Palliative care is an overlooked global health priority

Abstract

Improving access and tackling inequities in palliative care globally would help to reduce preventable suffering, write Anna Peeler, Oladayo Afolabi, and Richard Harding

Millions of people around the world live and die with virtually no access to pain and symptom relief.¹ We have failed to tackle this preventable suffering in people with life limiting illness, and the problem will continue to worsen as populations age and the burdens of non-communicable diseases and multimorbidity grow. Palliative care is neglected as a global health priority, and health systems around the world must better prepare to meet the growing need.

By 2060, 48 million people will die each year with serious health related suffering, an 87% increase from 2016. Moreover, 83% of these deaths will occur in low and middle income countries (LMICs) where access to adequate health services, palliative care, and essential medicines can be severely limited.^{2 3}

Overlooked priority

Palliative care—or holistic care that includes physical, psychological, social, and spiritual concerns and prioritises quality of life for people of all ages with life limiting conditions⁴— is associated with better outcomes, lower costs, and patients dying in a preferred place.³ The principles of palliative care are in line with the goals of the wider health system and those who work within it: detailed assessment and person centred care that puts patients and their families at the forefront of decision making and care planning.⁵ Adequate provision of palliative care has massive benefits for patients and families, those that organise and work clinically within health systems, and healthcare spending.

In 2014, the World Health Assembly attempted to correct the neglect of palliative care provision by passing WHA Resolution 67.19, which called on member states to develop, strengthen, and deliver palliative care across all ages as an essential component of universal health coverage.⁶ A decade later, only 14% of people around the world who would benefit from palliative care receive it.³ This is even worse in children, with less than 3% of those in need receiving palliative care.⁷ Inequity in access to services is growing, and use of essential medicines such as opioids is regressing in some countries, primarily LMICs, because of regulatory constraints and fears about opioid misuse and abuse. Just 20% of the global population, mostly in high income countries, consumes 86% of morphine produced globally.⁸ But even within high income countries, access to palliative care is highly inequitable, with factors such as socioeconomic status and ethnicity influencing who gets care and how.⁹

Reducing inequalities

Many factors contribute to the lack of progress in expanding access to palliative care worldwide. Misconceptions about what palliative care is and how it can benefit those at all stages of life limiting illness prevent people from requesting, receiving, and engaging in palliative care.¹⁰ A lack of palliative care research and educational opportunities, particularly in LMICs, stalls progress and worsens inequities.³ In many countries, discomfort around death and dying and a preoccupation with extending life at all costs means palliative care discussions take place when it is too late or not at all.¹¹

A decade since the WHA resolution the need for palliative care is still growing, and important opportunities for action have been missed. Progress has been extremely slow in expanding access and improving the quality of palliative care services globally.¹ Education, training, service delivery, and policy must recognise palliative care as both an essential skill for all healthcare professionals and a specialty that manages complex cases, triages, educates, and supports colleagues working in other specialties.

Research is critical to develop palliative care to tackle the escalating and changing burden. Yet in the US and UK, palliative care receives just 0.2% and 0.3% of all research funding respectively. In our upcoming report on palliative care for the World Innovation Summit for Health 2024, we analysed the evidence of progress since the WHA resolution and outline recommendations to expand access to palliative care services.

Our recommendations detail priority actions for national and local governments, multinational organisations, healthcare workers, researchers, educators, and communities. They centre around developing health policies that promote equity and sustainability, delivering core palliative care education for all healthcare workers, ensuring access to essential medicines such as opioids, engaging with communities to set priorities, and monitoring global progress so we don’t let another decade go by without substantial change.

Reducing inequity is key, and research should focus on developing and adapting models of palliative care that are feasible, sustainably funded, and context specific so that no one is left behind. Without urgent, coordinated action, the world’s most vulnerable people, those in pain, those who are dying, and children with debilitating or incurable conditions will continue to suffer.