This year’s theme was a deliberate focus on the importance of our 2014 resolution as a vehicle for global palliative care advocacy. The World Health Assembly (the governing body of WHO) unanimously passed the resolution, which included everything we asked for to advance palliative care as a human right and an integral part of all healthcare systems. Since WHA resolutions are not ‘enforceable’ we were concerned about whether the resolution has resulted in considerable progress. WHO does request information on progress bi-annually from all member states on resolutions that have passed and includes a few questions regarding palliative care that have been tracked.
According to responses to two WHO surveys and our surveys ‘mapping levels of palliative care development, there are some conflicting findings. According to the 2021 NCD country capacity survey 69% of responding countries reported that palliative care services were funded, while WHO’s report on cancer benefit packages reported that only 28% of countries have funded palliative care services for cancer patients. Mapping of palliative care services is currently being updated through the ATLANTES research program but as of 2017 in the last mapping done 64% of countries had no or very limited palliative care services.
In addition, the situation for access to opioids has actually gotten worse since passage of the 2014 resolution. In 2014 the average per capita consumption of morphine was about 6 mg, while in 2021 it had dropped to about 4.5mg. The International Narcotic Control Board reports that at least 80% of countries still have no or severely restricted access to all opioids.
Currently only about 56 countries have recognised the specialisation of palliative care and less than 15% of the need for palliative care is being met. While over 400,000 health professionals are delivering palliative care there are still millions more who need even basic training particularly those working in primary care.
Palliative care is reasonably available in high income countries meeting about 50% of the need but in low and middle-income countries (LMICs), where over 80% of palliative care need exists, only about 4% of this need is being met. Such a huge disparity must be addressed.
So, the situation especially for LMIC countries has not progressed enough and with the increase in the proportion of populations that are of older age we will continue to have a problem just keeping up with the increasing demand for palliative care.
We hope to know more when research is published later this year and early in 2025 and are pushing for a report to member states (countries) next year on the lack of progress. Next year the theme for World Hospice & Palliative Care Day will be not on ‘how we are doing’ but what needs doing to make a significant impact on improving access to palliative care and relief of serious health related suffering.
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