By Yasmin Noone
The Australian government, Palliative Care Australia and other end-of-life care advocates have helped to achieve United Nations action on palliative care which will help ensure that every dying individual throughout the world has access to pain management services and adequate pain relief.
Last week, a United Nations High-Level Summit agreed to embed a palliative care ‘indicator’ within its Global Monitoring Framework on Non-Communicable Diseases (NCDs).
That means that every country in the world can now use the same method or ‘indication’ to measure their pain management performance.
This is expected to lead to international improvements in palliative care data collection, cross-country comparisons on palliative care performance levels and worldwide pain control goal-setting.
The indicator will allow a country to calculate its number of deaths from cancer, in which pain was adequatley managed. In the UN’s terms, the indication is the “Morphine equivalent consumption of strong opioid analgesics (excluding methadone) per death from cancer”.
According to the CEO of Palliative Care Australia (PCA), Dr Yvonne Luxford, the indication is a relative way that countries can measure their pain management performance and hopefully help improve access to, and awareness of, palliative care services throughout Australia and around world.
It will also help the international community to monitor trends and assess information about a country’s policy-related progress on NCDs.
“The indicator can show whether there has been an improvement or not,” Dr Luxford said.
“It’s more that countries can now self-identify their base levels and what improvements they can make.”
The inclusion of the measurement method marks the first time that a palliative care indicator has been included indicator in any global monitoring framework.
“It’s long overdue and it’s incredibly exciting. It really demonstrates that the worldwide community understands how important it is for people to die well and live well until the end, and support [a dying person’s] family.”
Dr Luxford also stated that the indicator is vital so that the worldwide community – not just one nation’s government – can truly understand what the size of the problem in a specific country is, define where the problems lay and then seek improvement.
“In big countries like Canada, the UK, Australia and the US, probably 11 per cent of people who die from cancer aren’t receiving all the pain relief possible.
“In the low and middle income countries, around 70 per cent of people who die from cancer don’t receive adequate pain relief.
“It becomes quite ridiculous because morphine is so cheap.
“In places like Uganda, morphine only costs 25 cents for a daily dose so it’s not about the money. [Access is not] related to money. It’s about other issues.
“There’s legislative and legal limitations which stop people getting access to drugs [for pain management purposes].
“Then there’s the training of health workers and the prevalence of [misunderstanding of use of opioids fear of addiction…..
“All these issues come into play but we need to make sure that people do have access to these incredibly cheap drugs that make a world of difference to the quality of a person’s life….until they die.”
Currently, 42 per cent of the world’s countries have no identified hospice and palliative care services, with this figure jumping to 49 per cent in the Asia Pacific region.
“…People continue to die in pain around the world.
“Ninety nine per cent of deaths with untreated pain from cancer and HIV occur in the developing world, where we must improve the availability of palliative care and related medications.
“Support from Australia and internationally for this indicator will help achieve this.”
The new UN indication follows on a previous UN political declaration, passed last year, which states that worldwide access to palliative care is essential for every person in every country – developed or third world.
Dr Luxford said the indicator approval was the result of a detailed process of international negotiations and advocacy.
PCA campaigned for the inclusion of the palliative care indicator with the help of the Minister for Health, Tanya Plibersek; the Minister for Mental Health and Ageing, Mark Butler; the federal Department of Health and Ageing; the Public Health Association of Australia; Medicines Australia; the Pharmacy Guild of Australia; the Worldwide Palliative Care Alliance and others.
“We and our international colleagues lobbied hard for palliative care to be included in the political declaration. We had success and were really happy with that.
“It was absolutely fantastic….But, you can have 15,000 policies that state how something is a great idea but [you need] to be able to report against it.
“So it was important that when development the monitoring framework, that palliative care was included as an indication.”
To read more about which countries backed the indicator inclusion and which ones advocated for a change, visit the ehospice website