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Delivering optimal and equitable palliative care is an international challenge. There are few cross-national comparisons examining challenges in expanding palliative care along public health lines. This paper presents a critical review of palliative care in the USA and England, which share similar challenges but have different contexts of healthcare. Beyond some obvious differences in the organisation of palliative care, a set of underlying common issues can be identified. A key tension in both is balancing attention ‘downstream’ in the dying phase, as well as ‘upstream’ earlier in the course of serious illness. In both, the dominant models of palliative care provision have resulted in excellent care towards the end of life for some patients, but there remain major deficiencies in care for the majority. England has a National Strategy for End-of-life care; the US has no equivalent, although a number of influential agencies have published statements. Achieving a public health approach in palliative care requires international consensus on the meaning and target population of palliative care, replacement of prognosis based understandings of entitlement to palliative care with a needs-based approach and development of an evidence base for cost-effective partnerships between providers across the specialist–generalist divide. [ABSTRACT FROM AUTHOR]

Palliative and end-of-life care in England has undergone some remarkable transformations across the course of less than half a century and can be seen as a useful case study with which to understand international trends and challenges. This paper examines some of the long term influences which led to the emergence, for the very first time, of an End-of-Life Care Strategy in England. It revisits the critical contribution of Cicely Saunders to the development of a theoretical framework for palliative care before examining the gradual and as yet incomplete transformation of ‘palliative care’ into ‘end-of-life care’ which is occurring internationally. The paper then turns to examine two key challenges in contemporary end-of-life care, looking at how these are being addressed in England and forecasting the possible direction of travel in the future. [ABSTRACT FROM AUTHOR]

This article highlights the scientific meeting on palliative care held on June 23, 1998 at the Royal College of Physicians in London, England. The meeting was scheduled to celebrate the eightieth birthday of British physician Cicely Saunders. Baroness Jay opened the day with a speech in which she highlighted the achievement of palliative care over the past 30 years, in particular the partnership between the voluntary sector and the British National Health Service. The next session looked at advances in patient and family care. The final session of the day looked at five topics likely to be of increasing importance as palliative care looks to the future.