New UN report identifies unmet need for palliative care worldwide

28 January 2014

Only 1 in 10 people who need medical care to relieve the pain, symptoms and stress of serious illness is currently receiving it, according to a new United Nations report, which calls on countries to include palliative care as an essential component to their health systems.

The “Global Atlas of palliative care at the end of life,” published jointly by the UN World Health Organization (WHO) and the Worldwide Palliative Care Alliance (WPCA), is the first tool to map the need for, and availability of, palliative care globally as well as to identify the barriers to this important element of patient and family care.

“Palliative care is more than just pain relief. It includes addressing the physical, psychosocial and emotional suffering of patients with serious advanced illnesses and supporting family members providing care to a loved one,” WHO stated in a news release.

According to the agency, about one third of those needing palliative care suffer from cancer. Others have progressive illnesses affecting their heart, lung, liver, kidney, brain, or chronic, life-threatening diseases including HIV and drug-resistant tuberculosis.

It is estimated that every year more than 20 million patients need palliative care at the end of life. Some 6 per cent of these are children.

The number of people requiring this care rises to at least 40 million if all those that could benefit from palliative care at an earlier stage of their illness are included. Hospice and palliative care often encompasses some support to family members, which would more than double care needs.

“The Atlas shows that the great majority of the global need of end-of-life care is associated with non-communicable diseases such as cancer, heart disease, stroke and lung diseases,” said Oleg Chestnov, WHO Assistant Director-General for Non-communicable Diseases and Mental Health.

“While we strengthen efforts to reduce the burden of the biggest killers in the world today, we must also alleviate the suffering of those with progressive illness who do not respond to curative treatment,” Dr. Chestnov stated.

In 2011, approximately 3 million patients received palliative care, the vast majority at the end of their life. Although most palliative care is provided in high-income countries, almost 80 per cent of the global need for palliative care is in low- and middle-income countries. Only 20 countries worldwide have palliative care well integrated into their health-care systems.

Briefing reporters in Geneva on the report, WHO Senior Adviser Maria Cecilia Sepulveda Bermedo noted a lack of policy supporting palliative care as well as a lack of knowledge that such care is available.

“This is a very important topic that has been neglected for many, many years,” Dr. Sepulveda said, adding that often patients and family members do not know that they can access palliative care.

In addition, healthcare professionals do not know that they can integrate the practice of palliative care in their clinical work. There is the issue of lack of access to medicines, particularly opiates, the main medicine used for pain relief.

The Atlas calls on all countries to include palliative care as an essential component to every modern health-care system in their moves towards universal health coverage. This means addressing barriers such as lack of policies, of resources and of knowledge of health-care professionals and members of the public about the benefits of palliative care.

“Our efforts to expand palliative care need to focus on bringing relief of suffering and the benefits of palliative care to those with the least resources,” noted David Praill, Co-Chair of the WPCA. “This will take courage and creativity as we learn from each other how to integrate palliative care into existing but very limited health-care systems.”

It is expected that the 67th World Health Assembly, the decision-making body of WHO, will discuss the subject at its annual session in Geneva in May.

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