First global ranking of palliative care reveals that more than half the world lacks access to basic services

More than half of the world's countries do not have access to basic palliative care services. This is revealed in the World Map of Palliative Care by the Global Palliative Care Observatory ATLANTES of the Institute for Culture and Society (ICS) of the University of Navarra. The study, led by Drs. Carlos Centeno and Vilma Tripodoro, includes the first global ranking in this field, with information from 201 countries and territories. The result draws a worrying map marked by inequality: the countries with the highest Degree of socioeconomic development concentrate the majority of the world's palliative care systems.

The study, published by the scientific journal Journal of Pain and Symptom Management, has been elaborated with a rigorous methodology that follows the parameters of the World Health Organization (WHO), of which ATLANTES is a partner center, and has been supported by the Worldwide Hospice Palliative Care Alliance (WHPCA). Its launch coincides with the celebration of World Palliative Care Day (October 11), which this year has the slogan "Keeping the Promise: Universal Access to Palliative Care".

The world map has assessed 14 indicators that allow palliative care to be analyzed in the light of six dimensions: empowerment of society, health policies, research, Education, use of essential medicines and provision of palliative care for adults and children. The result allows countries to be classified into four levels of development: emerging (40%), in progress (28%), established (17%) and advanced (14%).

Spain, behind Uganda

The ranking, unpublished so far, is headed by Germany, followed by the Netherlands and Taiwan. At the leave of the table, ten countries share the last position: Antigua and Barbuda, Mali, Mauritania, Nauru, Niger, St. Kitts and Nevis, St. Vincent and the Grenadines, Suriname, Tuvalu and Yemen. "This is an unprecedented ranking: for the first time there is a world ranking of palliative care with comparative data . And it is not just a static map. It makes it possible to see which country is at the top, who is making progress and who is lagging behind," the researchers explain.

In general, most of the countries with a higher human development index (HDI) have the majority of palliative care systems at advanced level 6 and those classified as lower-income countries are at the emerging level. However, the cases of Uganda and Thailand, with significant economic constraints, "indicate that political will, local strategies and targeted investment can partially break the structural correlation," Centeno and Tripodoro note.

The research identifies regional benchmarks because it "sample that, with strategy, leadership and adapted community models, it is possible to move forward even without the resources of high-income countries. These cases prove that progress does not depend exclusively on national wealth, but also on political decisions, innovation and a commitment to community empowerment.

In the case of Spain, the regulatory and political framework , access to essential drugs, broad coverage of services and international leadership in the field of research have been identified as strengths. However, there are important areas for improvement. On the one hand, territorial inequalities, since the coverage and quality of services vary according to the autonomous community where they are located. On the other hand, integration in primary care: although partnership exists, it is not yet systematically consolidated throughout the country. It is also necessary to strengthen academic and professional training for physicians, nurses and other health professionals. Finally, there is a need to promote research, as it is still limited compared to other medical areas, and to promote pediatric care. The study reveals that, although there are pioneering teams, there is still no homogeneous coverage throughout the country.

The research reminds us that "health-related suffering will grow by almost 90% between now and 2060 if palliative care is not expanded. The problem will be much larger within a generation if no action is taken."

The results of the research also point to some core topic levers on which countries can develop to improve their status in the field of palliative care: to commit to solid public policies; to facilitate access to essential drugs, especially oral morphine in primary care; to strengthen academic and professional training ; to ensure hospital, home and community coverage, including pediatric; and to involve families, caregivers and civil associations in the planning and defense of the right to receive palliative care.

The study sample countries that, in their socioeconomic context, can serve as a compass, such as Germany, the Netherlands, the United Kingdom, Australia, Chile, Uruguay, Costa Rica, Uganda and Thailand. It also reveals setbacks, such as Israel, Canada, Liechtenstein, Romania and Mongolia. "While there are positive experiences that can guide other countries, progress should not be taken for granted. They can be lost if public policies and investment are not sustained," the researchers remind us.

Along with the Global Map of Palliative Care, this year ATLANTES is publishing a series of regional atlases of palliative care. To date, those for the Asia-Pacific, Europe and Africa regions have been presented. In the coming weeks, those for the Eastern Mediterranean and the Americas will be released. Both are two practical tools for awareness-raising and advocacy that, through maps and graphics, can contribute to the development of public policies.