The Institute for Palliative Medicine at San Diego Hospice

The Need

The need for comprehensive global palliative care is great

There is an urgent need for palliative care globally. While approximately 1 billion people have access to most of the World Health Organization's Essential Medicines, including opioids and at least some palliative care services (primarily in Australia/New Zealand, Europe and North America), more than 5.5 billion people do not.

With the increasing incidence of illness and the success of modern medicine, more people are living with advanced life-threatening illnesses for much longer. As a result, the need for pain relief and palliative care has become a major public health issue and an urgent imperative, worldwide.

Medical experts working with the World Health Organization (WHO) estimate that more than 60% of the 50 million deaths worldwide each year, especially the six million who die of cancer and the three million who die of AIDS, could benefit significantly from palliative care services if they receive them early enough in the illness experience, i.e., palliative care would prevent and relieve suffering, improve quality of life, ensure a safe and comfortable death, and help the bereaved rebuild their lives. Some patients would even live longer. The 600 million elderly worldwide (greater than 60 years of age) are particularly vulnerable as their risk of developing one or more life-threatening illnesses e.g., cancer, congestive heart failure, diabetes, dementia, etc. and becoming dependent increases as they age.

Today, in Europe, North America and Australia/New Zealand (areas that have developed healthcare systems), approximately 1 billion of the world's population have access to palliative care services and many of the opioid analgesics needed to control moderate to severe pain. However, in most of these countries there is still considerable need for extensive education for all healthcare workers, expanded and enhanced palliative services, and earlier/broader use of opioids and other palliative care medications and therapies.

In most developing and transition countries, where more than five of the 6.7 billion people in the world live, including more than 50% of the 600 million elderly, there is almost no pain control or palliative care. Yet, given 1) their disease demographics (80% of new cancer cases in developing countries present with late-stage disease, e.g., stage III (advanced) or IV (metastatic) cancer), and 2) their lack of resources to purchase/provide medical therapies even for patients who present with early stage disease, palliative care is the most appropriate focus of care for most patients with life-threatening illnesses in these countries (rather than just abandoning them to die).

Annually, 10 million people worldwide are diagnosed with cancer (50% of these are in developing countries) and 6 million die from cancer. By 2020, global cancer rates are expected to increase by 50% to 15 million new cases a year. At the same time, each year more than 5 million people are infected with HIV disease and more than 3 million people die of AIDS. Cancer and AIDS are excellent entry points for developing palliative care capacity as these diseases cause so much suffering for patients and families. Up to 60% of patients experience moderate to severe pain that requires opioid analgesics to control it, as well as exhibiting a wide range of other issues that cause considerable patient/family suffering. Needs for care are often intense and protracted. Family caregivers may lose their future; families go bankrupt buying medications and therapies, and providing care.

For Further Information:

International Programs
The Institute for Palliative Medicine at San Diego Hospice
4311 Third Avenue
San Diego, California 92103-1407
+1 (619) 278-6225