Public Health and Palliative Care An Historical Overview

1
Public Health and Palliative Care An Historical
Overview

• Allan Kellehear Libby Sallnow

2
What is Public Health?

• Improvements to health
• Reduce morbidity
• Reduce mortality
• System-wide approach
• Target population as a whole

3
History of Public Health

• Since Roman Greek Times
• Impetus during Industrial Revolution
• Increasing urbanisation
• Studies of mortality rates
• Link between disease poverty
• Link between pathological political
• Sanitary reform and legislation
• Germ Theory

4
The Rise of the New Public Health

• From infection to chronic diseases
• From an interest in disease to health
• Widening of interest into social determinants
  of health
• 1970s impetus
• Alma Ata (1978)
• Ottawa Charter (1986)

5
The Ottawa Charter for Health Promotion

• Build healthy public policy
• Create supportive environments
• Strengthen community action
• Develop personal skills
• Re-orient health services

6
Hospices, Poor Houses and the development of
Palliative Care

• Hospice hospital
• Pilgrims, displaced travelers, clergy
• Emphasis on spiritual care
• Hospitals refuse to admit incurables
• Gradual institutionalization of poor, disabled,
  ill, and dying
• Modern hospice continued these ideas of
  containment

7
The Emergence of Community Development

• The spread of health promotion ideas in modern
  health care
• Prevention, harm reduction, health education,
  service partnerships, community development,
  participatory approaches
• Gradual realization of the limits to the
  professions direct service provision
• Revision of the idea of the expert

8
Importance of Community Development in Palliative
Care

• Declining capacity of govts to supply services
• Limits to voluntarism
• The need for a seamless before, during and
  after-care approach
• Global cultural and economic limitations to a
  service-driven approach

9
Future Challenges

• 1. Conceptual and practice slippage
• 2. Lack of training and funding
• 3. Lack of public health recognition and
  involvement in dying, death loss