships (Box 5.1) (4). Communityprogrammes in palliative care can improve directservice provision by enhancing learning initiatives;this is done in many regions of Australia as partof its strategy for health-promoting palliative care(5). The primary objective of the End of Life CareStrategy in England is to raise national awareness aspart of its whole-system approach (see Section 4).Box 5.1. A state-wide effort to improve end-of-life care in HawaiiKokua Mau (Hawaiian for continuous care) is a state-wide campaign based on a community–state partnershipto improve awareness of end-of-life issues and services in Honolulu, Hawaii (6). Education in end-of-life issueswas developed, and 17 000 people attended educational events including: 95 policy-makers; 458 individualsfrom 33 faith-based groups who attended training in care of people who are dying and bereaved; 922 healthcare and social service providers; 347 individuals in academic training programmes; and more than 15 000people reached through the public speakers bureau. In addition, an estimated 847 000 individuals were reachedthrough newspaper stories, radio and television shows.The rates of completing advance directives increased, and the proportion of people supporting physicianassistedsuicide decreased. The use of hospices increased.Source: Braun et al. (7).19