2016; Volume 17, No 12, December
Policy and Advocacy
Policy and advocacy matters – October highlights
Dr. Katherine I. Pettus, PhD, IAHPC Advocacy Officer for Human Rights and Palliative Care, reports on key advocacy meetings in Vienna, Geneva, Wsahington DC, and New York among others.
Rights of Older Persons: the Inter-American Convention, UNECE, and OEWGA
I was privileged to spend some time last month with my sister, who was hospitalized in Baltimore for a minor stroke. Between coordinating the move to her new apartment and visiting the hospital to play Scrabble for therapeutic purposes, I took the opportunity of being in the Washington DC area to meet with colleagues at the Organization of American States. I wanted to consult with them on advocacy strategies for partners in Latin America and the Caribbean to promote ratification of the Inter-American Convention on the Rights of Older Persons. Uruguay is the first country to ratify the convention. Costa Rica, Bolivia, Argentina and Chile have signed, but ratification, which would make the treaty the law of the land, is still pending.
IAHPC and partners are so interested in this Convention because it is the first treaty ever to stipulate a right to palliative care and controlled medicines for the relief of pain and symptoms, and to identify older persons as beneficiaries of that right. The population of older persons in Latin America, as in the rest of the world, is growing as life expectancy increases. While this trend signals public health progress, and is a resource for growing economies, it also heralds an increase in chronic conditions and life-limiting illnesses for older persons, whose pain and symptoms can be well managed with palliative care, particularly toward the end of life. Ratification will support national palliative care organizations in their efforts to integrate services and train providers.
The civil society branch of the OAS is encouraging national palliative care organizations to join OAS in order to remain informed of relevant meetings and participate in meetings as necessary. IAHPC is joining as a civil society partner of OAS in order to consult with delegates about palliative care at regular meetings. More information is available here and we will provide support if you need it.
Palliative care for older persons also came up at the meeting of the Working Group on Ageing of the United Nations Economic Commission for Europe (UNECE), which is planning its 3rd Ministerial Conference in Lisbon in 2017. As one of the three key panels will focus on ‘Ageing with Dignity’, I proposed speakers on the topic of palliative care, which supports living with dignity through life-limiting illness. This was well received and incorporated into the final report. I will attend the Open Ended Working Group on Ageing in December at UN Headquarters as part of the Worldwide Hospice Palliative Care Alliance (WHPCA) delegation, to ensure that delegations considering the rights of older persons include the right to palliative care and controlled medicines in their resolutions and reports as appropriate.
The World Health Organization (WHO): Expert Committee on Drug Dependence (ECDD) and Global Strategy for the Health Rights of Women, Children, Adolescents
The WHO hosted the 38th meeting of the ECDD in November, and IAHPC presented a statement on the need to conduct a pre-review of the therapeutic value of cannabis. Currently, cannabis is listed in Schedules I and IV of the 1961 Single Convention on Narcotic Drugs meaning that it is a dangerous, addictive drug with no medical use. Although the substance was widely used for millennia for medical purposes, and is currently consumed now for both recreational and therapeutic purposes, the WHO last reviewed it in 1935, almost thirty years before the United Nations officially banned it in 1961. IAHPC has joined many other international organizations in calling for a pre-review, rather than the weaker ‘update’ process, which would further delay a critical review and possible re-scheduling. Read more information on this topic here.
Other work with WHO in November included submitting a report in collaboration with the International Children’s Palliative Care Network (ICPCN) and WHPCA to the Global Strategy for Women, Children, and Adolescent Health. Our contribution focused on the right of all these groups to palliative care.
Sustainable Development Goals
As many regular readers of this policy report will be aware, there is an important link between the Sustainable Development Goals (SDGs), which replaced the Millennium Development Goals, and palliative care, particularly in Target 3.8 of Goal 3 “Ensure Healthy Lives for All at All Ages”. Target 3.8 calls on countries to develop Universal Health Coverage (UHC) and ensure access to essential medicines. The WHO definition of UHC includes palliative care, which entails the use of essential controlled medicines such as morphine and oxycodone. In order to achieve the Sustainable Development Goals, countries must integrate palliative care and improve access to controlled medicines. I am working with Claire Morris of the WHPCA to prepare a report on this for the NCD Alliance and to encourage countries to report on their progress integrating palliative care during the 2017 High Level Platform in New York. The Economic and Social Council (ECOSOC) of the Untied Nations has requested all its functional organizations, such as the Commission on Narcotic Drugs (CND) and the Crime Prevention and Criminal Justice (CPCJ), to align their work with the SDGs, which call on countries to “leave no one behind”.
Palliative care is the quintessential ‘leave no one behind’ medicine as it offers care to all patients, from neonates to the frail elderly, suffering from serious illness.