Chair: Prof. Luc Deliens
Compassionate Cities: Their meaning and significance
Prof. Allan Kellehear
This talk outlines the historical and health care significance of Compassionate Cities. The hospice movement has developed from a service employing clergy, to one employing health care professionals, to one that has often developed into a service with volunteers. The public health movement, as it has in other areas of health care, has emphasised two important correctives to the idea of a profession-led end of life care - (1) communities must play a leading role; (2) This role should be a partnership with existing services; and (3) The role communities must play should be based on a culture of civic participation. The features of these compassionate civics are: participatory relations (everyone has a say), the development of care acknowledging cultural and social differences (policies not for the few but for everyone), the identification of support with social action (saying and feeling is pointless without doing), and finally, the best actions and policies are derived from cultural and end of life literacy. (informed understanding is crucial). The installation of these features - Learning, Community Action, and Compassion - into our world cities is essential if we are to bring a lasting change to end of life care beyond the ridges of mere professional services.
Bereavement support: From the poor cousin of palliative care to a core asset of compassionate communities
Prof. Samar Aoun
One of the modern public health paradoxes is the relative neglect of the experience of bereavement (though death is universal). The many negative consequences of bereavement, and the disruption of social relationships are primary determinants of both health and mortality. This puts the impact of bereavement squarely into a public health perspective that pursues health equity. Adopting and strengthening a compassionate communities approach is necessary, not only for end of life care for dying people but also along the continuum of bereavement support.
Guidelines propose that bereavement support should be matched to risk and need. However, many palliative care services continue to adopt an unhelpful blanket approach in offering bereavement support. So, who provides support to the bereaved; who needs bereavement support and to what extent, and importantly, who is perceived by bereaved people to have offered them support and was it helpful? Based on reported experiences of the bereaved in a national Australian survey, recruited through funeral providers, the majority of this support is provided in informal and other community settings by a range of people already involved in the everyday lives of those recently bereaved, whether care recipients received or did not receive palliative care. A public health approach to bereavement care is needed to support ‘everyday assets’ in the community without over-reach from professional services. The data from this survey provided empirical evidence for building a community’s capacity to provide the type of social and practical support advocated by the Compassionate Communities approach, which relies on identifying and developing local caring networks around the dying person and their family. This body of work, innovative in content, conceptual model and recruitment approach, has challenged the existing bereavement support structure and provision and has already influenced practice and policy.