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Dying well is a public health issue

Ahead of the King’s Fund Annual Conference (29-30 November) on population health and prevention, Dr Jane Collins, chief executive of Marie Curie, explains why dying well is a public health issue.

The idea that how people die can and should be seen as a public health issue is one that might seem strange to many people. After all, public health initiatives are traditionally a means to keep people healthy for longer and to prevent them getting ill.

Of course, we all die, and because most of us are living longer we are highly likely to die with one or more life-limiting conditions. This isn’t a public health failure – it’s an inevitability in our ageing society – and many people believe that public health still has an active role to play in supporting people to die well.

This is the argument that Allan Kellehear, professor of end of life care at University of Bradford, has made throughout his career and in particular his concept of compassionate communities. In his view, local government has a very important role to play in helping communities to better support not just people who are dying, but also their carers and families.

This has the potential to have a huge impact not just in the lives of individuals but also in the way a community uses health services, particularly hospital care. A very common experience of people at the end of life is a ‘yo-yo’ of emergency hospital admissions, often without clinical need, that can, in some cases, lead to prolonged stays and death in hospital.

There are many factors that cause this such as a lack of access to palliative care in the community and difficultly in sourcing appropriate social care. However, carers struggling to cope is a huge factor, especially when they are not only providing care themselves but also co-ordinating a host of health and social care services.  We have seen this through the research we have fundedbut also from the many carers that we support across the UK. They tell us that caring for someone at the end of life is the most isolating experience they’ve ever had – their mental and physical health is under constant pressure. 

You can see where a public health approach can become vital in this situation. If a community is prepared to break down that isolation and provide a carer with a support network, perhaps even spreading the caring duties over a number of people, then it is more likely that a crisis can be averted.

In many ways, this approach is about trying to regain something that we have lost as a society. At the turn of the 20th century most people died at home – not in the best conditions, to be sure, but with the support of family, friends and community. Hospital deaths rose throughout the century, peaking at close to 90% in some parts of the West. Through the work of the hospice and palliative care movement, hospital deaths are on the way down, but slowly – and these gains are fragile in the face of demographic realities.

To really achieve better outcomes for people at the end of life, we really need to pair innovative services with a compassionate communities approach, so that carers and family are supported both in the services they access and by the people that are around them on a day-to-day basis. Neither one can truly help us meet the challenge posed by more people dying with more complex conditions on their own.

Dr Collins is chairing day two of The King’s Fund Annual Conference (29-30 November). For more information about the event, visit

(Top image c. LPETTET, iStock)


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