Planning for the End of Life—An Emerging
Public Health Priority
Public health strategies, coupled with medical advances, have resulted in
a 30-year increase in life expectancy since the dawn of the 20th century.
People are living longer and expectations about their health and quality of
life are increasing. These expectations extend to wanting to ensure that the
last months and years of life are lived as fully as possible, as pain-free
as possible, and with dignity.
Traditionally, much of the nation’s public health network focus is about
infants and children—ensuring that babies are born into the world as healthy
as possible and that children thrive and are protected from injury and
communicable diseases. In more recent decades, additional strides have been
made in ensuring that our nation’s adults practice healthy behaviors and
take advantage of preventive measures that reduce their risk of chronic
disease, injury, and infectious diseases such as influenza and pneumonia.
Now, as more and more baby boomers reach their older years, opportunities
exist through the nation’s public health network to focus on more about the
end of life and help ensure that Americans have the resources needed to make
informed choices and decisions about how their final months and days are
Recognizing how important it is to be prepared for the end of life, CDC
defined better opportunities, public health roles, and responsibilities in
As a first step, CDC’s Healthy Aging Program, in collaboration with CDC’s
Division of Cancer Prevention and Control and the National Association of
Chronic Disease Directors (NACDD), worked with more than 200 key public
health stakeholders to identify short-, medium-, and long-term public health
priorities related to the end of life.
Of the priorities identified, five were deemed most critical and ready for
action. These include the following:
- Identify point of contact for end-of-life issues in state health
- Collect, analyze, and share data related to the end of life.
- Incorporate end-of-life principles in state comprehensive cancer
- Educate the public about hospice and palliative care.
- Educate the public about the importance of advance directives and
health care proxies.
Of these top priorities, CDC chose public education, data collection, and
data analysis, to pursue initially.
Back to top
Current CDC activities related to preparedness for the end of life
include the following:
- Equipping public health professionals.
In 2006, CDC Healthy Aging Program supported the development of a
curriculum about end-of-life preparedness for public health professionals.
The curriculum, developed by Myra Christopher, president and executive
director of the Center for Practical Bioethics (CPB), addresses the
importance of advance directives and palliative care.
In 2007, CDC’s Healthy Aging Program collaborated with CPB and the Directors
of Health Promotion and Education (DHPE) to pilot the curriculum for public
health professionals. The pilot, presented as a workshop at a national
meeting of DHPE and the Society of Public Health Educators (SOPHE), provided
valuable information on needed adjustments and additions to the curriculum
to best meet the needs of public health professionals.
CDC and CPB are seeking opportunities in 2008 and 2009 to again pilot the
curriculum with public health audiences, as well as with those in the aging
services network. Upon inclusion of further updates and changes on the basis
of participant feedback, CDC will support CPB to develop a curriculum
package for both public health and aging services professionals to help
inform those they serve about important considerations in preparing for
- Better understanding public perceptions and knowledge.
As a first step in better understanding public perceptions and knowledge
about preparing for the end of life, CDC has undertaken a project to
determine what information has already been collected about this issue. CDC
identified 36 relevant surveys that were then characterized by setting,
sample, mode of administration, perspective, and whether end-of-life-related
items specifically addressed hospice and palliative care, and advance care
planning. Results from this project help set the stage for identifying and
developing consensus on end-of-life-related items most useful and
appropriate for state-based surveillance systems, such as the CDC-supported
Behavioral Risk Factor Surveillance System.
Back to top
Family members are often asked to make decisions on behalf of a loved one
who is seriously ill without having a complete understanding of his or her
preferences. To avoid this situation, older adults should discuss their
end-of-life wishes with family members and health care providers well before
the onset of a serious illness, and they should designate a surrogate
decision maker for health care.
Having these conversations is the best way to protect one’s independence in
a myriad of unpredictable situations. Many people find it difficult to begin
a discussion about end-of-life issues, however. Fortunately, several
resources are available to help foster meaningful conversations and
practical planning for end-of-life care.
Back to top
Understanding Palliative Care and Hospice Care
For the past several decades, the health care system has provided a
number of options to ease the dying experience. Medical treatment has
expanded to include palliative care and hospice care. The goal of palliative
care is to achieve an optimal quality of life for patients by using a
holistic approach that focuses on the alleviating of pain, symptoms, and
other unique needs of the patient at any time during their experience with a
serious or life-threatening illness. A combination of social support,
emotional support, and attention to spiritual aspects of care and respect
for the patient’s culture, beliefs, and values are essential components of
this approach. Although the level of palliative care intensifies at the end
of life, the focus on the relief of suffering and improving quality of life
is important throughout the course of the illness, and aspects of palliative
care can be provided along with life prolonging treatment during earlier
phases of a patient’s illness.
Hospice care is an organized program for delivering palliative care that
involves an interdisciplinary team of specially trained health professionals
and volunteers. Hospice care is delivered to dying patients in inpatient
units, nursing homes, or, most often, in their own homes. In addition to
providing palliative care and personal support to individuals at the end of
their lives, hospice provides support to the family while their loved one is
dying as well as during the bereavement period. In 1982, Medicare began
reimbursing for hospice services. To qualify for the Medicare hospice
benefit, terminally-ill patients must have a terminal diagnosis, a
life-expectancy of 6 months or less, and is willing to forgo further
treatments. Patients who live longer than 6 months can be “recertified” if
their situation still meets the criteria for the hospice benefit.
Back to top
Advance Care Planning
Hospice and Palliative Care
Guardianship/Surrogacy Issues and Protection
Back to top
* Links to non-federal
organizations are provided solely as a service to our users. Links do not
constitute an endorsement of any organization by CDC or the federal
government, and none should be inferred. The CDC is not responsible for
the content of the individual organization Web pages found at this link.
Page last reviewed:
December 17, 2008
Page last modified: December 17, 2008
Content source: Division of Adult
and Community Health, National Center for Chronic Disease Prevention and