Arguments Supporting The Intersection of Palliative Care and Public Health

In 1990, the World Health Organization published "Cancer Pain Relief and Palliative Care: Report of a WHO Expert Committee," outlining a public health strategy to promote palliative care. In the ensuing 20 years, several lines of argument have emerged in the literature to support the inclusion of palliative care as a public health priority. Most of these arguments focus on demonstrating how and why symptom distress at the end of life has been, and will continue to be, an increasing burden on populations as one witnesses a rise in the mean age of populations, an increase in deaths from chronic (rather than acute) illnesses, and a resultant decompression of morbidity in the last years of life. Palliative care is then put forth as an effective way to address this burden and minimize its impact on populations. This paper first (and quickly) reviews the prominent lines of argument for including palliative care as a public health priority found in the literature of the past 20 years. Following, it proposes a new line of argument: that (i) the philosophical commitments underlying palliative care and (ii) an approach to health that focuses on populations, rather than individuals, are mutually supportive. The paper demonstrates that, if one defines palliative care as a particular philosophy of care, in addition to a specialization addressing a certain kind of symptom distress burden, significant synergies between palliative care and public health emerge, creating an additional kind of argument supporting the intersection of public health and palliative care.