Changing times: preparing to meet palliative needs in the 21st Century

Globally, 56 million people die each year and for many, in resource-rich as well as resource-poor countries, the process of dying is associated with significant but preventable suffering (Sepulveda et al, 2002; Seymour at al, 2010). Since the introduction of the modern hospice movement in the 1960s, marked by the opening of St Christopher's Hospice in Sydenham, London by the late Dame Cicely Saunders, the principles and practice of palliative care have been disseminated round the world, to the extent that palliative care has been coined by some commentators as a human right (Brennan, 2007). At the end of the first decade of the 21st Century, the provision of palliative care is beginning to feature in the political and policy agendas of many different countries as they seek to respond the challenges of epidemiological and socio-demographic change. The changing age structure of the countries in the developed world has given rise to a growth of palliative care needs among older people, often in association with long-term conditions other than cancer in which the onset of 'dying' is often hard to ascertain; while younger people with complex palliative care needs owing to life-limiting disease or disability are living longer than at any time previously because of changes in medical technology (Davies and Higginson, 2004). In the resource-poor nations, the tragedies of the AIDS pandemic pose a challenge of gargantuan proportions, especially in sub-Saharan Africa.