Values and principles of health promotion for end-of-life

Steve Conway

The shameful death

• Social change brought the professionalisation of death

• Also brought the decline of social support and collective responsibility

• General failure to make a good and well organised death possible

The shameful death

"It is an indictment of society that too many people are left to fade away, unable to make ends meet and lonely on the fringes of our communities. “

Liberal Democrat MP Paul Burstow (member of the Commons health committee)

The shameful death• ‘Resident may have been dead for six days,’ November 2009;

• ‘Elderly tenant lay dead for days,’ September 2009;

• ‘Woman, 85, lay dead in her flat for FIVE YEARS before anyone noticed,’ July 2009

Source: (Dead and Undiscovered http://deadandundiscovered.com/).

• ‘William Hunter lain dead in his Ross-shire flat for around 14 months’, Feb 2009

• ‘Helena Pugh lay dead in Bristol for an estimated 18 months’

‘Isabella Purves's body was found in her Edinburgh flat where it is believed she had lain for five years’

• ‘...other deaths of people undiscovered for between five weeks and two years - in Cardiff, Bury, Brighton, Lancashire and east London. Each case was revealed within the past 12 months. Few of those people made the national news.’

Source: Face the Facts: A Death Unnoticed, BBC Radio 4, 27 July, 2009.

The shameful death• The idea that one’s neighbour could be a stranger

would have been unthinkable in traditional societies.

• Yet this is often the reality of modern social orders based upon individualism, consumption and service cultures.

• The ‘freedoms’ of anonymity and the boundaries of a private self and life severely inhibit the creation and fostering of community

Community

What is community?

The shameful death• Lack of social and spiritual support

• Privileging of cancer care

• ‘Disadvantaged dying’

• Historical lack of community involvement

• Emphasis upon symptom control and individual psychological care

• Neglect of care issues away from the bedside

The reform model

• Consists of improving existing professional services

• ‘Raising awareness’ amongst professionals and the public alike – social marketing

The reorientation model• Health promotion approach geared towards social

change • draws upon synthesis of new public health and the

core principles of palliative care, as set out by its pioneers

• Works at the levels of environment, community, education and policy

• About bearing witness and face-to-face contact• Emphasis upon social and spiritual support • Empowerment: services to be reoriented to the

community

Values and principles of reorientation model

• Social justice and democracy• A good death• Overall focus of approaches to enhance and

strengthen community engagement and support

Neighbourhood Network in Palliative Care, Kerala, India

St Christopher's School’s project