Something as basic as pain management reaches too few, too late. A new report published online in The Lancet Thursday says that worldwide, more than 25.5 million people a year (almost half of all deaths in 2015), including 2.5 million children, die with serious physical and psychological suffering as a result of disease, injury or illness.
“At least 35.5 million people who did not die also experienced serious health-related suffering [in 2015], meaning that the total number of people needing palliative care per year was over 61 million, including 5.3 million children,” Dr M R Rajagopal, co-author of the Lancet study on Global Access to Palliative Care and Pain Relief told The Indian Express.
“More than 80% of people needing palliative care live in low- and middle-income countries. For India it is estimated that at least 10 million people are likely to require palliative care every year,” said Dr Rajagopal, chairman of Pallium India, and director of the Trivandrum Institute of Palliative Sciences (WHO Collaborating Centre for Training and Policy on Access to Pain Relief).
Almost 80% of deaths requiring palliative care in low-income countries are preventable with adequate prevention, treatment and care interventions, said Professor Felicia Knaul, co-chair of the Commission from the University of Miami, in a statement.
The Lancet Commission on Global Access to Palliative Care and Pain Relief is the result of a three-year project involving 61 co-authors from 25 countries.
In the first analysis of its kind, the authors estimate the global need for palliative care and pain relief by devising a new measure of serious health-related suffering. They analysed 20 life-threatening and life-limiting health conditions (including HIV, cancers, heart disease, injuries and dementia) and 15 corresponding symptoms (including pain, fatigue, wounds, anxiety and depression) that were most frequently associated with the need for palliative care and pain relief.
In Kerala, which has 170 institutions providing palliative care, a palliative care policy was introduced in 2008, Dr Rajagopal said. Today each gram panchayat has a palliative care nurse providing home visits to every bed-bound patient once a month.
“Oral morphine in palliative care in most countries is nonexistent. While stock-outs are no longer a problem for palliative care in Kerala, [at other places] there is a near total lack of access to morphine to alleviate pain and suffering,” Dr Rajagopal said.
The study highlights inequities in access to morphine for palliative care. Mexico meets 36% of its need, China 16%, India 4% and Nigeria 0.2%. In some of the world’s poorest countries, such as Haiti, Afghanistan and many countries in Africa, oral morphine in palliative care is virtually nonexistent. Of the 298.5 tonnes opioids in morphine distributed worldwide, 10.8 tonnes (3.6%) is distributed in low- and middle-income countries, with 0.1 tonne (0.03%) in low-income countries.