2017; Volume 18, No 6, June

Policy and Advocacy

Dr. Katherine I. Pettus, PhD, IAHPC Advocacy Officer for Palliative Care Medicines, reports on key meetings, first in Madrid at the EAPC World Congress and then later at the World Health Assembly in Geneva

Progressing palliative care – in Madrid and later in Geneva …

The 2017 World Congress of the European Association of Palliative Care (EAPC) in Madrid, ‘Progressing Palliative Care,’ was a heady gathering of inspirational plenary speakers, workshops, and poster sessions that provided a dynamic composite of palliative care development throughout the world. My only complaint was that it was impossible to choose from the program which parallel session to attend, since I wanted to go to all of them! IAHPC sponsored 30 Traveling Scholarships for providers from all over the world. We also participated in the Voice of Volunteering Charter and IAHPC co-sponsored the two new Atlases of Palliative Care in Africa and the Middle East.

The opening congress plenary featured palliative care pioneer, Dr. Eduardo Bruera, who paid tribute to what he called the ‘Don Quixotes of palliative care’, the providers who head stubbornly toward the chimera of human suffering, in the hope of relieving it patient-by-patient, changing policies that block access to opioids, training providers, and building essential platforms to grow palliative care in their communities.

Dr. Diane Meier provided an inspiring overview of the growth of hospital-based palliative care in the US, qualifying an otherwise glowing report with the observation that service availability depends on geography, with some states having more access to hospice than others, and there being very little information about community-based palliative care in general. Dr. Meier’s takeaway message was the importance of a consistent advocacy message, “Palliative care can help you have the best possible quality of life, and if you are not getting it, you are not getting the highest quality of care.”

IAHPC Executive Director, Liliana De Lima, receives the Fondazione Floriani Award from Dr Matteo Ilis Crippa following her plenary lecture at the EAPC World Congress in Madrid

Another conference highlight was IAHPC Executive Director Liliana De Lima’s Floriani Award Lecture, which addressed the low uptake of palliative care in the low- and middle-income countries, and called for increased advocacy at the national and international levels. I attended a meeting of the fledgling EAPC Taskforce on palliative care for prisoners, which is welcoming new members (email Mary Turner to join the mailing list), and is beginning a scoping exercise in seven European countries, with the goal of producing a white paper by 2019. I will be working on the state of palliative care for prisoners in Spain.

70th World Health Assembly

I flew to Geneva immediately after the Taskforce on Palliative Care for Prisoners, to attend an all- day meeting of the G2H2 Global Health Hub to prepare for the 70th World Health Assembly (WHA). Linking up with global health organizations that have not previously considered the importance of palliative care as a public health, poverty-reducing strategy, is one way to propagate our message transversally throughout the civil society health system. On Sunday, the NCD Alliance held a pre-WHA briefing concerning all the agenda items relating to non-communicable diseases (NCDs), another key area for palliative care strategy, particularly around the promotion of Universal Health Coverage and the 2030 Agenda for Sustainable Development.

#WHA70 Palliative Care Advocacy Team. Left to right: Dr. Stephen Connor, Dr. Katherine Pettus, Dr. Julia Downing, Dr. Jim Cleary and Dr. Christian Ntzimira

The #WHA70 Palliative Care Advocacy Team consisted of myself, representing IAHPC, and Dr. Stephen Connor, Executive Director of the Worldwide Hospice Palliative Care Alliance (WHPCA), Dr. Julia Downing (PhD), Executive Director of the International Children’s Palliative Care Network (ICPCN), and Dr. Christian Ntzimira from the Rwanda Hospice and Palliative Care Association. We were also joined by Dr. Jim Cleary, Director of the Pain and Policy Studies Group, who attended with the European Society of Medical Oncologists’ delegation. We worked together on joint statements delivered by myself, and colleagues from the Union of International Cancer Control (UICC) and the NCD Alliance, as everyone else had to leave before our agenda items came up! All the WHA 70 agenda items can be found here.

Advocacy accomplishments of WHA, namely the Cancer Resolution, promoted by and supported by Brazil, Canada, Colombia, Costa Rica, France, Netherlands, Nigeria, Panama, Peru, Russian Federation, Thailand and Zambia, supported by UICC, the NCD Alliance, and IAHPC among others, passed with good language of palliative care in the Resolution., Also, our joint advocacy succeeded in having palliative care included in the final Dementia Global Action Plan, and at the WHA. Assistant Director General Chestnov specifically remarked in his response to the WHA debate on the floor that it was very important to include palliative care for persons with dementia.

Although IAHPC, WHPCA, and the ICPCN had submitted a report on the right of Women, Children, and Adolescents to palliative care, it was left out of the draft considered by the Executive Board in January, and out of the final Secretariat Report presented to the WHA. My intervention on the floor made the point that we were disappointed by the exclusion, and that palliative care is an essential element of health of women, children, and adolescents. After my intervention, the Director of the Maternal Child Health Division spoke to me about convening a multi-sectoral meeting at WHO to ensure the inclusion of palliative care.

The Secretariat’s Reports on Access to Medicines and Public Health Dimensions of the World Drug Problem both contained clear language on the need to improve access to controlled essential medicines for the relief of severe pain and breathlessness, as well as for the treatment of mental health and substance use disorders. Our interventions complemented the Secretariat on this progress and offered to help with implementation.

The excellent coordination between Civil Society Organizations present at the meeting, and with members of the WHO Secretariat on specific agenda items relating to palliative care, have heartened and inspired us to continue with the work. Member states still need much more information concerning how palliative care, particularly community-based palliative care, is a ‘best buy’ for their NCD policies, as well as a poverty-reducing strategy in their progress toward the Targets of the 2030 Agenda for Sustainable Development. Effective implementation of WHA Resolution 67/19 on palliative care will require a culture change at WHO, just as in all of institutional medicine and public health policy. Continued teamwork and advocacy, such as we had at WHA70, will help member states to effect that sort of culture change.

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