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. 2020 Apr;59(4):794-807.e4.
doi: 10.1016/j.jpainsymman.2019.11.009. Epub 2019 Nov 22.

Mapping Levels of Palliative Care Development in 198 Countries: The Situation in 2017

David Clark  1 , Nicole Baur  2 , David Clelland  2 , Eduardo Garralda  3 , Jesús López-Fidalgo  3 , Stephen Connor  4 , Carlos Centeno  3
Affiliations

Mapping Levels of Palliative Care Development in 198 Countries: The Situation in 2017

David Clark et al. J Pain Symptom Manage. 2020 Apr.

Abstract

Context: Palliative care is gaining ground globally and is endorsed in high-level policy commitments, but service provision, supporting policies, education, and funding are incommensurate with rapidly growing needs.

Objectives: The objective of this study was to describe current levels of global palliative care development and report on changes since 2006.

Methods: An online survey of experts in 198 countries generated 2017 data on 10 indicators of palliative care provision, fitted to six categories of development. Factor analysis and discriminant analysis showed the validity of the categorization. Spearman correlation analyses assessed the relationship with World Bank Income Level (WBIL), Human Development Index (HDI), and Universal Health Coverage (UHC).

Results: Numbers (percentages) of countries in each development category were as follows: 1) no known palliative care activity, 47 (24%); 2) capacity-building, 13 (7%); 3a) isolated provision, 65 (33%); 3b) generalized provision, 22 (11%); 4a) preliminary integration into mainstream provision, 21 (11%); 4b) advanced integration, 30 (15%). Development levels were significantly associated with WBIL (rS = 0.4785), UHC (rS = 0.5558), and HDI (rS = 0.5426) with P < 0.001. Net improvement between 2006 and 2017 saw 32 fewer countries in Categories 1/2, 16 more countries in 3a/3b, and 17 more countries in 4a/4b.

Conclusion: Palliative care at the highest level of provision is available for only 14% of the global population and is concentrated in European countries. An 87% global increase in serious health-related suffering amenable to palliative care interventions is predicted by 2060. With an increasing need, palliative care is not reaching the levels required by at least half of the global population.

Keywords: Palliative care; global development; hospice; indicators; mapping.

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Figures

Fig. 1
Fig. 1
Scoring algorithm to determine categories of palliative care development.
Fig. 2
Fig. 2
Data sourcing process.
Fig. 3
Fig. 3
Global levels of palliative care development.
Fig. 4
Fig. 4
Movement of countries between palliative care development levels (four-part typology). *One additional country in Category 4 was not included in WM1 or 2. **Three additional countries in Category 1 were not included in WM1 or 2.
Fig. 5
Fig. 5
Loadings of the factor analysis with varimax orthogonal rotation. Points relate to indicators listed in Table 2.
Supplementary Figure 1
Supplementary Figure 1
Levels of palliative care development and World Bank income levels.
Supplementary Figure 2
Supplementary Figure 2
Levels of palliative care development and UN Human Development Index Levels.
Supplementary Figure 3
Supplementary Figure 3
Levels of palliative care development by WHO Universal Health Coverage Index Quintile.
See this image and copyright information in PMC

References

    1. World Health Assembly Resolution 67-19 . 2014. Strengthening of palliative care as a component of comprehensive care throughout the life course.
    1. Knaul F.M., Farmer P.E., Krakauer E.L. Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report. Lancet. 2018;391:1391–1454. - PubMed
    1. Declaration of Astana, Global Conference on Primary Health Care 25-26 October 2018. https://www.who.int/docs/default-source/primary-health/declaration/gcphc... Available from. Accessed December 9, 2019.
    1. Sleeman K.E., de Brito M., Etkind S. The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions. Lancet Glob Health. 2019;7:e883–e892. - PMC - PubMed
    1. Clark D. Oxford University Press; Oxford: 2016. To Comfort Always: a history of palliative medicine since the nineteenth century; p. p237.

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