Abstract
ContextPalliative care is gaining ground globally and is endorsed in high-level policy commitments, but service provision, supporting policies, education, and funding are incommensurate with rapidly growing needs. ObjectivesThe objective of this study was to describe current levels of global palliative care development and report on changes since 2006. MethodsAn online survey of experts in 198 countries generated 2017 data on 10 indicators of palliative care provision, fitted to six categories of development. Factor analysis and discriminant analysis showed the validity of the categorization. Spearman correlation analyses assessed the relationship with World Bank Income Level (WBIL), Human Development Index (HDI), and Universal Health Coverage (UHC). ResultsNumbers (percentages) of countries in each development category were as follows: 1) no known palliative care activity, 47 (24%); 2) capacity-building, 13 (7%); 3a) isolated provision, 65 (33%); 3b) generalized provision, 22 (11%); 4a) preliminary integration into mainstream provision, 21 (11%); 4b) advanced integration, 30 (15%). Development levels were significantly associated with WBIL (rS = 0.4785), UHC (rS = 0.5558), and HDI (rS = 0.5426) with P < 0.001. Net improvement between 2006 and 2017 saw 32 fewer countries in Categories 1/2, 16 more countries in 3a/3b, and 17 more countries in 4a/4b. ConclusionPalliative care at the highest level of provision is available for only 14% of the global population and is concentrated in European countries. An 87% global increase in serious health-related suffering amenable to palliative care interventions is predicted by 2060. With an increasing need, palliative care is not reaching the levels required by at least half of the global population.
Highlights
IntroductionIn 2014, the World Health Assembly passed a declaration calling upon all governments to integrate the provision of palliative care into their health plans.[1] The Lancet Commission Report on Palliative Care and Pain Relief in 2017 estimated that almost half of the people who die each year encounter ‘‘serious health-related suffering’’ that could benefit from palliative care, 80% of them in low- and middle-income countries.[2] The 2018 Declaration of Astana, focusing on primary care as an aspect of Universal Health Coverage and sustainable development goals, included palliative care across a spectrum of provision that must be accessible to all.[3]
The delivery of palliative care is seen increasingly as a global health issue
Spearman correlation analyses assessed the relationship with World Bank Income Level (WBIL), Human Development Index (HDI), and Universal Health Coverage (UHC)
Summary
In 2014, the World Health Assembly passed a declaration calling upon all governments to integrate the provision of palliative care into their health plans.[1] The Lancet Commission Report on Palliative Care and Pain Relief in 2017 estimated that almost half of the people who die each year encounter ‘‘serious health-related suffering’’ that could benefit from palliative care, 80% of them in low- and middle-income countries.[2] The 2018 Declaration of Astana, focusing on primary care as an aspect of Universal Health Coverage and sustainable development goals, included palliative care across a spectrum of provision that must be accessible to all.[3] Such high-level policy interventions, framed within the wider discourse of global health, are designed to support the worldwide improvement of palliative care and its integration into health systems. Progress is slow and it is unclear whether high-level policy interventions can escalate the speed and volume of palliative care development around the world.[6]
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