LONDON, England — According to Yugoslav writer Meša Selimović, "death is a certainty, an inevitable realization, the only thing that we know will befall us." This supports that death is one of the only universal facts of life (and) everybody dies.

And that is where palliative care, which aims to improve patients’ quality of life and relieve pain from serious and often incurable illnesses, comes in.

In actuality, it can include everything from breathing exercises to painkilling drugs and can take place at home, in hospice, in a nursing home or at the hospital—ideally long before someone is on death’s doorstep.
Yet a new study has found that millions of people lack access to palliative care, even as demand continues to rise worldwide. Based on recent study, the number of people in need of palliative care has surged by 74 per cent over the past three decades, reaching 73.5 million in 2021.

Flof this huge figure, four in five of these people are in lower-income countries, like the Philippines, where the need for palliative care has grown by 83 per cent since 1990. But demand has also risen by 46 per cent in high-income countries during that time.

Records show that most people who opt for medically assisted dying around the world have cancer.

“Life expectancy is increasing, but healthy life expectancy is not keeping pace,” Dr. Libby Sallnow disclosed.
Sallnow is a palliative care physician who leads the Marie Curie Palliative Care Research Department at University College London in the United Kingdom.

"While many palliative care patients have terminal conditions, it is different from hospice or end-of-life care," he noted.

A global research team identified demand for palliative care by tracking the number of people with serious health-related suffering or those with health-related pain or an impact on their quality of life that cannot be relieved without professional help.

Since the 1990s, infectious diseases have waned as a driver—despite a brief global uptick during the coronavirus or Covid -19 pandemic—largely due to a decline of infections in lower-income countries.

Meanwhile, the need for palliative care because of cancer, heart disease, dementia,l and other chronic conditions has grown in recent decades, particularly in high-income countries, the report found.

Today in low-income countries, most patients in need of palliative care are women ages 20 to 49. In higher-income countries, it’s mostly women ages 70 and up, likely related to dementia.

“People are living for longer with more illness and more serious health-related suffering. We see a need to manage this much earlier in the life course [and not just] the last few days or weeks” of someone’s life," Dr. Sallnow cited.

By 2050, the World Health Organization (WHO) has warned that breast cancer deaths are expected to climb by 68 percent worldwide, with children making up a smaller share of people grappling with serious health-related suffering. That percentage fell from 25 per cent in 1990 to 14 per cent in 2021.

However, in the previous year, WHO’s (WHO) European office, which spans 53 countries, raised the alarm about the estimated 4.4 million people in need of palliative care in the region who die each year. That toll is expected to rise in the coming years.

Nearly four in 10 of these patients have cancer, while a third have heart disease, 16 percent have dementia and 6 per cent have chronic lung diseases.

The European Association for Palliative Care recommends that countries have two specialized palliative services per 100,000 people.

The new report described the lack of access to palliative care globally as “one of the most neglected and inequitable facets of health systems.” WHO pointed to a handful of barriers, including the lack of specialised palliative care doctors and medical training, low awareness of how palliative care can help patients, and legal restrictions on opioid painkillers.

Finally, Sallnow advised that palliative care should now be “decoupled” from cancer or end-of-life care and instead integrated into other medical specialties.

“The first step is for healthcare to recognize that death is inevitable and the aim of medicine is not only to avoid death, it is also to relieve suffering,” she concluded.