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