On April 5 and 6, the University of Miami hosted the Global Launch Symposium of the Lancet Commission Report, ‘Alleviating the Access Abyss in Palliative Care and Pain Relief — An Imperative of Universal Health Coverage.’ At the symposium, the Lancet Commission launched its findings and recommendations. The symposium featured plenary panels of leading global health and palliative care experts from around the world. Session topics included global and regional collective action, implementing an essential package of palliative care services, prioritizing vulnerable populations, and national planning and implementation, including a discussion of the situation in the United States, contrasting the opioid epidemic with the global pain crisis. The symposium was followed by a half-day of closed implementation workshops on the afternoon of April 6 specifically designed to convene national and regional representatives of palliative care organizations, with a focus on low- and middle-income countries and especially Latin America and the Caribbean.
In the introduction and welcome message to participants at the symposium, WHO Director General Dr. Tedros Adhanom Ghebreyesus asked all of us to work together toward a dramatic expansion in access to quality care on a global scale.
Led by Dr. Felicia Knaul, the Lancet Commission described how 61 million people are affected by severe health-related suffering, 80% of whom live in low- and middle-income settings; 45% of those dying annually experience severe suffering, including 2.5 million children. The Commission identified a highly cost-effective package of interventions to address this neglected burden of suffering. Commissioners called on the entire health community, indeed the whole of society, to take pain and suffering more seriously — and to take collective action to remedy the access abyss, without question the most disfiguring inequity in health care today.
During the symposium, Dr. Knaul, Director of the University of Miami Institute for Advanced Study of the Americas (which organized the symposium), presented the results of the three-year project involving 61 co-authors from 25 countries. Dr. Knaul and, later, IAHPC Board Member and Harvard University Associate Professor Dr. Eric Krakauer, described the essential package of palliative care services — including medicines, equipment, and staffing models — suggested for health systems worldwide and called for more balanced global policies to facilitate access to opioid analgesics to meet medical need while limiting non-medical use.
The Lancet Commission was able to:
On the second day, Liliana moderated a session on the role of global and regional associations and networks. During this session, representatives of the African Palliative Care Association (APCA), Asia Pacific Hospice and Palliative Care Network (APHN), Caribbean Association for Palliative Care (CARIPALCA), European Association for Palliative Care (EAPC), International Children’s Palliative Care Network (ICPCN), and the Latin American Association for Palliative Care (ALCP) presented and discussed how advocacy efforts and collaboration between academia and civil society will catalyze change globally, and in countries in each region.
In his closing remarks, Richard Horton, editor-in-chief of The Lancet, said, ‘How did it happen that palliative care lost the dignity debate? Palliative care is a discipline dedicated to improving quality of life by preventing and alleviating suffering. There can be few higher callings in medicine. Yet those who advocate “dignity in dying” have successfully claimed that the idea of dignity lies not in palliative care but in assisted dying for the terminally ill. ”The Lancet’s commitment will be to work with the Commission to expand its network of supporters and collaborators, and to publish regular country-by-country assessments of serious health-related suffering.
Before the end of the symposium, all participants agreed on a joint statement and call for action called the ‘Miami DECLARAcTION,’ which will be published by The Lancet in a future edition.
IAHPC will be working with the University of Miami to coordinate the implementation process for the recommendations. The implementation group includes representatives of palliative care civil society organizations as well as academia. More information on the Lancet Commission Report is available at the University of Miami website dedicated page and The Lancet website.
In the afternoon of the second day, we held two workshops on the implementation of the recommendations of the Lancet Commission Report with representatives from palliative care associations and other guests. The participants selected between two topics: ‘Promoting a global observatory on palliative care,’ and ‘Activating the Lancet Commission recommendations for integration of palliative care into health systems strengthening.’ The participants discussed strategies and future steps to further collaborate in the implementation of the recommendations.
Last month the IAHPC, in collaboration with the Dominican Association for Palliative Care and the Latin American Association for Palliative Care, developed and implemented a workshop on the availability and rational use of opioids in the Dominican Republic. Guests included pain specialists, palliative care specialists, representatives of the government public fund, and national Ministry of Health authorities and representatives.
Dr. Stefano Berterame, Chief of the Narcotics Control and Estimates Section of the International Narcotics Control Board Secretariat in Vienna, and Ms. Julianna Erthal, Officer of the International Narcotics Control Board Secretariat, sent a video for participants. Participants learned about international drug control treaties, the World Health Assembly Palliative Care Resolution, Sustainable Development Goals, human rights conventions, and recommendations delivered by the United Nations at the recent Special Session on the World Drug Problem to improve access to medicines regulated as narcotics. They also learned how countries can improve estimates to prevent stockouts of medications, and which medicines are essential to palliative care. Participants, working in groups, identified challenges to safe and effective access to medicines. Patients who need opioids for palliative care and pain relief in the Dominican Republic face many challenges, including having opioids in only three of the country’s hospitals, limited availability in cities other than Santo Domingo, and no access at all through street pharmacies. Adding to the problem is the high cost of medications.
At IAHPC we appreciate our members’ loyalty and support of our mission to improve and advance palliative care throughout the world. The IAHPC offers membership fees based on each country’s socio-economic level, making IAHPC membership affordable to palliative care advocates and workers from all over the world.
For four years, we have kept membership fees the same. However, due to challenges in securing funding and grants to support our core operations, on 1 May 2018 we implemented an increase in membership rates. These new fees, listed on our Members’ page, are still based on each country’s socio-economic level. They are much lower than those of other membership organizations, especially when compared to the many benefits IAHPC offers to its members, such as:
1. Free access to the CINAHL database with unlimited on-line access/downloads of full text articles from leading journals, including:
2. Eligibility for a travel grant to learn or teach through the IAHPC Traveling Scholarship and IAHPC Traveling Fellowship programs.
3. Eligibility for an IAHPC Program Support grant for core support for institutional members.
Until next month,
Lukas Radbruch, MD
Chair, Board of Directors
Liliana De Lima, MHA