Universality and Palliative Care - …

1 Dr Rifat Atun Professor of Global Health Systems Harvard School of Public Health Harvard University Universality and Palliative care Hacia la Universalidad Efectiva del Sistema de Salud: Acceso a Cuidados Paliativos y Control del dolor Instituto Nacional de Ciencias M dicas y Nutrici n Salvador Zubir n M xico D. F. 13 de octubre, 2014 1. Palliative care : magnitude of the challenge 2. An effective response to Palliative care needs 3. Lessons from global movements 2 Palliative care : a global tragedy Each year globally more than 40 million pa5ents each year need pallia5ve care , including 20 million at the end of life.

2 With carers included, an es5mated 100 million need care each year Yet only 8% of those who need it access services 3 Global need and provision of Palliative care 4 Source: WPCA Global Atlas of Palliative care Pain control at end of life The ugly face of the unacceptable equity gap 80% of people globally lack adequate access to medica5on for treatment of moderate to severe pain Around 90% of all morphine is used by 16% of the popula5on 5 Morphine equivalent total opioid use 6 Total opioid consumption (morphine equivalent in kg) in low/middle-income and high-income countries 7 Source: End of Life care .

3 Report for WISH 2013 Palliative care : a holistic view To help all those with advanced, progressive, incurable illness to live as well as possible un5l they die Suppor5ve and pallia5ve care needs of the pa5ent and the carers, including management of pain, and other symptoms and provision of psychological, social, spiritual and prac5cal support *Na5onal Council for Pallia5ve care . UK. 2006 8 Palliative care and health systems Globally, in 2011, only 58% (113/234) of countries were providing one or more pallia5ve care services Yet, only (20/134) had effec5vely integrated their pallia5ve care within their health systems to ensure wide access to all ci5zens.

4 42% of countries (100/234) s5ll have no iden5fied hospice and pallia5ve care service 9 Investment in Palliative care Global investments not known : an indictment of the neglect for pallia5ve care worldwide Yet, the cost of care in the last of year is es5mated to be 25- 30% of total health expenditures in high income countries, just for Medicare in the US accoun5ng for around US $484 billion for pa5ents aged 65 or more 10 1.

5 Palliative care : magnitude of the challenge 2. An effective response to Palliative care needs 3. Lessons from global movements 11 An effective global response: there is Strengthening of pallia/ve care as a component of integrated treatment within the con/nuum of care Execu5ve Board of the World Health Organiza5on (WHO) adopted on 23 January 2014 its first pallia5ve care resolu5on, recommending member states to develop, strengthen and implement, where appropriate, pallia5ve care policies to support the comprehensive strengthening of health systems to integrate evidence- based, cost- effec5ve and equitable pallia5ve care services in the con5nuum of care , across all levels, with emphasis on primary care .

6 Community and home- based care , and universal coverage schemes 12 WHO EB Resolution The Execu5ve Board requested the WHO Director General to: ensure that pallia5ve care is an integral component of all relevant global disease control and health system plans, including those rela5ng to noncommunicable diseases and universal health coverage, as well as being included in country and regional coopera5on plans 13 Palliative care as a human right 14 Source: WISH End of Life care Report, 2013 Innovative Palliative care models: global examples 15 Source.

7 WISH End of Life care Report, 2013 Key actions recommended by the WISH End of Life care Group 1. Make care of the dying a priority for all 2. Reduce unnecessary suffering 3. Improve knowledge and use data to drive innova5on 4. Maximize resources 5. Improve skills 16 Source: WISH End of Life care Report, 2013 1. Palliative care : magnitude of the challenge 2. An effective response to Palliative care needs 3. Lessons from global movements 17 A global strategy and an investment framework for Palliative care 1.

8 Global strategy with ac5ons, costs, benefits and outcomes 2. An investment framework Healthcare: not just a cost Emphasises benefits in health and economic terms Clear 5me horizon An organising principle for a core set of ac5ons Makes a case for alloca5on of scarce resources UNAIDS HIV Investment Framework Schwartlander B, Stover J, Hallett T, Atun R, et al. Lancet 2011; 377: 2031-41 Tuberculosis Strategic Investment Framework DOTS- based TB care package MDR- TB package TB/HIV package* Cri/cal Enablers Health/Development Synergies High Risk Group Interven/ons Based on: Stop TB Strategy Global Plan to Stop TB 2011-15 Post-2015 TB strategy CORE PACKAGES Investment for cancer: making a case Farmer P, Frenk J, Knaul F, Shulman L, Alleyne G, Armstrong L, Atun R, others.

9 Expansion of cancer care and control in countries of low and middle income. Lancet 2010; 376: 1186-93. Rodin D, Jaffray D, Atun R, Knaul FM, Gospodarowicz M. for The need to expand global access to radiotherapy. Lancet Oncology 2014; 15 :378 380. Global Health 2035 Global Strategy for Women and Children Universal Health Coverage I regard universal health coverage as the single most powerful concept that public health has to offer. It is inclusive. It unifies services and delivers them in a comprehensive and integrated way, based on primary health care .

10 Dr Margaret Chan, WHO Director-General ..the World Bank Group will support countries in their drive towards universal health coverage. WE MUST BE the generation that delivers universal health coverage. Jim Kim, World Bank President Cri5cal success factors: lessons from the AIDS response 1. Commijed leadership 2. Norma5ve and technical legi5macy 3. Transforma5ve ac5on 25 The AIDS Response: 1. Leadership The AIDS Response: 2. Legitimacy Evidence driven Clear communication Global Crisis: Global Action The AIDS Response: 3.