Elsevier

The Lancet

Volume 391, Issue 10128, 7–13 April 2018, Pages 1391-1454
The Lancet

The Lancet Commissions
Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report

https://doi.org/10.1016/S0140-6736(17)32513-8Get rights and content

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Executive Summary

In agonising, crippling pain from lung cancer, Mr S came to the palliative care service in Calicut, Kerala, from an adjoining district a couple of hours away by bus. His body language revealed the depth of the suffering.

We put Mr S on morphine, among other things. A couple of hours later, he surveyed himself with disbelief. He had neither hoped nor conceived of the possibility that this kind of relief was possible.

Mr S returned the next month. Yet, common tragedy befell patient and caregivers

Section 1. Global burden of SHS

The key findings of our analysis are summarised in panel 5.

Section 2: An Essential Package with resources and interventions to respond to the burden of SHS

The Commission calls on all countries to ensure universal access to an Essential Package by 2030 to achieve SDG Target 3.8, which calls for UHC with financial risk protection. Ensuring effective access to the Essential Package (panel 2) implies taking a balanced approach to at the same time achieve SDG Target 3.5 on prevention and treatment of substance abuse.54

The Essential Package of palliative care health services is intended to guide policy makers in LMICs in choosing interventions across

Section 3. Strengthening health systems by integrating palliative care

In Haiti, there are no nursing homes, long-term ventilation facilities, or home hospice services. Opioids such as morphine are not freely available…Often, patients who are nearing the end of their lives are taken home to die where they often experience air hunger as well as pain. In state hospitals where the human and medical resources are low, patients in pain from trauma or malignancy are treated with medications like ibuprofen and acetaminophen […] Moreover, nurses are uncomfortable giving

Alleviation of the burden of SHS from life-threatening or life-limiting health conditions and with the end of life is a global health and equity imperative

Most high-income countries have responded to SHS with effective palliative care interventions, yet the needs of poor people have been neglected, and there is little or no access to pain relief or palliative care in LMICs.

More than 25·5 million people, 45% of the 56·2 million who died in 2015, experienced SHS, and these estimates exceed previous reports113 by about 25%. Furthermore, our estimates suggest that in 2015, an additional 35·5 million people with life-threatening or life-limiting

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