Challenges facing palliative care

For the second time in its history, the United Nations met to discuss specific clinical challenges facing the world.  The first of was about AIDS in 2001 and the second occurred this past September. Although the draft resolution agrees to ‘address the prevention and control of non-communicable diseases world-wide’, what does this really mean for palliative care?

The key drivers of this program include cardiovascular disease, cancer, chronic respiratory disease and diabetes. Cancer alone accounts for more deaths internationally than malaria, tuberculosis and AIDS combined. The numbers will worsen in the years and decades ahead. Importantly, the burden of cancer is rising across the world but proportionately more rapidly in medium and low resource countries. Age and poverty are two of the most important drivers of these health outcomes together with lifestyle factors. Poverty and lifestyle factors need to be urgently addressed if we are to improve the health of the global community.

At the other end of the spectrum, find an increasing proportion of the world where death will be heralded by a diagnosis of a life-limiting illness preceding a period of expected functional decline. Perversely, the more effective we are in controlling communicable and non-communicable diseases, the more likely we are to have a warning of our death, and the more likely that our death will be the result of inexorable systemic decline for each individual.

The United Nations has affirmed its intent to improve ‘access’ to and ‘affordability’ of medicines. They have not been specific about the very real challenges of providing palliative care. It is heartening to see that palliative care is ranked as one of the issues that each national health system should help to prioritise, but this is a very small part of a very large document. http://www.uicc.org/advocacy/cancer-fact-sheets.  This recognition falls far short of several submissions made to improve the breadth of what was explicitly covered in the final communiqué relating to palliative care. The final communiqué does not include either pain or pain medications as a fundamental focus.

Ultimately, organisations such as IAHPC have a huge task ahead to ensure that there is improved recognition of the need for good and affordable analgesia. This has not been achieved at this time by this United Nations Summit. If we are going to make basic medications for pain and symptom control available internationally, the work, in real terms, is still ahead of the global palliative care community.

David Currow, MD

Dr. Currow is a member of the IAHPC board and resides in Australia. His biography may be accessed at: http://www.hospicecare.com/Bio/currow.htm