Palliative Care and Health Promotion

Abstract

Allan Kellehear has written a thoughtful and provocative book that is well organized, identifies key concepts and builds a model in a clear, systematic manner. The author challenges the reader to consider the potential that might emanate from a marriage of the principles of palliative care and health promotion, both endorsed by the World Health Organization. Dr. Kellehear suggests that palliative care and health promotion are powerful, reformist traditions with the potential to move life threatening illness, death and dying, grief and loss into the public arena as a universal human experience. The combined traditions might exert greater pressure to resist negative changes in health care and advocate for such things as policy change, additional government and private revenues as well as social and political support. Dr. Kellehear challenges the palliative care movement to revisit its commitment to holistic care and move beyond a distress-oriented approach with a major focus at the end of life to an early intervention system that promotes overall well-being in the setting of life-threatening illness. On the health promotion side, the system is challenged to bring death and dying into their scope of practice by bringing such principles as social participation, education, and public policy development to bear on the experience of living with life-threatening illness. He suggests that palliative care and the universal experience of dying need to move beyond the walls of the acute care setting into the public health arena. Interventions designed to educate, support, and build social relationships are offered as a means to decrease death avoidance and denial, while at the same time helping individuals to discover their own vision of value, health, and meaning in the setting of life-threatening illness. The author introduces the concept of collaboration between the palliative care and health promotion system at the same time he encourages teams to resist a tendency toward decreased interdisciplinary cooperation as support and resources shrink and we are asked to do “more with less.” His vision of mutual collaboration includes such creative ideas as staff exchanges, rich in opportunity for cross-fertilization of ideas. The chapters in this book are organized in a practical and useful way, introduced with an overview so that the reader gathers a sense of contents and purpose. The outlines of key concepts and the chapter subheadings allow the reader easy access to summarized theories, interventions, and strategies. It is successfully designed to be useful to a practitioner working alone or in a health care institution. Chapter 1 reviews core concepts, problems, and underdeveloped areas of each model. Chapter 2 combines theoretical explanation with practical suggestions and examples to illustrate the philosophy and potential of Dr. Kellehear's model. The third chapter presents varied theories of health education, process issues, and strategies involved in the delivery of health education programs, while chapter 4 focuses on patient, family and the larger community discussing topics such as death and human experience, social legacy and life beyond death. An overview of the support potential of varied community and institutional resources is provided in chapter 5. Chapter 6 discusses influences that shape individualized experience and reviews potential responses precipitated by life threatening illness in the spheres of emotional, family and work life, sex and recreational life, spiritual life and health care experience. The final chapter is an invitation for those interested in palliative care to venture into the arena of changing professional practices, public policy and attitudes. This is a book rich in ideas and possibilities for future direction. It extends the traditional boundaries of palliative care by integrating a public health viewpoint. Those of us who work in palliative care, hospice, and with people living with life-threatening illness will find some novel and interesting perspectives as well as a practical presentation of theory and interventions useful in clinical practice.