Comprehensive and Integrated Palliative Care for People With Advanced Chronic Conditions: An Update From Several European Initiatives and Recommendations for Policy.

The number of people in their last years of life with advanced chronic conditions, palliative care needs, and limited life prognosis due to different causes including multi-morbidity, organ failure, frailty, dementia, and cancer is rising. Such people represent more than 1% of the population. They are present in all care settings, cause around 75% of mortality, and may account for up to one-third of total national health system spend. The response to their needs is usually late and largely based around institutional palliative care focused on cancer. There is a great need to identify these patients and integrate an early palliative approach according to their individual needs in all settings, as suggested by the World Health Organization. Several tools have recently been developed in different European regions to identify patients with chronic conditions who might benefit from palliative care. Similarly, several models of integrated palliative care have been developed, some with a public health approach to promote access to all in need. We describe the characteristics of these initiatives and suggest how to develop a comprehensive and integrated palliative approach in primary and hospital care and to design public health and community-oriented practices to assess and respond to the needs in the whole population. Additionally, we report ethical challenges and prognostic issues raised and emphasize the need for research to test the various tools and models to generate evidence about the benefits of these approaches to patients, their families, and to the health system.

Healthy by law: heading towards a brave new world?

The law is a tool used by Government to protect public health. Health is an omnipresent preoccupation, inviting each one of us to protect ourselves against potential risks at all times and in all places. The right to health protection is a source of benefit entitlements and rights-obligations that render it effective. However, believing that the law can and should regulate all sectors of human life, still a utopian belief. International law suffers from intrinsic weaknesses that limit its effectiveness. The current economic context has lead to stricter controls over healthcare expenditure faced with the ever-growing demand for treatment, limiting the right to healthcare protection. Through health law, the State has developed controls over individuals. Individual liberties tend to be limited to the cause of the public health policy. Healthy by law, raises a question: are we heading towards a brave new world as described by Aldous Huxley?

["Violence and health": an autopsy of a public health plan]. / "Violence et santé", autopsie d'un plan de santé publique.

The law provides for an evaluation and a five-year review of the French Public Health Act. Among its five strategic plans, the law of August 9, 2004 provided for a "national plan to limit the health impact of violence, risk behavior and addictive behavior." Under the impetus of the World Health Organization's World Report on Violence and Health in 2000, a rich reflection was conducted in France on this issue establishing some key axes for implementation. Although we can link several actions related to this field within the framework of specific policies since 2004 (road violence, addictions, violence against women, etc.), we note that a plan on violence and health has not emerged. The lack of enforcement and application of this part of the law raises questions about the quality of the law as well as the in the role and place for the theme "violence and health" in an upcoming law.