To watch We All Belong please visit:

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2 PRESENTER S NOTES - LIFE Before Death Documentary Screening 1. Screening We All Belong as a curtain raiser >> We have found that the Short Film We All Belong from the award-winning LIFE Before Death series is a good way to frame the issue for the audience as they enter the venue and take their seats. The Short Film features key statistical information about the subject and is accompanied by the original music of popular Boston folk singer Ellis Paul, created specifically for the project. 100% of all proceeds from the purchase of the song from are passed on as donations to the Union for International Cancer Control s Global Access to Pain Relief Initiative. To watch We All Belong please visit: 2. Introducing the film LIFE Before Death >> We suggest you introduce the film along the following lines to ensure a consistent message is being delivered to everyone attending hosted screenings. Welcome to the screening of LIFE Before Death. This film explores the issue of untreated pain and the need for improved access to palliative care globally. In the film you will hear from numerous experts in the field and meet the patients in their care. It is a powerful and intense film that exposes the suffering going on in the world today but it also shows the immense hope that comes from good care well delivered; that with hard work and perseverance this can be achieved for everyone. In order to best tell this story the film crew travelled to 11 countries around the globe and you will be exposed to the challenges in accessing essential medicines and palliative care in a number of different settings. You will meet patients at various stages in their illnesses and some approaching the end of their lives. You will view the personal hardships and also the triumphs they are experiencing as they near the end of their life journey. LIFE Before Death was created by Australian production company Moonshine Movies and is presented by the Lien Foundation. The project partners are the Union for International Cancer Control (UICC), Mayday Fund, International Association for the Study of Pain (IASP) and The Institute for Palliative Medicine at San Diego Hospice. It was developed with the assistance of Screen Australia and Film Victoria and was also supported by the Open Society Foundations, the Lance Armstrong Foundation and the Pettus Foundation. The broad goal of the project is to raise public awareness of the issue of untreated pain and the importance of palliative care. The project is designed to encourage conversation around these topics and to engage audiences to be actively involved in helping solve these problems. This could be done by becoming a champion for the cause, making a donation, helping educate others by simply talking about it, sharing the short films, visiting the websites, hosting your own screening or simply passing on a copy of the DVD. 2

3 Access to essential medicines and palliative care for all is possible and if we work together we can achieve these goals. The film LIFE Before Death tackles the difficult issues but will also leave you with a sense of hope that there is much that can be done to improve this situation, and we will give you the tools to help at the end of the screening. 3. While watching the film >> Ask your audience or expert panel to consider these questions: What is palliative care? Low and middle-income countries are home to 70% of deaths from cancer and 99% of deaths from HIV but consume just 7% of medicinal opioids. Why does this disparity exist? What level of access do patients have to pain control and palliative care in your area? What is the role of government in ensuring access to these essential medicines? What can be done to improve access? How does the growing burden of cancer affect your community? How will you die? 4. Bookend the Screening >> You may choose to bookend the screening of the film with your own film highlighting the good work you are doing. Alternatively, you may choose one of the 50 Short Films from the LIFE Before Death collection to highlight a specific topic relevant to your local context. 5. Discussion after the screening >> Use the above questions to initiate discussion about the film. The film should also drive mediated discussion around the relevant local issues. You can then use the discussion topics from the How to Host a Screening Guide to continue the discussion. Keep in mind that audience members and discussion participants will not necessarily have a working knowledge of palliative care. Some topics you may want to discuss are: What is palliative care? Why do 80% of all people lack adequate access to essential pain medicines like morphine? What level of access do patients have to pain control and palliative care in your area? What can be done to improve access? How does the growing burden of cancer affect your community? How will you die? 3

4 5 things people can do to help Support your organisation s programs and activities. Purchase a copy of the DVD from and join the mailing list. Purchase a copy of Ellis Paul s We All Belong from and share your story, sign up for a newsletter or make a donation. Petition your health minster and express your concerns and/or demand better services. Share LIFE Before Death with the most influential person you know. QUICK FACTS 15% of the world uses 93% of the world s medicinal opioids. (Source: 2009 Population estimates from the World Health Organization and estimate of narcotic consumption for 2009 from the UN International Narcotics Control Board) More than 3.3 million people die with untreated moderate or severe pain from cancer and HIV each year. (Source: Estimate of deaths from HIV or cancer in 2009 from the World Health Organization; prevalence of moderate or severe pain from Foley et al, 1996 and estimate of narcotic consumption for 2009 from the UN International Narcotics Control Board) 99.9% of those deaths are in low and middle-income countries. (Source: Estimate of deaths from HIV or cancer in 2009 from the World Health Organization; prevalence of moderate or severe pain from Foley et al, 1996 and estimate of narcotic consumption for 2009 from the UN International Narcotics Control Board) For useful resources visit % of the world uses 94% of the world s medicinal opioids. 4

5 PROMOTIONAL MATERIAL POSTER ETC A collection of films about living well and dying better THE INSTITUTE FOR PALLIATIVE MEDICINE at San Diego Hospice 5

6 BACKGROUND INFORMATION LIFE Before Death is a documentary project about people with life-limiting or painful illnesses, their families and the extraordinary health care professionals fighting to change the culture of medicine to be more focused on care, rather than exclusively on cure. Curative medicine is the cornerstone of national health systems around the world and the primary motivation for many aspiring doctors. While curing patients is unquestionably a key goal, the one-eyed application of cure-based approaches is often to the detriment of patient well-being, particularly towards the end of life. For patients with life-limiting illnesses cure is simply not an option. The global crisis of untreated pain is an issue that requires urgent attention. The central argument of this project is that if individuals want and need effective pain treatment they should be able to receive it. This seems self-evident, but the barriers to access are both daunting and complex for millions worldwide. As global projections of cancer, HIV/AIDS and chronic pain diseases skyrocket, the need for affordable pain relief has reached crisis levels. Doctors, patients and families around the world are crying out for reform of a global system condemned for torturing countless numbers of sick and marginalized individuals everywhere. Over twenty years ago, the World Health Organization determined that when pain becomes moderate to severe, treatment with narcotic medications derived from opium were medical best practice, and defined the drugs used for such purposes as essential. Yet as recently as March 2009, the WHO estimated that 600 million people alive today, in over 160 countries, would experience negative health impacts from ineffective pain treatment. The documentary style of LIFE Before Death is largely observational, demonstrating the positive life-changing influence of pain control and palliative care. The story ultimately provides hope that this is one global health problem that can be solved with a little help from the audience. The potential audience for the film which includes health professionals, regulators, policy makers and the general public is largely uninformed of the global crisis in untreated pain and the lack of access to morphine (or similar medicinal opioids) for millions of people worldwide. To date, there has been insufficient print or electronic coverage of the topic that would arouse public concern enough to drive change. There is almost zero public understanding that the solution to this appalling problem is essentially simple morphine is inexpensive to manufacture and relatively simple to administer safely. In addition to effective pain control, studies have shown that the application of palliative care addressing patients total pain be it a physical, psychological, social, spiritual or practical struggle not only improves quality of life and reduces depression, but also extends patients life spans. This is an important opportunity to tell a compelling story of universal dimensions, raise public awareness, and help mobilize concerned citizens by advocating for lasting change around the two core issues: 1. The crisis in untreated pain due to inadequate access to medicinal opioids. 2. The delivery of essential palliative care services around the world. 6

7 The project is being released on three distinct platforms: 1. Feature length documentary 2. One-hour TV documentary short-films for the web The short films are being disseminated by the Union for International Cancer Control through their Treat The Pain initiative and the Lien Foundation through their LIFE Before Death initiative In addition, over 100 syndication partners have supported the distribution of the short films to date. Everyone has been touched by pain in his or her life, particularly through cancer, HIV/ AIDS, arthritis, surgical or traumatic circumstances. Not to have felt pain is not to have been human, attests one Jewish Proverb. This is a story that everyone can relate to and should know more about, enabling them to make informed decisions. As documentary professionals, we are driven to contribute to this pressing humanitarian cause. By Mike Hill & Sue Collins Over 5 billion people are affected worldwide 600 million people alive today, in over 160 countries, will experience untreated severe pain. 3.6 million people die with untreated severe pain from cancer and HIV this year 99.9% of those deaths were in low and middle-income countries 7