Palliative care helps improve the quality of life of individuals facing life-limiting illness throughout the course of their disease. In Canada, delivery and access to palliative care has been fraught with challenges including differential availability of services based on geography, funding, language, and socioeconomic status. Many groups, including the World Health Organization, have advocated for a public health approach to palliative care as an antidote to fragmented service delivery. Multiple scholars, academics, and public health advocates have suggested that a public health approach to palliative care can help with issues of access, equity, and cost. Through the lens of Kingdon’s Multiple Streams Framework, this commentary will explore potential reasons why a public health approach to palliative care has not been adopted in the Canadian context and why this is an opportune time to consider this policy innovation. The Compassionate Communities concept is discussed as a potential solution to a public health approach to palliative care delivery.
LysykB. Annual Report of the Auditor General of Ontario: Palliative Care. Ministry of Health and Long Term-Care; 2014:258. Retrieved from the Office of the Auditor General of Ontario. www.auditor.on.ca/en/content/annualreports/arbyyear/ar2014.html. Accessed September 21, 2019.
3.
De LimaLPastranaT. Opportunities for palliative care in public health. Annu Rev Public Health. 2016;37:357–374.
4.
KellehearA. Compassionate communities: end-of-life care as everyone’s responsibility. QJM. 2013;106(12):1071–1075.
HenryBDosaniNHuynhLAmiraultN. Palliative care as a public health issue: understanding disparities in access to palliative care for the homeless population living in Toronto, based on a policy analysis. Curr Oncol. 2017;24(3):187–191.
HigginsonIJKoffmanJ. Public health and palliative care. Clin Geriatr Med. 2005;21(1):45–55, viii.
11.
StjernswardJFoleyKMFerrisFD. The public health strategy for palliative care. J Pain Symptom Manage. 2007;33(5):486–493.
12.
KingdonJW. Agendas, Alternatives and Public Policies. 2nd ed. New York, NY: Longman; 2011.
13.
HerwegNZahariadisNZohlnhöferR.The Multiple Streams Framework: foundations, refinements and empirical applications. In: SabatierPAWeibleCM, eds. Theories of the Policy Process. Boulder, CO: Westview Press; 2017:15–53.
14.
FraserJ. Palliative and End-of-Life Care Provincial Roundtable Report (Catalogue no. 020446). Toronto, Ontario: Ministry of Health and Long-Term Care; 2016.
TompkinsB.Compassionate communities in Canada: it is everyone’s responsibility. Ann Palliat Med. 2018;7(2):S118–S129.
18.
MarshallDKortes-MillerK. Was the 5th international public health palliative care conference 2017 Canada’s tipping point? A meeting report. Ann Palliat Med. 2018;7(suppl 2):S130–S134.
19.
Government of Canada. An Act Providing for the Development of a Framework on Palliative Care in Canada. The Justice Department; 2017. http://laws-lois.justice.gc.ca/PDF/2017_28.pdf. Accessed December 10, 2018.
Local Health Integration Networks and the Quality Hospice Palliative Care Coalition of Ontario (2015). Advancing High Quality, High Value Palliative Care in Ontario: A Declaration of Partnership and Commitment to Action. Toronto, Ontario: Queen’s Printer for Ontario; 2012. http://health.gov.on.ca/en/public/programs/ltc/docs/palliative%20care_report.pdf. Accessed October 15, 2018.
KelleyASDebPDuQCarlsonAMorrisonRS. Hospice enrollment saves money for Medicare and improves care quality across a number of different lengths-of-stay. Health Aff. 2013;32(3):552–561.
24.
MorrisonRSPenrodJDCasselB, et al.Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med. 2008;168(16):1783–1790.
25.
Canadian Hospice Palliative Care Association (CHPCA). Policy Brief on Hospice Palliative Care. Quality End-of-Life Care? It Depends on Where You Live…and Where You Die. Canadian Hospice Palliative Care Association; 2010. http://www.chpca.net/media/7682/HPC_Policy_Brief_-_Systems_Approach_-_June_2010.pdf. Accessed October 15, 2018.
