Advocacy to Integrate Palliative Care and Strengthen Health Systems in the Americas

By Afsan Bhadelia, PhD
Special to Pallinews

It was a great honor to serve as an IAHPC delegate for the 61st Directing Council meeting of the Pan American Health Organization (PAHO) held September 30 to October 4, 2024 in Washington, D.C. Discussions focused on strategies for better health within the Americas and member states recommitted to addressing key health challenges in the region by transforming health systems to be more resilient. PAHO Director Dr. Jarbas Barbosa called for regional coordination and collective action guided by the core principles of equity, excellence, integrity, respect, and solidarity.

Resolutions CD61/12, CD61.R8, and CD61.R11 that focused on strengthening responses to health emergencies, long-term care, and essential public health functions (EPHFs), respectively, were among those approved. 

As none of these resolutions explicitly referenced palliative care, IAHPC statements in support of these resolutions sought to highlight the importance of safe and affordable access to essential opioids for medical and scientific use to prevent the shortages experienced during the COVID-19 pandemic, the multifaceted benefits of alleviating serious health-related suffering through integration of palliative care into long-term care, and the win-win for people and health systems of actualizing palliative care as an essential component of primary health care. Member states Cuba and Jamaica cited palliative care in their interventions on the long-term care resolution, citing palliative care as part of their primary care agenda and as critical to ensuring people-centered care.

Urgent need to support unpaid caregivers and fight inequity

Overall, delegates repeatedly acknowledged the need to support caregiving, the majority of which is performed by women and through unpaid labor, and the urgency of  addressing the gendered aspect of long-term care. The commitment to leave no one behind and to account for worsening inequities among marginalized and vulnerable groups such as children, women, older adults, and migrants was central to the discourse across resolutions. Integrated and intercultural approaches to undertaking the EPHFs to better address social determinants of health and health inequities were welcomed. 

The broader discussion included calls to account for the impacts of climate crises on health, health information systems strengthening for improved health performance monitoring and evaluation, regulatory frameworks for high-quality care, as well as leadership and health workforce training to support all public health functions. Each of these has relevance for realizing universal palliative care in the region and globally. 

Side meeting on action for universal health coverage

A side meeting convened civil society members related to the resolution on social participation for universal health coverage, health and well-being, which was adopted at the 77th World Health Assembly in May 2024. Specifically, the meeting served as an opportunity to discuss regional needs and actions for meaningfully enhancing social participation. 

The fundamental role of civil society and its increased engagement in multilateral processes over the years was noted alongside an exchange of experiences, including of civil society members involved in pushing forward the social participation resolution. Reflections recognized the need for greater youth involvement and the importance of health journalists in citizen participation. Barriers to effective integration remain a challenge, especially the lived experience perspective.

View IAHPC's interventions:

• Agenda item 4.5 (long-term care) (at 9:11:11)
• Agenda item 4.8 (emergency, critical and operative care) (at 5:39)
• Agenda item 4.6 (EPHF) (at 2:50:48)

Afsan Bhadelia is a member of the International Association for Hospice and Palliative Care, and assistant professor, Department of Public Health, Purdue University, Indiana, USA. Her expertise is in global health and systems analysis, including from an equity lens and toward the development of value-based health systems. 

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