We all die and, despite some fanciful aspirations to the contrary, we will all keep dying into the future. Our daily routines keep us closed off to this fact. Death’s inevitability suggests that we should keep it in our sights as we think about the public’s health. There are three areas which might fruitfully draw our attention.
Once we accept that we are going to die, how we spend our money and our time on the business of health begins to shift. At core we should aspire to die healthy. That means focusing our energy on creating a world that maximizes health, not one where we invest our resources into the last few months of life, aiming to fight death at all cost. This would represent a radical shift in how we think about our limited health investment dollars. Perhaps death can help focus our mind on living better, on the conditions that we need to create to generate health, rather than asking serial medical specialists to tackle symptom after symptom until we die.
It seems important that we not neglect the experience of dying itself. We all wish to die with dignity, and yet our collective focus on creating the conditions for that has been lacking for decades. Two out of three Americans do not have advance directives that guide what treatments they receive if they are sick, and cannot communicate the end-of-life care that they want. Redoubling our conversation about how we manage our dying can perhaps get us much further on this front.
The dead leave behind the grieving, and the grieving have a burden of poor health that is linked directly to the death of their loved ones. Sudden unexpected death of a loved one is the largest contributor, for example, to post-traumatic stress disorder in populations. Death leaves behind lonely older adults, now socially isolated, and themselves at higher risk of dying soon. Death creates a population health challenge for the living, one that is foreseeable and perhaps preventable.
Our squeamishness in talking about death is entirely natural. But it remains our collective role to elevate issues that influence the health of populations; death is indeed one of them. Perhaps recognizing the inevitability of death can guide us towards ways in which we can live healthier, die with dignity, and protect our loved ones when we do die.
Warmly,
Michael Stein & Sandro Galea