Margaret Chan, the WHO’s Director General, was quite bold last week at the WHO Global Forum, Addressing the Challenge of Non Communicable Disease, a gathering of the World’s Health Ministers in Moscow. She stated:
“The rise of chronic noncommunicable diseases presents public health with an enormous challenge. For some countries, it is no exaggeration to describe the situation as an impending disaster. I mean a disaster for health, for society, and most of all for national economies. ………..Rest assured, in this day and age, ever more sophisticated and costly medicines, devices, and technologies will not be able to save the situation. They will not avert an impending disaster. Only smart, farsighted policies can do this.”
This Forum is a further step to the September UN High Level Summit on the prevention and control of NCDs in New York, an opportunity for the world’s leaders to step up and make a difference. These diseases are quickly overtaking “communicable diseases” as the leading killers around the globe. Already more people die of cancer around the world each year than from TB, HIV and Malaria combined. Lance Armstrong, at the start of his comeback, rode for the 27.5 million people around the world who had died from cancer in the 1274 days of that retirement.
And while it has been a struggle to find mention of Palliative Care in the Millennium Development Goals, Palliative Care has a place in this First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control’s Moscow Declaration.
Emphasize that prevention and control of NCDs requires leadership at all levels, and a wide range of multi-level, multi-sectoral measures aimed at the full spectrum of NCD determinants (from individual-level to structural) to create the necessary conditions for leading healthy lives. This includes promoting and supporting healthy lifestyles and choices, relevant legislation and policies; preventing and detecting disease at the earliest possible moment to minimize suffering and reduce costs; and providing patients with the best possible integrated health care throughout the life cycle including empowerment, rehabilitation and palliation.Section V, Preamble.
Cancer: Cost-effective interventions are available across the four broad approaches to cancer prevention and control: primary prevention, early detection, treatment and palliative care. Early diagnosis, based on awareness of early signs and symptoms and, if affordable, population-based screening improve survival, particularly for breast, cervical, colorectal, skin and oral cancers. Some treatment protocols for various forms of cancer use drugs that are available in generic form. In many low- and middle-income countries, access to care, oral morphine and staff trained in palliative care are limited, so most cancer patients die without adequate pain relief. Community- and home-based palliative care can be successful and cost-effective in these countries.Individual Health Care Interventions for NCDs.
A particular concern in low- and middle-income countries is access to palliative care. The availability of oral morphine and staff trained in palliative care are limited in many low- and middle-income countries, even though these services can be made available at very low cost, so that most cancer patients die without adequate pain relief or psychosocial support.Individual Health Care Interventions for NCDs
The availability of the oral morphine is further included in statements on what can be done with essential medicines at the International level. IAHPC (The International Association for Hospice and Palliative Care, http://www.hospicecare.com) currently has a working list of essential medicines for palliative care. The speedy approval of this list through the WHO process, would facilitate access to affordable, safe, effective and high quality medicine for palliative care. This all needs to be put in the public health model for palliative care, ensuring that policy changes also proceed. The documents talk about the availability of generic medications and ensuring the ability to procure these, an ongoing activity of the UICC’s Global Access to Pain Relief Initiative (GAPRI).
Finally, while September 2011 is a chance to broker an international commitment that puts NCDs high in the development agenda where they belong, it is equally a great opportunity to place palliative care firmly on that agenda both early in the course of a chronic NCD and at the end of life. As The Onion, a favorite news source, has stated, “the world death rate is holding steady at 100%.“
PPSG as the WHO Collaborating Center for Pain Policy and Palliative Care stands ready to continue its global efforts to improve access to palliative care.