Stephen Connor, Senior Fellow, Worldwide Hospice Palliative Care Alliance (WHPCA), and Katherine Pettus, Advocacy Officer for the International Association for Hospice and Palliative Care (IAHPC) participated in the dialogue and provided notes for this ehospice report.
The goal of the dialogue was: “to raise awareness that a world free of the avoidable burden of NCDs is achievable, but only if rich and poor countries alike follow a shared commitment to put in place the necessary policies and resources for the prevention and control of NCDs, and place action to address NCDs higher on the national and global political agendas, in collaboration with all stakeholders” (WHO, 2015).
We have the knowledge to combat NCDs
Many pre-eminent experts on global health and various aspects of NCDs were present. Dr K. Srinath Reddy, president of the Public Health Foundation of India (PHFI), reminded those in attendance that: “Never before in human history have we been so forewarned of the fate that awaits us if we neglect to take timely action. Again, never before in human history have we been so forearmed with the knowledge and tools to alter that destiny.
“It is a challenge to human intellect and enterprise as to how best we utilise that knowledge and ability to promote health and protect development.”
Dr Margaret Chan, World Health Organization Director General, agreed with Dr Reddy, saying: “We are not starting from scratch. We all know what to do (to combat NCDs), but the question is how.”
Dr Chan spoke passionately about the role of countries and communities in addressing NCDs, saying: “if we start thinking (about) the ‘how’ from the perspective of the community, of the health care providers, maybe we will find solutions of interaction. No country can afford to have parallel systems, such as those for NCDs, mental health, etc. We must think of the contact points between people. It is all about people at the end of the day, about communities.”
Referring to the post-2015 Sustainable Development Goal (SDG) indicators, she said: “To me, there are only three indicators: People, People and People!”
Dr Chan went on to remind those listening that, although the global conversation was important for advocacy and tracking progress, “at the end of the day, the action has to be at country level.”
Palliative care is an essential part of the response to NCDs
Dr Connor and Dr Pettus both gave interventions on the importance of palliative care in the response to NCDs.
Dr Connor spoke about the importance of keeping a focus on palliative care in carrying out the implementation of NCD plans and programs and inclusion in the post-2015 SDGs.
He reminded the meeting that, according to WHO, at least 40 million patients each year will need palliative care and of those over 93% suffer from NCDs.
He said: “Palliative care has a major role in the delivery of care to all those suffering and dying from NCDs each year and needs to be better integrated into existing health care systems as noted in last year’s World Health Assembly resolution on Strengthening Palliative Care as a Component of Comprehensive Care Throughout the Life Course.
“80% of those needing palliative care are in Low and Middle Income Countries, yet 80% of current palliative care is delivered in high-income countries.”
Dr Connor highlighted the fact that the continuum of Universal Health Coverage includes palliative care along with promotion, prevention, treatment and rehabilitation.
He said: “We need to ensure that palliative care guidance, support and technical assistance is included in plans for country level WHO support, which is in process. Please remember that palliative care is an essential part of the solution to the response to NCDs, not part of the problem.”
He went on to discuss why levels of funding for NCDs are so low, suggesting that: “Part of the problem is the obsession among funders with curing disease. While NCD mortality may be prevented or delayed, by and large these are incurable conditions.
“So we have a psychological problem or barrier to prioritizing funding. We in palliative care are very familiar with this issue. We’ve made plenty of mistakes in trying to engage funders and haven’t found the right solution except to stress the importance of human rights and dignity. The mortality rate remains stubbornly stuck at 100%.”
Calls for a horizontal, non-hierarchical, approach to the problem of NCDs
Dr Pettus agreed with other calls within the meeting for greater dialogue between Ministries of Health, civil society and other areas of government to create a multi-sectoral, whole-government approach.
She said: “One of the main areas in which I work is improving access to controlled essential medicines. Particularly morphine – for the treatment of moderate to severe pain. Morphine is on the WHO Model List of essential medicines, and on most countries’ essential medicines lists, yet is still unavailable in more than 80% of the world because of: fears of “addiction”, over-regulation, and lack of provider education.
“This means that millions of people dying from NCDs around the world die in pain that would be both treatable and unavoidable if it weren’t for national narcotics control laws.
“This is a plea for governments and international organisations to encourage dialogue between Ministries of Health, Ministries of Justice, Internal Security, narcotics control, and other relevant agencies and actors, to take coordinated policy action to make controlled essential medicines such as morphine available so that people don’t need to die in pain.”
Dr Pettus called for the NCD, HIV and palliative care movements to join forces. She also echoed an earlier call by Dr Chan for a horizontal, non-hierarchical, approach to the problem of NCDs, saying: “Margaret Chan talked about getting out of the silo mentality. I think that the palliative care approach, which is multidisciplinary, horizontal – non-hierarchical – and takes the patient, family and community as a unit of care, provides a template and team model for how we might link our movements.”
WHO has expressed its expectation that “the dialogue will increase awareness of the role of NCDs in development cooperation agendas and initiatives, internationally agreed development goals, economic development policies, sustainable development frameworks and poverty reduction strategies.”
A report summarising the dialogue proceedings will be published on the WHO website.