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Palliative Care and the Global Goal for Health

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Palliative Care and the Global Goal for Health Palliative Care and the Global Goal for Health Right. Smart. Overdue. Acknowledgements Special thanks to: Sharon Baxter, Sue Boucher, Sushma Bhatnagar, Joyce Chee, Stephen Connor, Liliana De Lima, Liz Gwyther, Hospice Foundation of Taiwan, Hospice Malaysia, Mhoira Leng, Aditya Manna, Joan Marston, Claire Morris, Christian Ntizimira, Katherine Pettus, M.R. Rajagopal, and Rini Vella. Published in December 2015 by the Worldwide Hospice Palliative Care Alliance, London. Copyright © 2015 Worldwide Hospice Palliative Care Alliance. Author: Kate Jackson has asserted her right to be identified as the author of this work in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or other- wise, without the prior written permission of the publisher. *Names in case studies have been changed throughout unless otherwise requested by the people involved. Cover photo credits (clockwise from top): African Palliative Care Association, rights granted by The Diana, Princess of Wales Memorial Fund, Hospis Malaysia, Hospice Ethiopia Palliative Care and the Global Goal for Health Contents Acknowledgements Introduction 1 What is the Global Goal for Health? 2 What is palliative care? 3 Palliative care as an essential part of the Global Goal for Health 4 Maternal and child health 5 Communicable diseases, specifically AIDS and tuberculosis 7 Non-communicable diseases 9 Substance dependence syndrome 11 Universal Health Coverage 13 Access to essential medicines 17 Health workforce 19 Challenges to strong focus on palliative care as part of the Global Goals 21 Palliative care: a vision for 2030 22 Recommendations 24 Conclusion 26 References 27 Palliative Care and the Global Goal for Health Introduction This report has been produced by the Limited availability of and accessibility to International Association for Hospice and palliative care globally for people living with Palliative Care (IAHPC), the International life-threatening and life-limiting illness is a Children’s Palliative Care Network (ICPCN), prominent example of extreme inequality and and the Worldwide Hospice Palliative Care injustice. It is vital that governments and UN Alliance (WHPCA) for global and national agencies include palliative care in the new policy makers, development NGOs, funders, Global Goals and create an environment that palliative care organisations and advocates. The welcomes citizen advocacy. Citizens must aim of the report is to show how the Global empower themselves to work towards equitable Goal for Health and accompanying targets could access to palliative care as part of the Global support a focus on improving palliative care for Goal for Health. people with life-threatening and life-limiting illness globally and to make recommendations for inclusion of palliative care within the Global Goal for Health. People occupy beds in corridors in Myanmar due to lack of capacity Photo: Asia Pacific Hospice Palliative Care Network Palliative Care and the Global Goal for Health 1 What is the Global Goal for Health? The Global Goals were adopted by the leaders Global Goal 3 includes 13 targets. An inclusion of 193 UN member states at the UN General of palliative care can contribute substantially to Assembly in New York on 25 September 2015. many of these. Particularly, palliative care is a The Global Goals build on the Millennium key component of Universal Health Coverage as Development Goals set in 2000, and consist of defined by the World Health Organization.3 17 Goals plus their accompanying targets. These Goals aim to “build a better world by 2030”1 by The report will discuss how the global health ending poverty, promoting prosperity and well- goal and accompanying targets can support a being for all, protecting the environment and focus on improving palliative care for people addressing climate change.2 with life-threatening and life-limiting illness Palliative care is an essential component of the globally. Global Goals, being a key part of Goal 3: ‘Good health & well-being: Ensure healthy lives and promote well-being for all at all ages’. Targets of Global Goal 3 (those in bold are relevant to palliative care) 1. By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births. 2. By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births. 3. By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases. 4. By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. 5. Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. 6. By 2020, halve the number of global deaths and injuries from road traffic accidents. 7. By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes. 8. Achieve Universal Health Coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. 9. By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination. 10. Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate. 11. Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all. 12. Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States. 13. Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks. 4 Palliative Care and the Global Goal for Health 2 What is palliative care? Photo: African Palliative Care Association, rights granted by The Diana, Princess of Wales Memorial Fund The central focus of palliative care is to relieve professionals in medicine, nursing, spiritual care, suffering and to improve quality of life for psychology, social work and any others as needed. adults and children affected by life-threatening A key aspect of palliative care is to support family and life-limiting illness. This includes their members and carers, to improve their quality of life family members and carers. and well-being, an often neglected area of care. Definition of palliative care The World Health Organization (WHO) defines palliative care as: “an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illness, through the prevention and relief of suffering, the early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” 5 It is a holistic approach that aims to meet the needs of the whole person, not just to treat their clinical condition. It addresses the physical, social, psychological and spiritual issues facing people affected by life-threatening or life-limiting illness. Palliative care should be provided in all settings, including in the community, rural hospitals and highly specialised centres in urban areas. The patient and the family are the focus of care, which should be provided by different Photo: Hospis Malaysia Palliative Care and the Global Goal for Health 3 Pain is one of the most common and distressing Palliative Care Network (ICPCN) identified that symptoms faced by people with life-threatening less than 1% of children are receiving palliative or life-limiting conditions. Strong opioids, care.8 which are under strict international control, are the most effective way to treat pain. Of these, The Global Atlas identified people needing oral morphine is the easiest and the cheapest in palliative care at the end of life. When including the international markets. However, morphine people needing palliative care early in the and other opioids are rarely available in many course of their illness the number doubles to countries because of fears of diversion, misuse at least 40 million each year. In addition there and dependence. These fears are the result are several family members and carers for each of lack of awareness of policy makers and affected person. Therefore the real need far regulators and limited knowledge and skills exceeds the estimate published. of physicians, pharmacists and nurses
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