THE PUBLIC HEALTH ROLES OF DEATH EDUCATION IN SUPPORTING ADVANCE CARE PLANNING
Like all public health campaigns for weight loss, smoking cessation, or workplace safety, a public health approach to death, dying, loss, and care encourages a normalization of discussion and support for these matters in the wider community. As part of the push to normalize topics about mortality, health education and community engagement practices commonly target procrastination, apathy, stigma, and superstition around all matters that erode good health and well-being: in other words, they can and should target community barriers toward openness in matters to do with death if these experiences erode good health and well-being. People living with life-threatening or life-limiting illness should not be precluded from efforts toward keeping them healthy or restoring well-being any more than we currently do for people living with disabilities.
Current community engagement practices in death education are designed to minimize or reduce fear and anxiety around death, dying, loss, and care and can limit its negative social, psychological, and spiritual
outcomes. For ACP, this can provide a broader and more “usual” context for discussions about EOL care. The “shocking,” “morbid,” or “distasteful” dimension of discussing matters to do with death and loss for many people can be eroded by placing these discussions in a broader and more widely accepted context. In this way, the specific topic of advanced care planning is given a “healthy” context. The discussion is couched in terms of future well-being.
This achievement is created by building on, consolidating, and linking personal experiences of death, dying, loss, and care with wider community experiences of these verities to strengthen the support capacity of both. This is commonly called “capacity building”—building a capacity for resilience and support that is sustainable because it relies on ordinary members of the community and not simply health services.
Furthermore, making death, dying, loss, and care a key part of the usual health promotion activities of any community provides a context to the more problem-focused image of death, dying, loss, and care. Just as “health” is now widely viewed as more than “avoidance of illness,” so too death, dying, loss, and care might be viewed as more than “tragic problems” and their creative and positive confrontation viewed instead as part of building personal well-being and resilience. This will encourage the maximizing of personal and community sources of hope, as well as personal control and social support. At the same time, such health-promoting ideas about death, dying, loss, and care may help combat ignorance and superstition as they enhance informed choices.
Just as health education and community engagement programs mobilize and maximize family, community, and workplace supports and reorient them to what they can do to keep each other healthy, so too this kind of approach to death and loss can reorient a culture of denial toward a culture of acknowledgment and support for life's commonplace and universal losses. It may do so by fostering an openness toward personal troubles in the face of mortality and this, in turn, can encourage individuals, institutions, and communities to learn more about the technical complexities of living and dying in medical contexts. In all these public health roles, death education becomes a population health approach that builds on existing health education and community engagement strategies for health promotion for other health topics. Because the strategies are identical, the goals are also the same—to not only change social attitudes but also the behaviors and qualities of experiences at the EOL. Like all modern public health campaigns, the pursuit of death education programs in the community seeks to create social changes that promote healthy behaviors; reduce or prevent physical, social, and psychological harms; and maximize well-being and resilience in the face of death, dying, loss, and long-term care. I review some examples and briefly summarize some of their achievements below.