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Public Health & End of Life Care Professor Allan Kellehear University of Bath The Australian Experience 1998 Est. of the PCU, School of Public Health, La Trobe University, Melb. To re-align a bedside care view of end of life care with all other existing and broader health service approaches Expanding both (1) the approach; and (2) the target populations Expand & align with other health services approaches FROM: direct service, clinical and institutional approaches TO: community, health promotion and partnership approaches Expand target population Go beyond illness esp cancer Include the aged Include the well and the ill Include carers and family Include schools, workplaces, business, unions and places of worship Conceptual & Practice Emphasis Prevention Harm reduction Health & death education Participatory relations Community development Service partnerships Ecological emphasis (not simply info and awareness) Some examples Poster campaigns Trivial Pursuit/World café nights Positive grieving art exhibition Annual emergencies services round table Public forum on death & loss Review of local policy and planning Annual short story competition Annual Peacetime Remembrance day Suicide aftermath pamphlets More examples Compassionate Watch programme School and workplace plans for death & loss Palliative care for beginners Compassionate book club Building/architecture prize for caring designs World spirituality show day Academic prizes for dissertations on DDL&C Animal companion remembrance day (involve vets) Beer mats, book marks, etc What did success look like? Greater participation in end of life care from all non-health sectors (eg A.C.T ‘garden of loss and reflection’) Increase in active partnerships between public health, aged care, bereavement care and palliative care services around DDL&C What did success look like? Greater recognition of the common experiences of DDLC from previously disconnected groups - cancer, HIV, aged, youth, children New local policy developments around DDLC from schools, councils, unions, workplaces What did success look like? A greater ‘sense’ of normalisation around DDLC (eg beer mats, book marks, etc) Increase in community involvement and experience in DDLC (eg Sydney home care, neighborhood watch, world café, memorial days, etc) Evidence - thine thorny chestnut Does not define the limits of action Tests and trials crucial to collection Check record of health promotion evidence HIV, dietary ed, drug & alc, bullying, neighborhood watch, anti-smoking, cancer ed Poor evidence? - palliative care, counseling, history of medicine, WMD, God… Need for evidence must not overtake equal need for perspective in policy & practice Further Reading A. Kellehear (2005) Compassionate Cities: Public health and end of life care. London, Routledge A. Kellehear & B. Young (2007) Resilient Communities. In B. Monroe & D. Oliviere (eds) Resilience in Palliative Care: Achievement in Adversity. Oxford, Oxford University Press.