In the UK
By the mid-1980s, the hospice movement had matured. In the UK around 100 hospices had been formed, complemented by home-support services and the first hospital palliative care teams. The National Health Service and major cancer care charities started to provide funding.
In the US
In the US, growth was even more striking: there were 516 hospices just 10 years after the foundation of the first initiative in New Haven, which had opened in 1974.
Even more significant was the creation of a federal benefit in 1982 under Medicare for patients with terminal disease and a prognosis of six months. The legislation proved a stimulus to not-for-profit and commercial hospices. By the end of the twentieth century, around 3,000 hospice organisations were operating in the US.
Beyond the UK and US
Elsewhere, the potential for development varied enormously. In Eastern Europe, for example, there was little opportunity for hospice initiatives until communism began to break down.
In Kracow an informal society was first formed to support hospice developments in 1981, the year martial law was imposed. In Russia, the first hospice was opened in St Petersburg in 1992, with the support of the émigré journalist Viktor Zorza, who established Russian links with supporters in the UK in the wake of the new era of glasnost.
The Island Hospice, which began in Zimbabwe in 1979, is thought to be the first to be established in a third-world country.
In several countries, such as India, the first hospices were modelled quite explicitly upon St Christopher's, but local variation was also common.
In Spain the word 'hospice' has negative cultural associations of poverty and incarceration, so a strong emphasis was placed from the outset on the integration of services within the mainstream healthcare system.
Support and collaboration
Pioneers of the first wave of hospice development, and some of their successors, have worked tirelessly to promote their work in many countries. They have built international networks of support and collaboration, fostered by groups such as the World Health Organization, the International Association for Hospice and Palliative Care and the European Association of Palliative Care.
Global care in the twenty-first century
It is estimated that some form of specialist palliative care now exists in 90 countries. There is evidence that this number is growing, with developments in Asia, Eastern Europe, Africa and Latin America.
More hospice history
Read about other chapters in hospice history including:
