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Improving Palliative Care at a Global Level

Improving Palliative Care at a Global Level. Kathleen M. Foley, MD Patient Advocacy Meeting Budapest June 29-30,2009. 2002 WHO Definition of Palliative Care

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Improving Palliative Care at a Global Level

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  1. Improving Palliative Care at a Global Level Kathleen M. Foley, MD Patient Advocacy Meeting Budapest June 29-30,2009

  2. 2002 WHO Definition of Palliative Care "Palliative care is an approach which improves quality of life of patients and their families facing life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual"

  3. Palliative Care as a Public Health Issue • affects all people • need for better information on end-of-life care • potential to prevent suffering • potential to prevent disease

  4. Palliative Care as a Prevention Model • prevents needless suffering • provides peer education • provides patient centered care • incorporates self-management programs

  5. The continuum of palliative care Life Closure Therapies to modify disease(curative, restorative intent) Actively Dying Death Diagnosis 6m BereavementCare Therapies to relieve suffering, improve quality of life

  6. WHO Public Health Model Policy Outcomes Context DrugAvailability Education Implementation

  7. WHO Public Health Model Policy Outcomes Context DrugAvailability Education Implementation

  8. WHO Public Health Model Policy Outcomes Context DrugAvailability Education Implementation

  9. Consumption of Morphine in Europe mg/capita, 2001 Mg/capita Global mean5.4 mg/capita Ukraine1.3 mg/capita Source: International Narcotics Control Board; United Nations Demographic Yearbook By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2004

  10. 2006 Global Consumption of Morphine Moldova Serbia Armenia Hungary Georgia Albania Romania Ukraine Sources: International Narcotics Control Board; United Nations population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2008

  11. EURO Consumption of Morphine, 2006 Armenia Serbia Georgia Ukraine Hungary Albania Romania Moldova Sources: International Narcotics Control Board; United Nations population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2008

  12. World Health Assembly Cancer Prevention and Control 58.2225 May 2005 • Urges member states to ensure the medical availability of opioid analgesics • Requests the WHO Director General (1) to explore mechanisms for funding cancer prevention, control and palliative-care, especially in developing countries. (2) to examine with the International Narcotics Control Board how to facilitate the adequate treatment of pain using opioid analgesics.

  13. INCB Annual Report for 2004March 2005 “In view of the continued inadequate global consumption of opiates for the treatment of pain, the Board reiterates that it would welcome a further increase in global demand for opiates. The Board encourages Governments to take steps to increase the medical use of opiates in their countries in order to meet their real needs for the treatment of pain.”

  14. WHO Access to Essential Medicines Program • Created an office for controlled substances as essential medicines • Appointed Willem Scholten as program director • To develop a strategic plan with NGO partnerships

  15. WHO Access to Essential Medicines Program • To focus on low and medium resource countries • To support pain and palliative care as a human right

  16. Publications on International Palliative Care Issues • Journal of Pain and Symptom Management Volume 33 ,Number 5 May, 2007: Advancing Palliative Care: The Public Health Perspective • Health Economics and Palliative care; What We Know and What We Need to Know. In press, 2008

  17. World Cancer Declaration 2008 Outlines the critical steps needed to build the basis for sustainable delivery of effective cancer prevention, early detection, treatment and palliative care worldwide World Cancer Summit, Geneva,2008

  18. World Cancer Declaration 2008 Based on: Article 25 of the Universal Declaration of Human Rights declares that “everyone has the right to a standard of living, adequate for health and well being for himself and his family, including medical care.”

  19. 2020 Goals 7. many more cancer patients in pain will have access to effective pain control measures

  20. Intermediate Targets 7. the number of cancer patients with access to appropriate treatment, rehabilitation and palliative care in adequately equipped treatment facilities 9. the number of cancer patients in pain worldwide that have access to effective pain control

  21. Strategies for the advancement of Palliative Care as a Human Right • Submission to the committee ICESCR • Submission to the office of the Special Rapporteur to the UN Human Rights Commission on the right to health • Promotion of an International Convention on Pain • Encourage human rights organizations to become involved in advocacy for palliative care • Use current declarations (Cape Town, Korea, Budapest) as advocacy tools with your government

  22. www.equalpartners.info

  23. “Please , do not make us suffer anymore…….” Access to Pain Treatment as a Human Right In this 47-page report Human Rights Watch said that countries could significantly improve access to pain medications by addressing the causes of their poor availability. These often include the failure to put in place functioning supply and distribution systems; absence of government policies to ensure their availability; insufficient instruction for healthcare workers; excessively strict drug-control regulations; and fear of legal sanctions among healthcare workers. http://www.hrw.org/en/reports/2009/03/02/please-do-not-make-us-suffer-any-more

  24. Promoting Hospice & Palliative Care Worldwide

  25. IAHPC 2006 • Developed essential drug list for palliative care • Drafted WHO monograph on palliative care • Sponsors international faculty scholars award • Sponsored 2006 Venice Declaration o the need for research in palliative care.

  26. Joint Declaration and Statement of Commitment: Palliative Care and Pain Treatment as Human Rights Project coordinated by the IAHPC and WPCA sign on at www.hospicecare.com

  27. IAHPC List of Essential Medicines • 34 medications are listed • 14 medications currently on the existing WHO Essential List

  28. IAHPC List of Essential Medicines

  29. Global Access to Pain Relief Initiative • Supported by International Union Against Cancer (UICC) -global advocacy initiative -raise awareness for policy change -focus on cancer patients

  30. 2006 International Pain Policy Fellowship Pain & Policy Studies Group University of Wisconsin October, 2006 Madison, Wisconsin Supported by the Open Society Institute

  31. To provide research-based information on palliative care in the global context To disseminate this information through the Observatory website and through other means To undertake primary research studies to generate such information To support academic work in resource poor regions To work in partnership with key organisations and individuals IOELC Aims

  32. Grants Funded Monitoring—Opioid Consumption

  33. The Romania Project WHO workshop in Budapest (2002) (Bulgaria, Croatia, Hungary, Lithuania, Poland, Romania) Prescribing severely restricted in Romania - Complicated forms and authorizations Dose and time limits; no flexibility For incurable cancer, not for HIV/AIDS Many patients die before obtaining morphine 35 year-old anti-narcotics law and regs Ministry of Health appointed a Commission New statute sent to Parliament July 2005 New regulations to be finalized in 2006

  34. WHO Workshop, Budapest 2002

  35. Change is possible if we work together

  36. Progress in Europe 1. France: 7 days28 days 2. Italy: 8 days 1 month; Rx simpl. 3. Germany: 1 day no limit 4. Poland: 100 mg 4.0 grams 5. Romania: 3 days 30 days

  37. Mongolia Pain Relief &Palliative Care Initiative MongolianPalliative CareSociety WorldHealth Organization MongolianMinistry of Health

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