Volume 24, Number 2: February 2023
A Public Health Challenge: Broaden the medicalized view of death
Oxford Textbook of Public Health Palliative Care
Julian Abel, Allan Kellehear (eds)
Oxford University Press, 2022
Hardcover, 336 pp
ISBN: 978-0198862994
MSRP: $125 USD, £95
Also available: eBook
By Frank Brennan, MD
While the death of each person is unique, the experience of death is universal. The pandemic reminded humanity of the highly personal, familial, and societal dimensions of illness, death, and grief. The universality of death inevitably leads us from the bedside of the individual to the whole of society. The discipline that intensely thinks and innovates in this perspective is public health palliative care. The term encompasses “a variety of approaches that involve working with communities to improve people’s experience of death, dying, and bereavement.”1 In many ways, public health palliative care stands as a constant reminder to the discipline of palliative care of the importance of this broad perspective. Of how villages, communities, towns, and cities view illness and death. Of the delicate interplay of the particular with the general. Of the role of culture, economics, language, education, and religious faith in these experiences.
The Oxford Textbooks in Palliative Medicine series is to be congratulated on publishing the inaugural Textbook of Public Health Palliative Care. The editors and authors are the founders and international leaders in this field. Methodically, they set the scene by arguing the case for the discipline, outlining the theoretical foundation of the concept, and describing basic practice and approaches.
Theoretically and practically, the synergy between palliative care and public health is examined. Multiple ideas and innovations flow from this alliance: a whole-population approach; community development, including the concept of compassionate communities; the development of end-of-life literacy in society; early interventions; the recognition of the social determinants of health; health services design in all locations, including low- and middle-income settings; and the importance of the equitable access to palliative care, including those who suffer structural vulnerability, such as indigenous peoples, people who are homeless, older persons, refugees, prisoners, and those who are part of LGBTQ+ communities.
One of the themes of this textbook is that, over time, palliative care has come to be largely practiced by trained health care professionals and that this may be at the expense of the broader lay population. The authors point out that, historically, serious illness and death occurred at home with families highly involved. The editors propose a shift from a medicalized model of care to a communitarian, public health model that “requires seeing communities as equal partners in a social and medical model.” The extent to which palliative care is or has accommodated this perspective varies considerably throughout the world. One of the book’s striking examples of public health being embedded in palliative care is the Institute of Palliative Medicine in Kerala, India, where there is strong community participation.
From its inception, palliative care stood counterculturally to the paradigm of remarkable advances in medicine and pained uncertainties, felt by many health practitioners, of how to care for patients who were incurable. Public health palliative care whispers in the ear of palliative care a broader message: given its universal nature, illness, mortality, and bereavement have simultaneously personal and societal dimensions. That message is also a challenge.
This book is a valuable addition to the literature on palliative care. It provides a clear and systematic introduction to these concepts and, hopefully, will broaden the discussion about the experience of illness, death, and grief in society.
Reference
Archibald D, Patterson R, Haraldsdottir E, et al. Mapping the Progress and Impacts of Public Health Approaches to Palliative Care: A scoping review protocol. BMJ Open 2016; 6:e012058. DOI: 10.1136/bmjopen-2016-012058
Editor’s note: IAHPC Senior Director of Advocacy and Partnerships Katherine Pettus co-authored the section on “Health Policy: The Imperative of Palliative Care Advocacy” with Dr. Pati Dzotsenidze, from the Republic of Georgia. Contact Katherine if you want to receive a PDF of the chapter.
Dr. Frank Brennan is a palliative care physician, past president of the Australian and New Zealand Society of Palliative Medicine, a senior lecturer in the Faculty of Medicine, University of New South Wales, and a lawyer.
New on the Shelf
Dignity in Care: The Human Side of Medicine by Harvey Max Chochinov. Oxford University Press, 2022. Publisher’s description: Draws from lessons and insights gained by conducting interviews with over 20 senior health care professionals. Provides clinical examples demonstrating a dignity model of optimal therapeutic effectiveness.
Global Perspectives in Cancer Care: Religion, Spirituality, and Cultural Diversity in Health and Healing by Michael Silbermann and Ann Berger. Oxford University Press, 2022. Publisher’s description: Widens understanding of the cultural nuances that determine how to deliver cancer care. Spans the cultural and technical divide between the world of clinical care and that of policy.
Comprehensive Guide Supportive and Palliative Care for Patients with Cancer, 4th ed., by Janet L. Abrahm, Molly E. Collins, and Bethany-Rose Daubman. Johns Hopkins University Press, 2022. Publisher’s description: Leading palliative care experts illustrate how you can improve both communication with cancer patients and their quality of life.
Dignity for Deeply Forgetful People: How Caregivers Can Meet the Challenges of Alzheimer's Disease by Stephen G. Post. Johns Hopkins University Press, 2022. Publisher’s description: A book that combines new ethics guidelines and key practical topics with an innovative program on how to communicate and connect with people with Alzheimer's.
Note for authors and publishers
If you wish to have your book reviewed, please contact Newsletter Editor Alison Ramsey.
NB: Review copies become the property of IAHPC and are not returned to the author. Only books related to palliative care that have been approved and have an ISBN will be reviewed.