Dr. Katherine I. Pettus, PhD, IAHPC Advocacy Officer for Palliative Care Medicines, with her latest roundup of advocacy news.
When United Nations member states prepare for a meeting such as the High-Level Meeting on NCDs (non-communicable diseases) scheduled for October 2018, two countries usually lead the issue by drafting a ‘political declaration’ that expresses the will and commitment of the parties (governments). Staff at each country’s Permanent Mission, in consultation with staff in their capitals, negotiate the language over the course of a series of meetings, and eventually ratify a document that reflects their consensus. Governments then use that language to frame and prioritize national policies.
The mission staff who work at the United Nations in New York, and who negotiate the consensus language of Political Declarations and resolutions, tend to be employees of ministries of foreign affairs, not health or social services. The representatives of health ministries are usually found in Geneva, and those of ‘drugs and crime’ in Vienna.
Uruguay and Italy were in charge of producing the Zero Draft of Political Declaration on NCDs, released in early June. UN member states may now begin to negotiate the language and consult civil society and academic partners on the document, which will be finalized in October. The draft made no reference to palliative care as an essential service for people living with NCDs, but referred only to ‘prevention and control’ of NCDs. The prevention and control narrative ignores the needs of people who live and die with NCDs that have been neither prevented nor controlled. Furthermore, lack of language on palliative care deepens the existing policy vacuum.
The document’s focus is on prevention and control because its focus is development and trade, not health. This focus encourages taxation and monetary policies that affect the relevant ‘social determinants of health’ driving the epidemic of NCD morbidity and mortality. The claim that the ‘huge human and economic cost of non-communicable diseases contributes to poverty and inequality and threatens the health of peoples and the development of countries’ expresses the underlying economic rationality driving the Political Declaration.
While this is entirely legitimate in itself, the problem is that this is the only high-level declaration on NCDs. There is no parallel — or complementary — person-centered, high-level declaration on NCDs that focuses on promotion, treatment, rehabilitation, and palliative care. The ecosystem in which NCDs flourish and cause severe health-related suffering calls for a holistic approach that explicitly addresses both the social determinants and the needs of most affected persons and communities.
Interestingly, the PD is also peppered with statements about improving mental health, which, although an achievement in itself, is another reason to name palliative care as an essential service. Community-based palliative care supports the mental health and resilience of both patients and family members, thereby helping to prevent and control stress-related NCDs. The PD urges governments to provide ‘specialized care for people affected by NCDs,’ a catchall phrase that presumably includes palliative care, but needs to be unpacked in the operational paragraphs of the document.
IAHPC’s suggested text for the next iteration of the Political Declaration is here. We have distributed it among our partners and are now sharing it with IAHPC membership. It has been endorsed by the Asociación Latinoamericana de Cuidados Paliativos and all its members.
The Political Declaration approved at the 2012 High Level Meeting on NCDs mentions palliative care four times in the context of health system strengthening, providing a precedent for palliative care language in 2018.
Another exciting advocacy development is our participation in the Geneva Global Health Hub, or G2H2.
I was recently elected as Secretary of the Steering Committee, and will be working on preparations for Alma Ata 40 to ensure that palliative care is included in that political declaration as a key primary care service. The May G2H2 meeting ratified a declaration recognizing the radical nature of the 1978 Alma Ata meeting, and stating, among other things, that:
‘Health for All’ demands inter-sectoral collaboration and must provide access to prevention, promotion, treatment, care, rehabilitation, and palliative care to everyone within a sustainable framework.
To deliver on primary health palliative care, many countries will have to consider supporting palliative care education for primary health care providers, and revising regulations that prevent general practitioners from prescribing and dispensing internationally controlled essentials, such as morphine. I hope to attend this historic Alma Ata 40 meeting, which takes place in Astana, Kazakhstan, in October.
Stay tuned for updates on this event as well as reports from the preliminary meeting on the High Level Meeting on NCDs, which I will attend in July.
We have begun posting evidence-based policy briefs and short videos from the first cohort of the joint IAHPC/WHO Policy Brief Course in Palliative Care, held online in January and February 2018. Check them out on the Advocacy Page of our website.
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