Global atlas identifies greatest need for palliative care in low-and middle-income countries

Only 1 in 10 people who need palliative care - that is medical care to relieve the pain, symptoms and stress of serious illness - is currently receiving it. This unmet need is mapped for the first time in the "Global atlas of palliative care at the end of life", published jointly by the WHO and the Worldwide Palliative Care Alliance (WPCA).

More than just pain relief

Palliative care is more than just pain relief. It includes addressing the physical, psychosocial and emotional suffering of patients with serious advanced illnesses and supporting family members providing care to a loved one.

About one third of those needing palliative care suffer from cancer. Others have progressive illnesses affecting their heart, lung, liver, kidney, brain, or chronic, life-threatening diseases including HIV and drug-resistant tuberculosis.

It is estimated that every year more than 20 million patients need palliative care at the end of life. Some 6% of these are children. The number of people requiring this care rises to at least 40 million if all those that could benefit from palliative care at an earlier stage of their illness are included. Hospice and palliative care often encompasses some support to family members, which would more than double care needs.

Greatest need in low-and middle-income countries and for noncommunicable diseases

In 2011, approximately 3 million patients received palliative care, the vast majority at the end of their life. Although most palliative care is provided in high-income countries, almost 80% of the global need for palliative care is in low- and middle-income countries. Only 20 countries worldwide have palliative care well integrated into their health-care systems.

"The Atlas shows that the great majority of the global need of end-of-life care is associated with noncommunicable diseases such as cancer, heart disease, stroke and lung diseases," says Dr Oleg Chestnov, WHO Assistant Director-General for Noncommunicable Diseases and Mental Health. "While we strengthen efforts to reduce the burden of the biggest killers in the world today, we must also alleviate the suffering of those with progressive illness who do not respond to curative treatment."

Integrate palliative care as essential health-care component

The Atlas calls on all countries to include palliative care as an essential component to every modern health-care system in their moves towards universal health coverage. This means addressing barriers such as:

• lack of policies recognizing palliative care and the need for care both at the end of life and during progressive illnesses;
• lack of resources to implement services, including access to essential medicines, especially pain relievers;
• lack of knowledge of health-care professionals, community volunteers and members of the public about the benefits of palliative care.

"Our efforts to expand palliative care need to focus on bringing relief of suffering and the benefits of palliative care to those with the least resources," adds David Praill, Co-Chair of the WPCA. "This will take courage and creativity as we learn from each other how to integrate palliative care into existing but very limited health-care systems."

Last week, the Executive Board of WHO called on countries to strengthen palliative care and to integrate it into their health-care systems. It is expected that the Sixty-seventh World Health Assembly will discuss the subject in May 2014.

The importance of palliative care is being emphasized by the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020 and the most recent WHO essential medicines list that includes a specific section on medicines for palliative care.