Abstract
BackgroundQuality end-of-life care has emerged as an important concept in industrialized countries.DiscussionWe argue quality end-of-life care should be seen as a global public health and health systems problem. It is a global problem because 85 % of the 56 million deaths worldwide that occur annually are in developing countries. It is a public health problem because of the number of people it affects, directly and indirectly, in terms of the well being of loved ones, and the large-scale, population based nature of some possible interventions. It is a health systems problem because one of its main features is the need for better information on quality end-of-life care. We examine the context of end-of-life care, including the epidemiology of death and cross-cultural considerations. Although there are examples of success, we could not identify systematic data on capacity for delivering quality end-of-life care in developing countries. We also address a possible objection to improving end-of-life care in developing countries; many deaths are preventable and reduction of avoidable deaths should be the focus of attention.ConclusionsWe make three recommendations: (1) reinforce the recasting of quality end-of-life care as a global public health and health systems problem; (2) strengthen capacity to deliver quality end-of-life care; and (3) develop improved strategies to acquire information about the quality of end-of-life care.
Highlights
Quality end-of-life care has emerged as an important concept in industrialized countries
We begin by addressing the question, what is quality end-of-life care? we argue why it is a public health and health systems problem
Why is quality end-of-life care a global public health problem? As noted, there are 56 million deaths per year in the world, 85 % of which are in developing countries
Summary
Why is quality end-of-life care a global public health problem? As noted, there are 56 million deaths per year in the world, 85 % of which are in developing countries. Integrating local, culturally based perspectives of health, illness and dying in combination with building national consensus to changes in policies, and procedures, are apt to have a greater effect on improving end-of-life care in the developing world than implementing contemporary Western medical advances. It is a reasonable challenge to any global effort to improve end-oflife care to ask, "In such an unjust world, where apparently the lives of many people in developing countries do not matter, why should their deaths?" (A less blunt version of this question would be to ask whether a focus of quality end-of-life care is justifiable when many of the deaths in developing countries are preventable.). By focusing on improving end-of-life care, itself a significant humanitarian crisis, we may be laying the groundwork for a more comprehensive, humane and ethical health care systems in developing countries
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