Palliative care in the USA and England: a critical analysis of meaning and implementation towards a public health approach
- Publisher: Taylor & Francis
Delivering optimal and equitable palliative care is an international \ud challenge. There are few cross-national comparisons examining \ud challenges in expanding palliative care along public health lines. \ud This paper presents a critical review of palliative care in the USA and \ud England, which share similar challenges but have different contexts \ud of healthcare. Beyond some obvious differences in the organisation of \ud palliative care, a set of underlying common issues can be identified. A \ud key tension in both is balancing attention ‘downstream’ in the dying \ud phase, as well as ‘upstream’ earlier in the course of serious illness. In \ud both, the dominant models of palliative care provision have resulted \ud in excellent care towards the end of life for some patients, but there \ud remain major deficiencies in care for the majority. England has a \ud National Strategy for End-of-life care; the US has no equivalent, \ud although a number of influential agencies have published statements. \ud Achieving a public health approach in palliative care requires \ud international consensus on the meaning and target population of \ud palliative care, replacement of prognosis based understandings \ud of entitlement to palliative care with a needs-based approach and \ud development of an evidence base for cost-effective partnerships \ud between providers across the specialist–generalist divide.
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