Compassionate Cities. Public Health and End of Life Care- by Kellehear, A

Kellehear, A. Compassionate Cities. Public Health and End of Life Care . London : Routledge . 2005 xi+179pp . £20.99 ISBN 0 415 36773 5 (pbk) This thought-provoking book focuses on our communities' lack of compassion for those who experience loss in their midst, and suggests, rather ambitiously, how we could put things right. More specifically, Kellehear argues that the two disciplines of Public Health and Palliative Care are currently too narrowly focused; the former denying the inevitability and universality of death and loss, and the latter concentrating too much on the end of the lifecourse, from within specific professional services and sites. Both disciplines, he suggests, must begin working with the entire community in thinking about, and being compassionate towards, those who experience loss in its many forms, to build what he terms the Compassionate City. Compassion, Kellehear argues, is an ethical imperative for health that should not be a professional-only response to those in need, but founded on the principle of social interdependencies. Kellehear begins by mapping the social history of organised care for dying people from community care to hospice and palliative care, before briefly sketching the role that public health initiatives played during this time. In doing so, seven themes in historical and cultural depictions of death and loss are put forward and recur throughout the book: that care of the dying has traditionally been a normal and routine event for communities; that community relationships have historically been an integral part of community care; that care must be whole-person care of a citizen rather than a patient; that it is the family, not the individual, that must be the basic unit of care; that state involvement in care is crucial; the role of prevention is paramount; and that any form of healthcare must go beyond formal service organisation. In Chapter 2, Kellehear sketches the contemporary positions of public health and palliative care, predominantly in the UK and Australia, in particular questioning how 'social' psychosocial palliative care currently is, and the limits to health promotion (i.e. for providing education, information and policy-making for health, dying, death, loss and grief) in both palliative care and public health. Chapter 3 traces the theoretical foundations of Compassionate Cities to the World Health Organisations' Healthy Cities, and in doing so Kellehear presents nine defining characteristics of a Compassionate City, including an ability to meet the special needs of its aged people those living with life-threatening illness and those living with loss, including displaced and marginalised groups. In this chapter Kellehear pre-empts many criticisms and objections to a Compassionate City approach to loss and grief, and deals admirably in considering the practicality, relevance and value of such an approach to meet the current goals of palliative care and public health. In Chapters 5 and 6, Kellehear tackles the social character of, and threats to, Compassionate Cities. After considering the tensions of postmodern society, in particular, reflexivity, globalisation, and perceptions of and responses to risk, the social nature of Compassionate Cities, or communities, is presented. Kellehear considers and responds to particular threats to these Cities, namely: professional and medical dominance; the gentrification of death and loss; corporate managerialism; economic rationalism; the philosophical conservatism towards new ideas; media reticence towards death and loss; general taboos around death; and multicultural taboos on the subject of death and loss. Chapters 4, 7 and 8 take a more practical approach in considering how Compassionate Cities might work in practice. First, Kellehear suggests up to four operational policies for each of the nine policy visions for these Cities. In Chapter 7, he considers four models of community development practice, and how the aim of each of these models might guide the roles, politics, skills and commitment of those involved. Action strategies, such as poster campaigns to raise awareness amongst the community, and a 'Walk-a-mile-with-me Week', whereby members of one community group speak to other groups of their experiences of caring, ageing, loss and grief, are suggested in Chapter 8. This is certainly a thought-provoking book, although I would have welcomed deeper consideration of how current tensions in our societies, the competing demands that people in many communities face, and the individualisation of our lives might influence the success of Compassionate Cities. This at times controversial book would be of particular interest to those in the fields of Palliative Care and Public Health, and those following vocational courses. Those who feel that increased professionalisation of services for the dying and grieving has left society without the basic skills and compassion required to deal with those experiencing loss will find an ally in Allan Kellehear

Assisted suicide · Compassion · End-of-life care · Environmental ethics · Health care · Interdependence · Palliative care · Political science · Public health · Public relations · Social science · Sociology · Grief, Bereavement, and Mental Health · Law · Medicine · Nursing