A Global Victory for Palliative Care

On May 23, the World Health Organization passed its first ever stand-alone palliative care resolution. It calls on all member states to integrate palliative care and pain relief into their national health systems. I spoke with Mary Callaway, director of the Open Society International Palliative Care Initiative, about its significance.

What does this resolution do?

World Health Organization resolutions serve to encourage member states to make policy changes and to provide guidance on global health policy that should be implemented at the country level. This historic resolution calls on all member states to integrate palliative care and pain relief into their national health systems.

This resolution is important because it requires the WHO to develop a global implementation plan to:  

  • work with national governments to integrate palliative care into national health policies;
  • educate and train health care professionals;
  • remove legislative barriers restricting access to opioid medications for pain relief;
  • ensure essential palliative care medicines are available;
  • provide palliative care across all levels of care including inpatient facilities and home care.

Why is a global palliative care plan needed?

More than six billion people worldwide have little access to pain relieving medications for the control of pain. The WHO estimates that of the 58 million people dying annually, about 80 percent would benefit from palliative care in their final days of life. 

The world is experiencing a “silver tsunami,” with a growing number of older persons and a heavy burden of noncommunicable diseases like cancer, heart disease, and neuro-degenerative diseases. The majority of people who need palliative care live in low- and middle-income countries where there is little access to even basic palliative care services. Adults and children with life-threatening illnesses require treatment and palliative care at the same time, so their pain and symptoms can be managed and they and their families can receive the psychological, social, and spiritual support they need. 

How did the Open Society Foundations and other palliative care advocates achieve this victory?

This resolution is the result of years of advocacy by the Open Society Foundations; many individual palliative care champions; and national, regional, and international palliative care associations. These include our grantees, like the African Palliative Care Association, Asia Pacific Hospice Network, European Association for Palliative Care, International Association for Hospice and Palliative Care, International Children’s Palliative Care Network, Worldwide Palliative Care Alliance, and Human Rights Watch.

Advocates held thousands of meetings with health policy makers, UN agencies, government development agencies, and private NGOs—educating them about palliative care and the barriers to essential pain relieving medicines, and supporting study tours for government officials to see firsthand what palliative care really is. 

Advocates published dozens of articles in leading medical journals and gave thousands of presentations at national, regional, and international medical conferences on cancer, pediatrics, geriatrics, cardiology, and HIV. All of this got palliative care on the agenda of lawyers, health economists, and spiritual leaders.

These efforts convinced numerous ministries of health to create working groups charged with reforming health care education and training, developing health policies and legal frameworks, reforming drug policies, revising health care financing, reallocating human resources, and creating palliative care services in existing health facilities.

What are the next steps for advocates to ensure that palliative care is a universally recognized right?

Implementation of the resolution will require coordinated collaboration and leadership.

The WHO will need time to develop their implementation plan, and this will require the technical assistance of palliative care experts. International, regional, national and local palliative care leaders, human rights advocates, and leading international organizations will need to work with the WHO, and local governments to create the necessary frameworks to integrate palliative care in their countries. 

The development of the field of palliative medicine and the practice of palliative care began initially in the UK in the early 1970s. In the intervening years, amazingly dedicated health care providers made palliative care services possible. They often volunteered their time and expertise because they knew there was a better way to care for patients—that they had a right to pain and symptom relief, and families had the right to support. 

Local fundraising efforts—from concerts to marathons—led by patients’ families have raised public awareness and supported community services. Government officials’ personal experiences, watching their own loved ones die in needless suffering, ignited their own desires to improve the health care systems in their countries.  

Change takes time and requires stakeholders to work together. It doesn’t happen linearly, but with many strands of overlapping work intertwining and building on each other.

The WHO resolution is a truly pivotal victory. But in so many ways, the work has just begun.

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I have been working as a volunteer in end of life care, specifically at Mt Sinai Hospital PCU and with the organization, Accompany and Comfort in NYC. Through my own personal experience assisting and advocating for my own mother, who resided in Palm Beach FL before her recent death, I am determined to move the ship there and create a long needed initiative to implement Palliative Care for the elderly. It is my intension to focus attention on a problem that desperately needs to shift. I am very interested in meeting with Mary Callaway or Sebastian Krueger.

This is great news and it makes me glad that our Foundation started an initiative in this direction with some 40 nurses and community health officers about 5 years ago although there has been much frustration due to financial challenges. Unicef in Nigeria is also facilitating a national social policy that is capturing similar issues, so we hope that we shall be able to lobby its domestication in Nigeria. Keep up the good job

You should come in Serbia to see what happen in our country where Serbian pharmaceutical company produce fake Methadone incapable to stop pain, craving, and withdrawal symptoms. Worse crime against addicts ever seen in World. No one from world know and no own from world want to stop pain, agony and suffering of people who get fake Methadone without opiate effect on receptors=result no analgesic effect. Someone should stop killing of people in middle of Europe.

May God bless you all keep it up thanks and have a nice time global family

This is a big push.

However, meaningful progress can be achieved only if the awful narcotics laws in countries are changed. These are ONE of the main prohibiting reasons for easy access to pain and palliative care.

The OTHER reason is costing and the enormous profits that pharmaceutical companies make. They have to be reigned in somehow. In India a 10 mg morphine tablet costs about US 15 cents, while in the US and other parts of the world it costs about US $ 15 at least.

In India despite the cheap price morphine per capita consumption was about .2 mg in 2012. Down from .9 mg in 1985 when the draconian new Narcotics Drugs and Psychotropic Substances Act was implemented. Early this year the too suspicious portions of the Act rigidly controlling morphine supply were made quite lenient, and it is hoped that pain and palliative care in India would be more widespread in future.

In countries where the laws are not rough on the user but the prices are availability of morphine is restricted to just about 40-50% of the population.

I think that this also ought to bother WHO at least.

i am from sierraleone a founder of Tombo a well earth Organization, an Organization that care for the health of mankind in the rural area of sierraleone,because the rural area people are suffering with pains.so my Organization is looking forward to me with Mary Callaway & Sebastian Krueger in person, because we don't know about this in sierraleone. we are in the rural area.so we want this to be known so that all of us can move this progress ahead.if we have the Financials to support this.than we are looking to was that,for implementation.

After 2004 people with addictions are by law given the right to the same health care as everyone else ; this aint worth the papir its written on. Pain relief shold be for all , also opiod addicts. Norwegian gov. must remove the power from Lar , & give it back to G.P.s.

Without financial affordability and payment it is impossible to achieve hospice services. Countries cannot pay for TB, HIV, Hep C services and they cannot pay for palliative care. Primary health care system is overwhelmed and community health workers cannot carry professional health care hats. It is not only access to medicines and legal barriers. Palliative care is a part of health care and poor countries just do not have it – health care for all.
Many policies will stay policies forever and in my opinion vertical approaches is not sustainable and cost effective in health care. Charity based activities always will depend on charity and some people may benefit but not all and everybody.

huge congratulations from the Team at South Coast Hospice. KwaZulu Natal South Africa.
We are committed to partnering with our Department of Health for positive patient outcomes and in that we have a mobile clinic that assists overburdoned Primary Health Care Clinics 4 days a week. Combined with the daily treatment of people living with MDR/TB in their homes. Palliative Care makes a difference..

This is surely a great victory for all the palliative care advocates globally. Living and dying with dignity can now be achieved .... The work has surely just begun.

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