Two: Contemporary health and social care

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The social and demographic changes outlined in Chapter One have also created a situation in which dying has become the business of professional services. Very few people now live their lives to the end, in their own homes, without any recourse to formal health or social care services. For the vast majority of people dying in old age, these service providers will be involved to a greater or lesser extent with their lives, and the lives of their families, often intensively in the last few weeks or days. For the younger person who dies suddenly and unexpectedly, perhaps as a result of accident or injury, accident and emergency services will be called upon not only to deal with the medical emergency but also to support the bereaved relatives. Thus the ways in which health and social care services are organised and delivered have a profound effect on the experiences of dying and bereavement and also on the ways in which the individual professional may seek to offer help. These services have themselves been subject to considerable change and challenge in the late twentieth and early twenty-first centuries. In the developed societies of Europe and North America, the pace of national policy change has been rapid and can be seen to reflect common global trends as these societies respond to the overlapping health and social needs of an increasing sector of the population which requires more intensive interventions over a longer period of time (Tester, 1996; Walker and Maltby, 1997). In the developing world, the scale of epidemics, such as the HIV/AIDS crisis in Africa, has required the rapid training of non-professional healthcare workers who deal with death on a daily basis and in large numbers.

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