2019; Volume 20, No 6, June
Policy and Advocacy
Dr. Katherine I. Pettus, PhD, IAHPC Advocacy Officer for Palliative Care Medicines, with her latest roundup of advocacy news.
Advocacy as Extreme Sport: Global needs in Geneva, Prisoners’ Rights in Berlin and Year of the Nurse in 2020
Newsflash! The World Health Assembly voted to designate 2020 as the International Year of the Nurse and the Midwife. IAHPC will be very involved, collaborating with partners in the International Council of Nurses and palliative care associations in countries that allow nurses to prescribe morphine, in preparing side events and interventions at next year’s WHA. As we all know, nurses are integral to the delivery and development of palliative care.
Dr. Stephen Watiti of Uganda tells the panel, ‘I was supposed to have been dead 20 years ago, but because of palliative care I am still here!’ Seated beside him, left to right, are: Drs. Dzulkefly Ahmad and Mariângela Simão (WHO ADG), Ms. Natasha Dormoi (Panama), and Drs. Ed Kelley (WHO ADG) and Marie Charlotte Bousseau (Advisor, WHO). (Photo: Harleen Gill)
Prior to the 72nd WHA, I coordinated and participated in the two-day meeting of the Geneva Global Health Hub (G2H2) as a member of the steering committee. Palliative care is still isolated from the global health agenda and narrative, despite the fact that it is officially included (with prevention, promotion, treatment and rehabilitation) in the spectrum of universal health coverage (UHC) and primary health care. Participants at the meeting analyzed WHA agenda items including planetary health, UHC, and access to medicines. We also discussed a resolution proposed by Italy on pricing transparency for medicines and vaccines.
Our PC side event drew a lively crowd
IAHPC’s delegation to the WHA included Dr. Felicia Knaul, Dr. Eric Krakauer, Dr. Axel Klein, and four Global Health students from the Executive Program of the University of California, Los Angeles. [See their report below.]
The highlight for all of us was the only side event at the WHA on palliative care, cosponsored by the governments of Malaysia and Panama. The event was supported by the World Hospice and Palliative Care Alliance, the Union for International Cancer Control, and the International Federation on Aging. Although the side event was held at 7 p.m., at the end of a long day at the WHA, the room was packed and the panel presentations were followed by a lively discussion. Panel members included: his Excellency Hon. Dr. Dzulkefly Ahmad, Health Minister of Malaysia; Ms. Natasha Dormoi, representing the Ministry of Health for Panama; Dr. Knaul, Chair of the Lancet Commission on Pain and Palliative Care; Hon. Dr. Miguel A. Mayo, Minister of Health of Panama; Dr. Stephen Watiti, who brought the patient and provider perspective from Uganda; and Dr. Ed Kelley, Director of the Department of Service Delivery and Safety from the WHO Secretariat. The IAHPC statement, interventions and statements on the WHA agenda and reports, most of which were delivered by the UCLA students, can be found on our Advocacy Page.
Crucial global needs discussed
at other side events
Colleagues at the Global Commission on Drug Policy [author of ‘The Negative Impact of Drug Control on Public Health: The global crisis of avoidable pain’] organized an excellent tribute to their late leader His Excellency Kofi Anan, and the World Federation of Societies of Anesthesiologists (WFSA), with the G4 Alliance, hosted an informative side event at Red Cross Headquarters. The global need for essential surgery and associated medicines, including those controlled under international law, is as pressing and dramatic as the need for palliative care and essential palliative care medicines. We look forward to partnering further with these passionate professionals dedicated to global health justice.
PC integration and indicators
discussed with the WHO
After an intense week at the World Health Assembly, which included many meetings with senior World Health Organization (WHO) Secretariat staff on how best to integrate palliative care into the Primary Health Care agenda and develop measurable indicators, I flew to Berlin to present with our Task Force on Palliative Care for Prisoners at the EAPC Congress [see my PowerPoint pdf]. IAHPC Board and staff members had several scientific posters and presentations at the Congress, including ‘Use of Tramadol in Palliative Care and Pain Treatment: Potential Consequences of Placing it under International Control’, which have been uploaded to our Advocacy Page.
After the two-day IAHPC Board meeting in Berlin, I returned to Geneva to participate in the World Health Assembly session on Access to Medicines, and to give IAHPC’s comment on the WHO roadmap.
Anyone up for a WHO Hospice/PC Day?
IAHPC will participate with WHPCA to identify some friendly governments that might consider proposing an official WHO World Hospice Palliative Care Day. Such an event could result in increased global visibility of palliative care and would command technical and communications support from WHO. Might any of your governments be interested in convening or joining a Group of Friends on this at the January 2020 Executive Board meeting? If so, please get in touch with me, [email protected], so we can strategize.
Universal Health Coverage at the UN
We are collaborating with the WHPCA on suggested text for the Political Declaration on Universal Health Coverage, to be approved at the High-Level meeting at the United Nations in September. Please look for email from Claire Morris and/or myself on this crucial topic.
ALCP submission on
boosting the workforce
On another note, IAHPC was proud to support the ALCP’s [Latin American Association of Palliative Care] submission to the Special Rapporteur on Health providing input to a thematic report on medical education and health workforce strengthening. The global workforce trained in palliative care, from community health workers to specialized interdisciplinary teams, is woefully inadequate to meet the need. Dr. Tania Pastrana, President of ALCP, worked with Dr. Roberto Wenk and IAHPC Liliana de Lima to prepare this submission.
Stay tuned for next month’s report from Amsterdam, and the meeting of Health Action International on improving access to internationally controlled essential medicines.
UCLA Global Health Students’ Attendee Report on WHA72
By David Delgado, Harleen Gill, Erlinda Laska, and Angelica Lewis
University of California, Los Angeles
There is a desperate need for palliative care services worldwide, yet as a result of our experience presenting at the 72nd World Health Assembly in Geneva in May, we discovered that the issue is not at the forefront of the agenda of World Health Organization Member States.
The team from University of California’s Executive Program in Global Health collaborated with IAHPC at the WHA.
At least 90% of the world’s population is vulnerable to suffering from poorly managed disease-based pain and lack of access to essential palliative medicines. Improving access and basic palliative care training for health care workers and administrators is crucial. This can only occur if palliative care is incorporated into the agenda of policymakers for Member States. In bringing the issue to the attention of the Member States, we had the privilege and honor to deliver statements on behalf of IAHPC and advocate for palliative care during side events.
On public health emergencies
Angelica Lewis delivered the ‘Public Health Emergencies: Preparedness and Response’ intervention statement in Committee A. ‘It gave me the opportunity to express our concerns of not delivering palliative care to those who need it most, especially during health emergencies and crises,’ said Lewis.
The following day, Erlinda Laska addressed Committee A on universal health coverage and primary health, urging Member States to refer to WHO palliative care guidelines and institute training programs for health professionals.
On intregrating hospice care
David Delgado challenged Member States to not be afraid of using the words palliative care, during a side event on the ‘Decade of Healthy Living’ initiative. Integrating palliative care as a key strategy of healthy aging has been shown to provide not only better care at the end of life, but higher quality and often longer life for the individuals receiving care. At the ‘Prevention in an Aging World’ event, David and Angelica met and had an engaging discussion with Admiral Brett P. Giroir from the U.S. Commissioned Corps of Public Health Service about expanding the coverage period for hospice care under the new Medicare ‘value-based’ reimbursement system.
All four UCLA student delegates played central roles in promoting and assisting during the IAHPC side event on universal health coverage; Harleen Gill ensured that panelists stayed within their allotted time. A side event in future WHA meetings, in a larger room, would build on the momentum gained in advocating for hospice and palliative care.
U.S. bipartisan report fuels
an incorrect perception
On May 22nd a U.S. Congressional bipartisan report was released, alleging that the WHO drew directly from Purdue Pharmaceutical’s opioid marketing strategies. We, as the UCLA delegate team, were concerned about the erroneous perception of the correlation between prescribing pain medication for palliative purposes and the non-medical abuse of opioids. Thus, in a meeting with the US delegation to the WHO, the team highlighted the issue and urged U.S. delegates to push for funding of an evaluation study to understand the true root causes of the North American opioid epidemic, determining the impact of prescribing practices, institutional guideline interpretation, and palliative prescribing practices patient and provider behaviors. As an advocacy group, IAHPC is well-positioned to play a role in disseminating findings of such a research study.
Representing IAHPC was rewarding
Representing IAHPC has been one of the most memorable and rewarding professional experiences. We are so grateful to have had the opportunity to participate in such an important governing body, and to have so much autonomy from the IAHPC to bring in our own experiences and expertise while doing so.
Because ‘palliative care adds life to days, not just days to life,’ we encourage advocates and supporters to become members of the IAHPC.
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