He tāngata, he tāngata, he tāngata

September 19 2017

Colleen Dempers did a fantastic Master’s project with Merryn last year exploring public health approaches to palliative care. Given that the 2017 conference of Public Health and Palliative Care International is now happening, it felt timely to invite her to write about her work. Reflections on the conference itself to follow.

Colleen writes.

‘We live in the context of the people around us’ Julian Abel recently tweeted from the Public health Palliative Care Conference in Ottawa (follow the tweets at #PHPC17). His point was that care at the end of life should involve all the people around us. This reminded me of two wise indigenous proverbs from my two home countries. The first is from South Africa which says “a person is a person through people’ (in Zulu: Umuntu ngumuntu ngabantu). The other, from New Zealand, is the powerful answer to a question – what is the most important thing in the world? It is people, it is people, it is people (in Māori: He tāngata, he tāngata, he tāngata).

Recognition of the role of social networks in caring for people at the end of life is not a new idea. Although in our individualistic western societies it seems to be a long forgotten phenomenon. The social model of palliative care promoted by the public health palliative care movement is reconfiguring palliative care in a number of countries like the UK, Canada, and Australia. This involves an intentional shift from positioning end of life care in the medical environment to placing it squarely back in the social environment (with clinical support as needed).

However, one challenge for proponents of this approach lies in the ambiguity of the terms. Palliative Care and Public health are both very broad in definition; so the confluence of ideas from both fields is at risk of being a muddy river. Even as a health professional who had studied both palliative care and public health, I certainly had reservations about my own understanding of what exactly ‘a public health approach to palliative care’ entailed.

Last year I put myself to the task of doing a thesis on the topic at the University of Auckland. A review of the literature confirmed that this approach is viewed in three distinct ways.   It is viewed as addressing palliative care from an epidemiological or population health perspective. It is also viewed as the integration of palliative care into health systems as promoted by the WHO in their global public health strategy for palliative care. However, the third and dominant view was indeed from the framework of this social model, namely public health palliative care or health promoting palliative care.

The study gauged support for the model in New Zealand, and found that 60% of hospice services supported a shift towards this social model of palliative care. The New Zealand study also identified issues for the movement that have been confirmed in other studies. These include a lack of resources, difficulties in measuring and validating the approach, paternalism on the part of medical professionals and a lack of clarity around some of the terminology.

One poorly understood term is the concept of community engagement. Yet this is at the heart of public health palliative care; it is the way to get a social model of palliative care going, it is the means to the desired end. However, community engagement is most often viewed as a consulting exercise, rather than a sincere recognition of the role and value of community. This brings me back to where I started. People live and die in the context of others – they find meaning and personhood through others – it’s all about people.

(If you want full copies of Colleen’s papers, please email: m.gott@auckland.ac.nz)