What is the global context of palliative (relieving pain and symptoms) care?

From the Guidelines

Palliative care globally faces significant disparities in access, quality, and integration within healthcare systems, with approximately 40 million people worldwide needing it annually, yet only about 14% receiving it, as noted in various studies 1. The World Health Organization recognizes palliative care as a fundamental human right, emphasizing a holistic approach that addresses physical, psychological, social, and spiritual needs of patients with life-limiting illnesses. Key aspects of palliative care include:

• Providing relief from pain and other distressing symptoms
• Affirming life and considering dying a normal process
• Integrating psychological and spiritual aspects of patient care
• Offering support systems to help patients live as actively as possible until death and to help their families cope during the illness and through bereavement Some of the most recent and highest quality studies, such as 1, highlight the importance of opioid availability for pain relief as a fundamental component of providing adequate palliative care. Major barriers to palliative care include:
• Opiid availability restrictions
• Inadequate healthcare infrastructure
• Limited professional training
• Financial constraints Successful global palliative care models often:
• Integrate community-based approaches with existing healthcare systems
• Utilize trained community health workers
• Adapt practices to local cultural contexts while maintaining core principles of symptom management, psychological support, and family involvement. The most recent study 1 emphasizes the need for material support for pharmacologic and other strategies to deliver the full spectrum of palliative care, highlighting the importance of coupling demonstration of palliative care expertise and training with material support.

From the Research

Global Context of Palliative Care

• The Global Atlas of Palliative Care at the End of Life estimated that every year, more than 20 million patients need palliative care at the end of life, with only 1 in 10 people in need currently receiving it 2.
• Approximately 80% of the global need for palliative care is in low- and middle-income countries, while most palliative care is provided in high-income countries 2.
• Only 20 countries have palliative care well integrated into their health-care systems, highlighting the need for improved access to palliative care worldwide 2.

Access to Palliative Care

• More than 5 billion people (83% of the world's population) live in countries with low to nonexistent access to opioids, while 250 million (4%) have moderate access, and only 460 million (7%) have adequate access 2.
• The World Health Organization (WHO) has pioneered a public health strategy to integrate palliative care into existing health care systems, which includes four components: appropriate policies, adequate availability of medications, education of health care workers and the public, and implementation of palliative care services at all levels throughout society 2.
• Palliative care improves symptoms, most frequently pain, and improves quality of life for patients and their families, especially in the terminal disease phase 3.

Integration of Palliative Care into Health Systems

• The WHO is calling for the integration of palliative care in all health care settings globally, and a multi-country intervention study in Africa demonstrated that integration of palliative care within different government health services can be achieved through agreed interventions being delivered concurrently 4.
• Palliative care should be integrated into routine disease management for all patients with serious illness, regardless of settings or prognosis, and should be culturally tailored to assist patients worldwide 5.
• Mapping levels of palliative care development in 198 countries showed that palliative care is gaining ground globally, but service provision, supporting policies, education, and funding are incommensurate with rapidly growing needs 6.

Challenges and Future Directions

• There is a significant association between levels of palliative care development and World Bank Income Level, Human Development Index, and Universal Health Coverage, highlighting the need for increased investment in palliative care in low- and middle-income countries 6.
• An 87% global increase in serious health-related suffering amenable to palliative care interventions is predicted by 2060, emphasizing the need for improved access to palliative care worldwide 6.
• Ongoing advocacy efforts call for increased awareness, palliative care integration with cancer care, and public and professional education to address the growing need for palliative care globally 3.