Volume 23, Number 10: October 2022
Array of Advocacy Advances
By Katherine I. Pettus, PhD
IAHPC Senior Advocacy and Partnerships Director
Human rights of older persons include access to palliative care
At the end of August, I represented the IAHPC at a multi-stakeholder meeting in Geneva sponsored by the United Nations Office of the High Commissioner for Human Rights (OHCHR). At this follow-up to Human Rights Council (HRC) Resolution 48/3 on older persons, we discussed the recent OHCHR report on protection gaps for older persons, including lack of access to palliative care.
The meeting, held both in person and online, was attended by more member state delegates than usual (always a good sign), representatives of national human rights organizations (NHRIs), and colleagues from other nongovernmental organizations that work to protect and advance the rights of older persons. All NGO participants had consultative status with the UN Economic and Social Council (ECOSOC). The agenda consisted of expert panels, interactive dialogue, and questions and statements from the audience. I gave an oral intervention and submitted a statement on the right of older persons to palliative care that was supported by Pallium India, which has ECOSOC status. [Find all documents, speeches, etc. here.]
Despite the well-known fact that the world’s population is aging and that, globally, serious health-related suffering will increase most rapidly among people aged 70 years or older, few governments ensure provision of palliative care for older persons, let alone protect it as part of the human right to health. I was shocked to learn that human rights command only 3% of the UN budget: the other 97% goes to development and security. The fact that human rights are an integral part of development and security makes this paltry share even more puzzling. Much of the work to advance human rights falls to NGOs, such as IAHPC.
Palliative care also received a mention in the new report by the Independent Expert on the enjoyment of all human rights by older persons, Dr. Claudia Mahler. The report on older persons deprived of liberty touches on many important protection gaps for older persons, including the global lack of palliative care in prisons, a focus of my mine for years. I will be giving a joint presentation on the topic at the 2023 EAPC Congress in Rotterdam in June.
INCB meeting in Vienna
I then attended an International Narcotics Control Board (INCB) meeting on “Adequate Levels of Opioid Consumption for Medical Purposes” in Vienna. The meeting’s goal was to provide the INCB with a set of recommendations to serve as the basis for a reliable tool to evaluate the adequacy of opioid consumption in various countries, as related to medical needs. Once we receive those recommendations, which will contribute to the ongoing global debate on availability and access to opioid analgesics, I will report on them here.
Of all morphine available globally, 88% is used to manufacture other controlled substances, particularly codeine. That makes it difficult for countries with fewer resources to procure morphine for palliative care.
[See 2018’s INCB Annual Report's executive summary, and IAHPC’s Table of Authorities and Resources.
The meeting addressed the fact that, although providing adequate access to internationally controlled, “indispensable” essential medicines is a treaty obligation of all states party to the Single Convention on Narcotic Drugs, consumption remains “low to inadequate” in most countries. [See Modules 2 and 3 of my Advocacy Course.]
The meeting was the fruit of decades of advocacy at the Commission on Narcotic Drugs and the INCB by IAHPC and our global partners to draw attention to serious health-related suffering all over the world due to lack of access to controlled medicines. All expert panelists and online participants endorsed the imperative of ensuring global availability of generic oral morphine, to remove the profit motive from decisions about procurement, manufacturing, and distribution.
WHO European region meeting
Dr. Victoria Hewitt was IAHPC’s delegate to the 72nd session of the World Health Organization Regional Committee for Europe. Together, we drafted and circulated IAHPC statements on the agenda and submitted them to the Secretariat, often with endorsements of other nonstate actors in official relations with the WHO. [See Special Report #1, on a big win there, and three lessons Hewitt learned.]
CND Intersessional Meeting
Dr. M.R. Rajagopal of Pallium India gave a powerful video statement on the need to improve availability of controlled medicines, especially oral morphine, at the Commission on Narcotic Drugs session on drug policy and treaty compliance in September. Belgian Ambassador Ghislain D’Hoop’s #NoPatientLeftBehind initiative has brought much needed attention to this neglected issue. IAHPC will attend a final high-level meeting on the topic on October 10 in Vienna.
Upcoming
Dr. Maria Cigolini, a lifetime member of IAHPC and founder of Health Professionals Say No!, is representing the IAHPC at the World Medical Association Assembly in Berlin as this issue of the newsletter goes to press. See next month’s report.
CUDECA visit
I had the great privilege of a second visit this year to IAHPC Institutional member the CUDECA Foundation in Málaga to accompany home care teams and lecture on global advocacy challenges and progress. We visited three people in different stages of illness being cared for by their families with support from the mobile palliative care team comprising Dr. Maria Josefa and Nurse Alicia. They provided morphine and other essential medicines to family caregivers, with careful written and oral instructions. There is nothing unusual about this in a high-income country such as Spain, which has appropriate regulations for the use of essential medicines in hospice and palliative care. Our advocacy work aims to make the sort of care I experienced with the CUDECA team the norm worldwide.