This World Health Day, the WHO has released a petition to rally public opinion for universal health services to be accessed, without financial hardship.
The emphasis of this year’s theme is on the economic choices millions of patients and caregivers make between health care and other daily expenses such as food, clothing and even a home.
Watch the World Health Day theme video here.
The palliative care policy connection
The WHO petition is precursor to the United Nations General Assembly high-level meetings on universal health coverage in September 2019. Palliative care advocates are working hard to ensure that palliative care is included as an essential package in Universal Health Coverage at these meetings.
The process has required both clarity and collaboration among lead palliative care advocates — especially around measurable indicators, according to Stephen Connor, Executive Director for the WHPCA. Currently, the World Health Organization’s only measurement of palliative care achievement is “Access to palliative care assessed by morphine-equivalent consumption of strong opioid analgesics (excluding methadone) per death from cancer”.
With integration into UHC, there would likely need to be an expansion of this single indicator. Beyond prevention and treatment, additional indicators would need to include promotion and rehabilitation, notes Stephen Connor, Executive Director for the WHPCA.
“Work on indicators for palliative care under UHC and the new WHO 13th General Program of Work is underway and a palliative care indicator working group will soon be formed.”
From an advocacy standpoint, there is a lack of clarity about what it means to include palliative care into UHC. What must or should be included in a package of PC services under UHC and how will this be paid for? The essential package of palliative care services and resources published in the Lancet Commission Report on Palliative Care and Pain Relief  is a starting point for what should be included but needs further testing and implementation.
For example, considering that for every adult or child dying from a disease requiring palliative care, there is at least one or two caregivers involved, the total number of people in need of palliative care would double or triple within a UHC framework.
This, according to The Global Atlas of Palliative Care at the End of Life, does not account for patients needing palliative care prior to their last year of life — nor does it include orphans, vulnerable children, or the bereaved.
By including palliative care into UHC – the financial trickle-down effect of palliative care services as an affordable option for both patients and caregivers would be more attainable through palliative care integration into primary health care services within an essential package. Here’s why:
- Palliative care reduces unnecessary hospitalizations and expenditures on medications and interventions that are ineffective and may result in needless suffering.
- It supports those with some of the highest health needs, and those who are particularly vulnerable to catastrophic expenditure on health.
- By improving quality of life, household income generation can improve among patients with complex health conditions.
“Palliative care is everyone’s business! Universal Health Coverage isn’t universal without palliative care,” said Connor.
In a message for World Health Day Prof Julia Downing, Chief Executive of the International Children’s Palliative Care Network (ICPCN), writes:
“We know that at least half of the people in the world do not received the health services they need, and within children’s palliative care it is estimated that between 90-95% of children globally needing access to palliative care don’t get it. Palliative Care is a core component of Universal Health Coverage which aims to ensure that all people have access to the quality health services they need, when and where they need them, without financial hardship. Thus, by making Universal Health Coverage a reality we will improve the lives of children and their families needing palliative care around the world. Health is a human right so let’s make universal health coverage a reality, and with it access to palliative care for children.”
Do you have any questions about what it means to integrate palliative care into UHC? We would love to hear from you. Email us here with your questions and we’ll address them on the International Edition of ehospice.
 Knaul F, Farmer P, Krakauer E, et al.(2017). Alleviating the Access Abyss in Palliative Care and Pain Relief: an imperative of universal health coverage: Report of the Lancet Commission on Global Access to Palliative Care and Pain Control. Lancet http://www.thelancet.com/commissions/palliative-care
 Connor, S & Sepulveda, C (Eds.). (2014) Global Atlas of Palliative Care at the End-of-Life London UK, Geneva CH: Worldwide Palliative Care Alliance and World Health Organization. http://www.who.int/cancer/publications/palliative-care-atlas/en/