SEATTLE…..Palliative care is a specific form of healthcare where the primary purpose is to mitigate suffering, whether it be physical, psychological, spiritual or social. In 2014, The World Health Organization (WHO) resolved to make palliative care accessible to all by 2030 as part of The United Nation’s Sustainable Development Goal for Health. Making palliative care accessible to all would be to bring an end to what WHO has deemed “one of the greatest disparities in global health care”- suffering.
The Need for Palliative Healthcare for Low and Middle-Income Countries
Globally, only 14 percent of those with serious health-related suffering (SHS) receive palliative care. The other 78 percent, the majority of the 40 million who remain in need of pain relief each year, live in low- and middle- income countries (LMICs). According to The Lancet Commission on Palliative Care and Pain Relief, those with SHS spend an annual, cumulative total of 6 billion days enduring their symptoms. At least 80 percent of people who die with SHS come from LMICs, many of them located in the developing world.
The gap in access to palliative care in LMICs is due in part to a failure to incorporate this kind of care into healthcare systems, which tend to prioritize treatments meant to completely cure conditions over pain-management treatments. Healthcare workers often receive limited or no training at all in palliative care. Additionally, stigmas regarding the use of opioids also influence national healthcare policies that make basic pain-relief medications difficult or impossible for people in these countries to access.
Disparities in Opioid Access
The ability of a country’s citizens to access morphine to treat SHS is a major indicator of the state of palliative care. According to the International Narcotics Control Board, patients in LMICs consumed only nine percent of the total amount of morphine consumed worldwide in 2013 even though they comprise 81 percent of the global population. Conversely, the 19 percent living in wealthier countries consumed 91 percent of the drug.
In terms of pharmaceutical opioid consumption, patients in the 10 percent poorest countries have access to, on average, less than two percent of the estimated amount needed for palliative care. In contrast, consumption among the HIC is 500 times higher than that in LMICs.
The disparity in care worsens when considering children. Around 66 percent of countries have no pediatric palliative care (PPC) services whatsoever. WHO estimates that as many as 21 million children around the world are in need of PPC each year. The majority of them live in Africa (49 percent) and Southeast Asia (24 percent). Across regions, 98 percent of the children in need live in LIMCs.
Children tend to be more difficult to treat partially because young children may not be able to communicate their symptoms as effectively. As childhood is a period of growth and change, children’s needs are much more diverse than those of adults. This difficulty has contributed to the exclusion of children from palliative care.
Improving Access To Palliative Care
In its 2017 report, The Lancet Commission expressed the need for concrete guidelines for improving access to palliative care in developing nations as well as a need for methods of holding countries accountable for making these improvements. The report likewise called upon The World Bank to establish a fund for countries whose progress could be hindered by cost.
In 2018, WHO followed suit by publishing three reports that offer recommendations and guidelines for making palliative care accessible to all, two of which dealt specifically with PPC and palliative care for people affected by humanitarian crises. These reports addressed matters such as appropriate training for healthcare workers, revisions to nations’ healthcare policies, cost management and financial protections for patients and their families.
The reports also outlined essential care packages based upon the Essential Package laid out in The Lancet Commission’s report. These essential care packages are cost-conscious lists of the absolute minimum medical resources that should be available to everyone, including basic medications, basic equipment and appropriately-trained healthcare workers.
According to WHO, once past the initial costs, making palliative care accessible to all is likely to reduce overall healthcare costs by reducing hospital stays since palliative care can take place in people’s homes. It is additionally expected to cut down on the use of curative treatments that are not actually beneficial to the patient.
Although far from reaching this point of progress, these recent developments seem to at least lay the groundwork for making palliative care accessible to all and, in so doing, bringing an end to what is arguably one of the worst injustices facing the world today.
– Ashley Wagner