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E2 Global palliative care development: promoting access to services and essential medicines, through understanding of international policy and processes
  1. Joseph Clark
  1. Wolfson Palliative Care Research Centre, University of Hull, UK


The modern hospice movement began in the 1960s. Since then, the practice of palliative care has spread such that services now exist in at least 136 of the world’s 234 countries. However, despite increased service availability in the last 50 years, most of the world’s population lack access to palliative care despite significant need. Within this time-frame, global health actors have emerged and significantly influenced national healthcare systems, spending hundreds of billions of dollars in the process. Yet, despite the importance holistic approaches to care of the seriously ill, until recently, palliative care has received little global attention and almost no global funding. This lecture will identify challenges and opportunities for the future development of palliative care through understanding of international policymaking and processes.

Prioritisation by global health policymakers has the potential to accelerate the development of palliative care worldwide through global resolutions and financing. In context of serious global need for palliative care, Global Social Policy perspectives will be used to show how global health priorities are not made simply on the basis of need, but based upon how important the problem is, how straightforward the problem is to solve and the benefits which accrue from solving a problem. This raises serious questions for palliative care advocates and researchers. Whilst advocates argue that palliative care is feasible in all settings, awareness of palliative care remains low and countries with limited, or no palliative care services also face significant public health challenges.

This lecture will argue that advocates must move beyond human-rights approaches to ‘re-frame’ palliative care as an issue for the international development community. Serious illness impacts upon social and economic wellbeing of societies. Researchers must do more to provide evidence of the positive effects which palliative care can have on economic and social wellbeing, to alter discourse so that policymakers ask: ‘what does it cost if we do not implement palliative care?’

Dr Clark will argue that one of the few global policies of direct relevance to palliative care—the Single Convention on Narcotics—has served to limit palliative care development and availability of appropriate analgesia, by reinforcing ‘Opiophobia’ (fear of opioids) through implementation of global policies. Further questions will be raised about the pace of improvements in access to pain management around the world by demonstrating that increases in stocks and consumption of morphine are often out-stripped by increasing need.

The lecture will conclude by making positive recommendations for changes to global drug regulations and point to how research can better support advocacy efforts, by producing evidence of the feasibility and benefits of palliative care, from economic, rather than human-rights perspectives.

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