It is estimated that every year over 20 million patients need palliative care at the end of life. Some 6% of these are children. At present, only 1 in 10 people who need palliative care, receive it. These startling statistics have been revealed today at the launch of the Global Atlas of Palliative Care at the End of Life, published by the World Health Organization (WHO) and the Worldwide Palliative Care Alliance (WPCA), the first document to map the need for the availability of palliative care globally.
Even more disconcerting is that these numbers only reflect those needing palliative care at the end of life and rises significantly to at least 40 million when you include people who would benefit from palliative care at an earlier stage of life. Adding family members to the equation, as palliative care always includes aspects of care to multiple family members, the actual need could triple.
In 2011, approximately 3 million patients received palliative care, most of which was at the end of life. Most of this care was provided in high-income countries, although close to 80% of the global need for palliative care is in low- and middle-income countries. Only 20 countries have palliative care for adults well integrated into their healthcare systems. These countries are Australia, Austria, Belgium, Canada, France, Germany, Hong Kong, Iceland, Ireland, Italy, Japan, Norway, Poland, Romania, Singapore, Sweden, Switzerland, Uganda, United Kingdom, and United States of America. The number of countries with palliative care for children integrated into their healthcare systems is significantly lower than this with only a handful of countries in this category.
The Atlas shows that the great majority of the global need of end of life care is associated with non-communicable diseases and the greatest number of children in need of palliative care died from congenital anomalies, followed by neonatal conditions, protein energy malnutrition, meningitis, HIV/AIDS and cardiovascular diseases. The majority of children in need of palliative care are concentrated in the African region (49%), followed by Southeast Asia (24%) and Eastern Mediterranean regions (12%). It also reveals an indirect correlation between the rates of children in need of palliative care at the end of life with the level of income group to which their country belongs with the lower income groups having the highest rates.
The Atlas calls on all countries to include palliative care as an essential component to every modern healthcare system. This means addressing barriers such as the
• lack of policies recognising palliative care and the need for care both at the end of life and during progressive illnesses;
• lack of resources to implement services, including access to essential medicines, especially pain relievers;
• lack of education for health care professionals and members of the public about the benefits of palliative care
David Praill, Co-Chair of the WPCA said, “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. This will take courage and creativity as we learn from each other how to integrate palliative care into existing but very limited healthcare systems.”
In her response to the launch of the Atlas, Chief Executive of the International Children’s Palliative Care Network (ICPCN) Joan Marston had this to say: “Recent research carried out by the ICPCN and UNICEF in developing countries indicates that less than 1 in 20 children needing palliative care are receiving it, even in countries with fairly extensive hospice palliative care reach. Many children live with life-limiting conditions over many years, and statistics at the end of life do not show the full picture. Based on our research results, we estimate that between 15 and 20 million children worldwide would benefit from palliative care.”
She went on to say, “The Atlas challenges each one of us to work even closer together as Champions for palliative care, to ensure that the needs of infants, children and young people are included in the development of palliative care worldwide. It is our hope that the Atlas will be an effective tool in helping us to advocate for more commitment from governments to integrate palliative care for children into their healthcare systems.”
Last week, the Executive Board of the WHO called on Member States to strengthen palliative care as a component of integrated treatment throughout the life course and recommended that the 67th World Health Assembly adopts a resolution on the subject in May 2014.
The Atlas can be downloaded at http://www.who.int/nmh/publications/en/ or at http://www.thewpca.org/resources
Kate Jackson, editor of the International edition of ehospice, will be reporting live from Geneva at the launch of the Atlas. Click here to read more about the launch on this edition.
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