Twenty-first century Western culture has a problem with talking about dying, death and bereavement. Death and all that surrounds it must be seen as a major public health issue before we can start to change this, but unfortunately, it is not. We need to encourage more open and honest conversations now.
The Scottish Government’s Public Health Priorities for Scotland was published in June and it was disappointing that despite calls, the government did not take the opportunity to include dying, death and bereavement as a priority.
When you’re living with a terminal illness it is important that you are able to discuss your wishes and plan ahead. This can make a big difference to the care a person receives and where they get their care. By not talking about it, this can have an impact on your quality of life and that of your family and carers. By not planning you might have to face an unnecessary hospital admission and a long stay in hospital.
Talking about the care you want and having a plan can make a real difference. It can allow for wills to be written and power of attorneys set up, funerals to be planned and affairs settled. Not only can this reduce stress and worry while the person is still alive, it can also support families and friends through their bereavement. Evidence shows that it can reduce the amount of times someone who is terminally ill is admitted to hospital, including through accident and emergency.
People are considerably more likely to die in their preferred place of death, often in the community. Not only is this much more in line with a person’s preferences, but can help save the public purse some money as it takes away a lot of those unnecessary hospital costs.
Our public health debates are largely confined to issues of prevention, living healthier and living longer. We seem to somehow forget the dying bit, yet it is something that we will all have to go through. For those living with terminal illnesses in the run-up to their deaths we should be doing everything we can to ensure that people can live as well as possible in the time they have left.
There are growing examples of good practice where public health approaches have made a positive impact. Good Life, Good Death, Good Grief is a campaign that brings together people and organisations with information and resources to support communities to do more to help each other with dying, death, and bereavement.
The To Absent Friends festival is coming up for its fifth year in November and is a growing celebration of storytelling and remembrance. It enables people to talk about friends, loved ones and family members who have died, as well discuss their own mortality.
The Compassionate Communities movement is about communities working together to provide support to someone who is dying through small acts of compassion, often enabling them to die well and, if possible, at home. It is a movement that is growing and in Scotland we have already seen the emergence of Compassionate Inverclyde.
It is great to see these, but many of them are still quite small in scale and cannot reach the mass numbers required without additional support.
Commitment and support from national government and buy-in from local community leaders in NHS boards, local authorities, businesses, religious groups and charities is so important in making these things happen. There is willing among all these groups, but there needs to be so much more action.
The Scottish Government’s new promised public body on public health, which is due to begin next year, can still take this forward as a priority, linking in with the Scottish Government strategy on culture, expected later this year. We would urge them both to have some committed resource to support the good initiatives taking place around the country. This will help them spread, and tackle the negative culture and stigma in Scotland around these topics so that more communities and more people can benefit.
Working towards a Scotland that is open and honest about dying, death and bereavement should be something we all see as a priority.
If you have any questions about terminal illness Marie Curie Support and Information can help. Contact 0800 090 2309 (Calls are free from landlines and mobile phones) or visit mariecurie.org.uk/support
Richard Meade is Marie Curie head of policy and public affairs Scotland. Visit mariecurie.org.uk/change