Palliative Care is an essential aspect of healthcare that focuses on improving the quality of life for patients and their families facing challenges associated with life-threatening illnesses. It’s a holistic approach that addresses not only the physical symptoms but also the psychological, social, and spiritual needs of individuals. By employing a team-based strategy, palliative care provides support for both patients and their caregivers, ensuring comfort and dignity throughout the course of an illness. This support extends to practical needs and includes bereavement counseling to families after the patient has passed. Ultimately, palliative care aims to help patients live as actively as possible until the end of life.
Palliative care is not just a medical service; it’s a fundamental human right, explicitly recognized as part of the right to health. This means it should be integrated into person-centered healthcare systems, tailored to meet the unique needs and preferences of each individual.
Children receiving palliative care, highlighting the global need and WHO collaboration with UNICEF
Who Needs Palliative Care?
The need for palliative care spans a wide spectrum of diseases, affecting millions globally. Chronic conditions are the primary drivers of this need, with cardiovascular diseases leading at 38.5%, followed by cancer at 34%, chronic respiratory diseases at 10.3%, AIDS at 5.7%, and diabetes at 4.6%. Beyond these major categories, numerous other conditions necessitate palliative care, including:
- Kidney failure
- Chronic liver disease
- Multiple sclerosis
- Parkinson’s disease
- Rheumatoid arthritis
- Neurological diseases
- Dementia
- Congenital anomalies
- Drug-resistant tuberculosis
Pain and breathing difficulties are among the most prevalent and distressing symptoms for patients requiring palliative care. Studies indicate that a significant percentage of patients with serious illnesses experience moderate to severe pain towards the end of life. For instance, approximately 80% of individuals with AIDS or cancer, and 67% of those with cardiovascular disease or chronic obstructive pulmonary disease, will suffer from considerable pain. Opioids play a crucial role in managing this pain effectively, as well as alleviating breathlessness and other distressing physical symptoms. Early and effective symptom control is not only an ethical imperative to relieve suffering but also to uphold a person’s dignity.
The Global Palliative Care Gap
Despite the clear need and human right aspect, access to palliative care remains woefully insufficient worldwide. It is estimated that 56.8 million people annually require palliative care, with a disproportionately high number residing in low- and middle-income countries. For children, the disparity is even more pronounced, with 98% of those needing palliative care living in these resource-limited regions, nearly half of whom are in Africa.
Several significant obstacles contribute to this unmet need for palliative care globally:
- Lack of National Policy Integration: Many national health policies and systems fail to incorporate palliative care as a standard component of healthcare services.
- Limited Professional Training: Education and training in palliative care for healthcare professionals are often inadequate or entirely absent from curricula.
- Inadequate Access to Opioid Pain Relief: Populations in many countries lack sufficient access to opioid medications for pain management, contradicting international guidelines on essential medicines.
A WHO survey from 2019 revealed that while 68% of member states reported some funding for palliative care, only 40% indicated that services reached at least half of the patients in need. Data from the International Narcotics Control Board further highlights the disparity: in 2018, 79% of the world’s population, predominantly in low- and middle-income countries, consumed a mere 13% of the global morphine used for pain management. This starkly contrasts with high-income countries, revealing a significant inequity in access to essential pain relief medications.
Beyond policy and resource limitations, other barriers hinder the expansion of palliative care:
- Low Awareness and Misconceptions: Lack of understanding among policymakers, healthcare providers, and the public about the nature and benefits of palliative care.
- Cultural and Social Barriers: Cultural beliefs and societal attitudes surrounding death and dying can impede acceptance and utilization of palliative care.
- Misconceptions about Scope: False beliefs that palliative care is solely for cancer patients or only relevant in the final weeks of life limit its broader application.
- Concerns about Opioid Abuse: Misguided fears that increasing access to opioid analgesics will inevitably lead to a rise in substance abuse.
Strengthening Palliative Care Systems: What Countries Can Do
National health systems bear the responsibility of integrating palliative care into the continuum of care for individuals facing chronic and life-threatening conditions. This integration should begin early in the course of illness and be linked with preventative, diagnostic, and treatment programs. At a minimum, effective national palliative care strategies should include:
- Integrated Health System Policies: Policies that seamlessly incorporate palliative care services into the structure and financing of national healthcare systems across all levels of care – from primary to specialized.
- Human Resource Development: Strategies to strengthen and expand the palliative care workforce. This includes specialized training for current healthcare professionals, embedding palliative care education into the core curricula for all new health professionals, and educating community volunteers and the public.
- Essential Medicines Policies: Medicine policies that guarantee the availability of essential medications for symptom management, particularly opioid analgesics for pain relief and respiratory distress.
Early integration of palliative care is crucial for maximizing its benefits. Research demonstrates that initiating palliative care early not only significantly improves patients’ quality of life but also reduces unnecessary hospitalizations and minimizes the overall utilization of healthcare services.
Palliative care delivery must adhere to the principles of universal health coverage. Access should be guaranteed for all people, irrespective of their income, disease type, or age. A nationally determined set of basic health services, including palliative care, should be available to everyone. Financial and social protection systems must acknowledge and uphold the human right to palliative care, especially for vulnerable and marginalized populations.
Nurses, as integral members of multidisciplinary teams, require specialized training in palliative care skills, particularly those working with patients facing serious illnesses.
While specialist palliative care is a vital component, a sustainable and accessible system necessitates integration into primary healthcare settings, community-based care, and home-based care. Support for informal caregivers, such as family members and community volunteers, is also essential. Providing palliative care should be recognized as a core ethical responsibility for all healthcare professionals.
WHO’s Commitment to Palliative Care
The World Health Organization (WHO) recognizes palliative care as a global health priority. Palliative care medicines, including those essential for pain management, are included in both the WHO Essential Medicines List and the WHO Essential Medicines List for Children. Palliative care is also explicitly referenced in key global mandates and strategies related to universal health coverage, noncommunicable diseases, and people-centered integrated health services. In 2019, WHO released comprehensive guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents, further solidifying its commitment.
In 2014, the landmark World Health Assembly resolution WHA67.19, the first global resolution on palliative care, urged WHO and member states to prioritize improving access to palliative care as a fundamental component of health systems. The resolution emphasized the importance of integrating palliative care within primary healthcare and community/home-based care models.
WHO’s ongoing efforts to strengthen palliative care are focused on several key areas:
- Integration into Global Health Plans: Integrating palliative care considerations into all relevant global disease control and health system planning initiatives.
- Service Development Assessment: Monitoring and assessing the development and progress of palliative care services worldwide.
- Guideline and Tool Development: Creating evidence-based guidelines and practical tools for integrating palliative care across various disease groups and levels of care, while addressing ethical considerations in palliative care provision.
- Improving Medicine Access: Supporting member states in enhancing access to essential palliative care medicines, particularly through improved national regulations and efficient delivery systems.
- HIV Palliative Care Focus: Specific attention to palliative care for individuals living with HIV, including the development of tailored guidelines.
- Children’s Palliative Care: Promoting increased access to palliative care for children in collaboration with UNICEF.
- Global Monitoring and Evaluation: Monitoring global access to palliative care and evaluating the effectiveness of palliative care programs to track progress.
- Indicator Development: Developing specific indicators to evaluate the quality and impact of palliative care services.
- Resource Mobilization: Encouraging the allocation of adequate resources for palliative care programs and research, especially in resource-constrained countries.
- Evidence-Based Models: Building a robust evidence base for palliative care models that are effective and adaptable in low- and middle-income settings.
Through these comprehensive efforts, WHO continues to champion the global expansion of palliative care, ensuring that more individuals have access to the compassionate and essential care they deserve when facing life-limiting illnesses.
