Professional Documents
Culture Documents
http://www.thelancet.com/commissions/palliative-care
The night of my high school graduation dance visiting my
father, Sigmund Knaul, at Mount Sinai Hospital, Toronto a
few weeks before his death from cancer. May 1984.
Hospital Regional de Ciudad Guzmán, Zapotlán el Grande, Jalisco, México
Overview of Lancet Commission and Report
• Chair, co-chair
• 33 commissioners
• 61 co-authors from
over 25 countries
Led by the
University of Miami in
collaboration with
Harvard University
5 Key Messages
1. Alleviation of the burden of serious health-related suffering from life-
threatening or life-limiting conditions and at end-of-life is a global health and
equity imperative.
3. LMICs can improve the welfare of poor people at modest cost by publicly
financing the Essential Package of palliative care and through full integration
into Universal Health Coverage.
25.6 million
35.5 million
61.1 million
Symptoms (15): physical (11) and psychological (4); days with SHS
Dementia
MS pain
Mild pain
Fatigue Dyspnea
Weakness
Itchiness Wounds
Anxiety
Bleeding Psychological
Symptoms
Measuring SHS:
Symptom: Pain,
by health condition HIV
MSD
Pain
Malignant neoplasm
(except leukemia)
Injury
Cerebrovascular
diseases
Global burden of serious health-related
suffering (SHS) in 2015
25.5 millon deaths
• 45% of the 56.2 millon
deaths worldwide
And…
• at least 35.5 million
5.3 million children with SHS
people experienced
• 99% are in LMICs
SHS (non-decedents) • 88% of deaths: avoidable
• 230,000 deaths
• 37% of the total
• 240,000 patients
• 150 million days
• Cancer, HIV/AIDS, injuries,
dementia, liver and lung
diseases
Outline
1. Global Need: Serious Health-related
Suffering
2.Unmet need: level and
equity
3. Intervention: an essential package
4. Strengthening the global and national
health systems
5. Next steps
“In agonizing, crippling pain from lung cancer, Mr S came to the
palliative care service in Calicut, Kerala, from an adjoining district a
couple of hours away by bus. His body language revealed the depth of
the suffering.
Mr S returned the next month. Yet, common tragedy befell patient and
caregivers in the form of a stock-out of morphine.
• The 50%
poorest: <1%
• The 10%
richest:
almost 90%
Distributed opioid morphine-equivalent
mg/patient & (% of SHS palliative care need)
Russia:
W. Europe: 124 mg (8%)
Canada: 18,316 mg (870%)
68,194 mg (3090%)
China:
314 mg (16%)
USA:
Vietnam
55,704 mg (3150%) 125 mg (9%)
Haiti:
5.3 mg (0.8%) India:
Mexico: Nigeria: 43 mg (4%) Australia:
562 mg (36%) 0.8 mg (0.2%) 40,636 mg
(1890%)
Bolivia: Uganda:
53 mg (11%)
74 mg (6%)
Argentina:
2,374 mg (115%)
Source: Author calculations using INCB (2010-13) and GHE 2015 (www.incb.org,
http://www.who.int/healthinfo/global_burden_disease/en/) . See Data Appendix for methods.
Total medical and palliative care unmet need
for opioid analgesics (in DOME)
Benchmark: Western Europe High-Income
Palliative Care need Projected total need Western
Europe High
Income
Countries:
Austria
Belgium
Denmark
Finland
France
Germany
Greece
Iceland
Ireland
Total need: 82 Tons Italy
(Unmet need = 49 Tons) Luxembourg
Malta
Netherlands
Norway
Low Portugal
Income Spain
Lower middle Sweden
regions Switzerland
Upper middle Total need: 581 metric tonnes United Kingdom
High (Unmet need: 548 metric tonnes)
Equipment 31 5 31
Total 219 182 248 119 115 194 796 694 793
% public health expenditure4 8.8 7.3 9.9 1.0 1.0 1.7 1.0 0.8 1.0
• At current prices:
$US600 million
• At best
international
prices:
$US145 millon
For all children with SHS in low income countries:
$US 1,034,000
Outline
1. Global Need: Serious Health-related Suffering
2. Unmet need: level and equity
3. Intervention: an essential package
4.Strengthening the global and
national health systems
5. Next steps
The Diagonal Approach to
Health System Strengthening
Rather than focusing on either disease-specific vertical or
horizontal-systemic programs, harness synergies that provide
opportunities to tackle disease-specific priorities while
addressing systemic gaps and optimize available resources
Diagonal strategies add value:
Drive systemic change
Compound, which means increase effectiveness at a given cost
Bridge disease divides using a life cycle response
Avoid the false dilemma of disease silos
CARIPALCA
Four streams of work
following report release:
1. Research: ex. Suffering-intensity-
adjusted life years (SALYs)
2. Global collective action: ex. INCB
3. Advocacy and awareness
4. In-country implementation
Advocacy Tool-kit and Background Resources
– Advocacy Toolkit:
www.miami.edu/lancet --> background resources
• Fact sheets
• Country data sheet
• Video presentation
• Wall map
• Data Appendix
Miami DECLARAcTION:
Outcome of Launch, April 2018
Forthcoming, The Lancet
• Statement of action by critical mass
gathered at symposium to evoke change
– Commitments by advocates and researchers
– Calls to task diverse stakeholders
http://www.thelancet.com/commissions/palliative-care