Volume 24, Number 6: June 2023
Summer School, the World Health Assembly, & Much More!
By Katherine I. Pettus, PhD
IAHPC Senior Advocacy & Partnerships Director
May was full of learning, including at Summer School, a program of the CUDECA Foundation and the International Collaborative for Best Care for the Dying Person. I was not the only “older person” among the faculty and students, who comprised senior palliative care leaders and practitioners from all over Europe and even Latin America. You can view the program here. Consider joining the collaborative and submitting an abstract to the Annual Symposium to be held in Rotterdam in November. The collaborative is a group of leading thinkers, practitioners, and researchers from 24 countries united by the common goal of improving care for dying people and their families. Their vision is: A world where all people experience a good death as an integral part of their individual life, supported by the very best personalized care. The work is based on the 10/40 Model of Care, which consists of 10 principles and 40 goals of care that can be adapted to different contexts.
It was very interesting to get out of my global advocacy comfort zone and listen to discussions that were conducted at a micro level, in more clinical and academic terms than I am used to. I asked questions about how a goal concerning medication—"The person has medication prescribed on an ‘as required’ basis for all of the following five symptoms which may develop in the last few days and hours days of life: pain, nausea and/or vomiting, dyspnea, restlessness and agitation, and respiratory tract secretions”—could be realized in contexts prevalent all over the world, where there is no meaningful availability of internationally controlled essential medicines, a situation that consumes much of my advocacy work and time. The model seems very focused on medicalized care of the dying rather than community care as modeled by Compassionate Communities, although the goals of care have been adjusted to a “community setting.”
There’s always something new to learn, and I look forward to more collaboration with the collaborative in the months to come!
IAHPC at the World Health Assembly
Five IAHPC members participated in the 76th World Health Assembly at the end of May as IAHPC delegates: Board Members Drs. Hanan Hazboun, Natalie Greaves, and Victoria Hewitt; Focal Point for the United States Dr. Kristin Forner from MedStar Health; and Dr. Kathryn Richardson from Doctors Without Borders and PallCHASE. It was their first experience of the stimulating and chaotic annual meeting that brings together representative of all the world’s governments, international organizations, and civil society organizations (such as IAHPC) to report on progress toward health goals, discuss challenges, and set budgets for global health issues.
Predictably, health emergencies, mostly the situation in Ukraine, dominated many WHA plenaries and meetings. However, the usual agenda items—concerning persons with disabilities, healthy ageing, polio, TB, the health of women, children, and adolescents, noncommunicable diseases, and other topics—were discussed at great length, often without any mention of palliative care until IAHPC or HelpAge International took the floor to deliver our one-minute statements, all of which can be found here. We also joined several “constituency statements” that reflected the collaboration of non-state actors with similar interests, so palliative care got more airtime than usual.
Apply to be a delegate at WHO Europe
The IAHPC will participate in the WHO Regional Meeting for Europe to be held in Astana, Kazakhstan, in October 2023. Gulnara Kunirova, our board member in Almaty, will lead our delegation. If you would like to apply to participate as a self-funded member of the delegation, please contact me. September will be a preparatory month of European civil society activities on public health in the region, including challenges integrating palliative care, accomplishments, best practices case examples, and so on. Board Member Dr. Victoria Hewitt and I will coordinate participation, so stay tuned for updates and how to join in.
Citizens Like You Can Influence Policy
Citizens like you prepare the soil and plant the seeds for national palliative care policies. The uphill work of advocacy is convincing your health ministry contacts to ensure that palliative care is mentioned in the interventions your national delegations make on relevant agenda items at the World Health Assembly and other UN meetings. Since those texts are usually drafted weeks prior to the meeting itself, you must have made the contacts and built a relationship months or years beforehand.
Only you, as citizens of your countries, can inform your government contacts about the importance of palliative care. As an international charity, IAHPC is prohibited from trying to influence national governments: if invited by a representative of a national entity, institution, or government officer, however, we can advise.
How merely saying 'palliative care' helps
Palliative care will only become normalized—as has sexual and reproductive care—when the words are said aloud at all levels of governance and official delegates hear them from one another, not just from us as a civil society organization that gets the floor for one minute at the World Health Assembly. With ongoing multilevel advocacy, this verbal encouragement will eventually lead to sustainable policies to relieve health-related suffering.
IAHPC members can take my online, self-paced advocacy course to learn more about how to effectively participate. This document lists all delegates to the 76th WHA: note your country's delegates and start building a relationship with at least one of them.
Preparing for a notable anniversary
The year 2024 marks the 10th anniversary of the World Health Assembly's 2014 palliative care resolution (WHA67/19). We plan to make it a banner year at the 77th World Health Assembly. Our goal is to have all national delegations in the plenary session report on how far each has come in implementing the resolution. Only you can make that happen by advocating with your ministries of health starting now. Consider joining our delegation: we are planning activities for the next 12 months. You can approach your institution and ministry about funding your participation.
A million thanks to our delegates
Thanks a million Victoria, Kristin, Hanan, Natalie, and Kathryn for your stellar work during the 76th assembly, your cheerful can-do attitude, and your patience with the multiple schedule changes and seemingly endless debates that have little to do with the frontline work of practitioners dealing daily with serous health-related suffering. I called for "patient militancy" when I wrote a blog about the challenges of the WHA during COVID. You can read our delegates’ reports next month when I will be taking some time off to be with my family.
Side event on controlled medicines
One highlight of the WHA was a high-level side event convened by the Global Commission on Drug Policy, featuring remarks calling out the global inequity of access to essential medicines for palliative care and treatment of opioid use disorder. Panelists were WHO Director-General Dr. Tedros Ghebreyesus; United Nations Office on Drugs and Crime Executive Director Ms. Ghada Fathi Waly; Dr. Michel Kazatchkine, former executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria; Her Excellency Nora Kronig, Vice Director of the Swiss Federal Office of Public Health; Dr. Jaime Urrego, Colombia Vice Minister of Health; Dr. Michel Sibidé, former executive director of UNAIDS; and Dr. Zukiswa Zingela, chair of the International Narcotics Control Board working group on access to controlled substances. As Dr. Kazatchkine, with whom I have worked for many years, said in his introduction, “The world needs to move out of complacency and stagnation on this issue.” Read the Global Commission Report, The Negative Impact of Drug Control on Public Health: The Global Crisis of Avoidable Pain.
IAHPC report on human rights
can aid your advocacy
The IAHPC submitted a report to the UN High Commissioner on human rights on drug control and access to essential medicines supported by all global and regional palliative care associations. This is an excellent document to aid your national advocacy to improve availability.
Report on human rights of older persons
Finally, the Organization of American States—the regional body that brings together all 35 independent states of the Americas and constitutes the main political, juridical, and social governmental forum in the hemisphere—just released a new report, Human Rights of the elderly and national protection systems in the Americas that makes multiple references to governments’ obligations to respect, protect, and fulfill the right of older persons to access palliative care at all times. This is an excellent advocacy tool for those who live in the region.
Language tip: The IAHPC prefers the term “older persons” to “elderly,” which is inaccurate and stigmatizing, just as the term “medicines” is preferred to “drugs.”