Palliative Care

Chronic Non-Communicable Diseases: A trojan horse for global palliative care.


Attending the World Health Assembly as a member of an NGO (Non Governmental Organization) is like sitting in a limited view seat in the second balcony for a Broadway or West End Show.   Where are the binoculars???!!!!  The delegates are on the third floor and I am on the sixth.
And a very interesting World Health Assembly. At a time when the WHO is over U$300m in debt and there is likely to be a 300 staff positions cut from the HQ staff of 2700, Margaret Chan, the Director General, is proposing changes to the WHO that will make it more efficient, more transparent and more accountable.
Bill Gates was an invited speaker as was the Prime Minister of Bangladesh, an interesting mix. Bill talked about the decade of the vaccine but no mention of NCDs.  The PM at least addressed non communicable diseases (NCDs) as well as the many other issues facing Bangladesh including global warming.  NCDs were meant to be the focus of discussions as each country’s representative (Health Ministers from the UK, NZ, Canada and the US; chief medical officers from others) rose to give a 5 minute address in the plenary session. 193 countries is a lot of 5 minute time slots. Almost all addressed NCDs but non addressed palliative care.  All are preparing for the NCD Heads of Government summit in New York in September of this year, and health ministers from around the globe were preparing for this in Moscow 2 weeks ago.
The Moscow Declaration does address palliative care as part of the NCD situation.  The NCD Alliance (http://www.ncdalliance.org/) has brought together 800 organizations that have committed to having palliative care addressed at the September Summit. At a briefing in Geneva on Tuesday night, hosted by Richard Horton the Editor of the Lancet, a leading primary care physician, asked “of what exactly will women be allowed to die?”  The response from Sir George Allenye, former director of the Pan AmericaHealth Organization, was classic. “I have to see my wife after this, so I am not going to quoted saying that women should be dying of anything.  But I don’t want women to be dying of childbirth, of sexually transmitted disease, of road accidents, of cervical cancer that could have been prevented by a vaccine and detected by screening, of diabetes caused by obesity.”
But women will die and increasingly will die of non communicable diseases around the world.That is why the NCD alliance is recognizing palliative care and its essential role in the relief of suffering.  But let me reassure you. This is not a means to restrict palliative care to those with only NCDs. The whole NCD movement is NOT about creating a silo for NCDs.  It is an opportunity to improve health care systems, to get children exercising, to reduce their weight and to stop smoking and reduce excessive alcohol use. Notable goals all round.  No it is an opportunity to work with those dealing with infectious diseases. In fact from a cancer perspective, at least 30% of cancers have an infectious or communicable disease origin.
So this is an opportunity to change the language of health, to create health care systems, rather than disease management systems. But ensuring the appropriate treatment of those with advanced disease, regardless of the etiology, and including palliative care, should be part of the world’s leaders in September. Lets keep our fingers crossed!!

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