Evolution and change in palliative care around the world

Palliative care developed in the later part of the 20th century as a social movement and medical speciality. Central to its modern development were the ideas of Dr Cicely Saunders, whose vision for improving the care of the dying encompassed the physical, psychological, social and spiritual domains while emphasizing the importance of rigorous clinical practice, training and research. St Christopher’s Hospice, which she founded, inspired generations of practitioners and influenced the expansion of hospices nationally and internationally. Terminal care evolved into the discipline of palliative care, which applied holistic principles to the care of those earlier in their disease trajectory and in different settings, such as hospitals and the community. Some countries now have national strategies for palliative care that are supported by government. Palliative care attracts increasing attention as an aspect of the public health system and there are calls for access to it to be recognized as a human right. Yet around the world, palliative care is not uniformly developed and it needs to press hard to secure full integration with prevailing health policies. Palliative care still reaches only a tiny proportion of those who could benefit from it, especially those with diseases other than cancer. The global challenge for palliative care in the 21st century is to develop models and coverage appropriate to those in need, whatever their diagnosis, income or setti