Quality end-of-life care: A global perspective

We 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.We 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.Each year 56 million people die in the world [1], 85% of these in developing countries [2]. Yet little is known about the quality of end-of-life care in developing countries. This article aims to explore this problem from a global perspective and to define why it is a major global public health and health system concern.Modern research in end-of-life care can be seen as passing through three phases. In the first phase the focus was at the clinical level. An example of important research at this level is the WHO pain treatment ladder [3]. In the second phase the focus was at the organizational level. Early work centred on the organization of special units or services