Why the world needs to get ready for more people dying

For decades, lifespans have grown ever longer, delaying the inevitable fact of death. But the coming years will see a sharp rise in the number of people dying, presenting a challenge about how we care for those at the end of life.

We started the 20th Century without penicillin, but now genomic medicine raises the possibility of increasingly sophisticated treatments tailored to an individual’s genetics.

Death had been an unpredictable event: most people died suddenly, often from infectious diseases.

We are living longer and dying slower, but how well prepared are we for the challenges that come with that?

A central challenge is presented by the fact that we are going to have to prepare for many more deaths.

As lifespans increased – and individuals delayed dying – the number of deaths decreased.

But everyone has to die and we are now at a tipping point.

In England, for example, there are currently around half a million deaths each year.

This will increase by about 20% in total over the next 20 years, until an extra 100,000 people are dying each year.

Worldwide, the pattern is similar.

This rise will mainly be caused by an increase in non-communicable diseases such as heart disease and cancer.

This is illustrative of a second challenge: most people will suffer from multiple medical problems in their final years. They will experience a gradual physical – and often cognitive – decline before they die.

So, how can we best care for these people?

Palliative care aims to improve the quality of life for people approaching the end of their life.

Working in teams including nurses, social workers, counsellors and chaplains, palliative care specialists identify the worst problems for patients with terminal, or life-limiting illnesses and aim to improve these symptoms.

Many will be experiencing physical symptoms such as pain, nausea, or breathlessness. For others, the greatest problems may be psychological, social or spiritual.

Historically, palliative care was used after all other medical options had been exhausted, but we now know that it works best when used early and alongside other medical care.

However, some less wealthy countries such as Uganda, Mongolia and Panama have also demonstrated rapidly improving standards of palliative care, through a combination of national policies, public campaigns and strong leadership from advocates.

But challenges remain if palliative care is to be made available to all those who need it, particularly as the number of people dying increases.

For example, access to opioid painkillers is a key indicator of the quality of end of life care.

Drugs such as morphine are relatively inexpensive, but access can be hampered by legal restrictions that aim to prevent abuse.

Opioids were freely available and accessible in only 33 of 80 countries studied for the 2015 Economist Intelligence Unit report.

In Uganda, public awareness campaigns, as well as legal changes, have helped promote use of opioids at the end of life.

Further challenges are found around funding.

This is a particular issue in poorer countries, where even basic research on symptoms in advanced disease and how to treat them can be lacking.

Even in high-income countries, research funding is limited.

Improving end of life care is a global challenge, made more urgent by ageing populations.

Medical and scientific progress over the past decades has changed how we die.

But it has not changed the fact that it will happen to all of us.

This analysis piece was commissioned by the BBC from an expert working for an outside organisation.

The Cicely Saunders Institute is a purpose-built institute for palliative care, combining research, education and clinical care.