Palliative Care in WHO's Approach to Noncommunicable Diseases

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1 Palliative Care in WHO's Approach to Noncommunicable Diseases Dr Cecilia Sepulveda Senior Adviser Cancer Control Chronic Disease Preven6on and Management World Health Organiza6on Geneva Switzerland

2 WHO's definition of palliative care Pallia%ve care is an approach to improve the quality of life of pa%ents and their families facing life- limi%ng illness, through the preven%on and relief of suffering by assessment and treatment of physical, psychosocial and spiritual problems Source: National Cancer Control Programmes, Policies and Managerial Guidelines, 2 nd edition 2002

3 Comprehensive NCD Prevention and Contrrol Health-disease continuum Healthy population " Exposed to risk factors Early disease Advanced disease Terminal! disease Health Promotion Primary prevention Early detection Diagnosis " " " Treatment Palliative care

4 Major causes of death worldwide Source: GBD 2008

5 People in need of palliative care at the end of life 26.8 Million Adults % Children % Adults % N = Source: WHO estimates based on mortality (GBD 2008)

6 Diseases Requiring Pallia6ve Care at the End of Life in adults Noncommunicable Diseases Cardiovascular disease Cancer Chronic lung Disease Diabetes Chronic kidney / liver disease Neurological and degenera6ve Musculoskeletal Communicable diseases HIV/AIDS TB Hepa66s B and C Demen6a/ Ageing

7 Adults in need of palliative care at the end of life by diseases groups Hepatitis C 0.17% Rheumatoid arthritis 0.10% Multiple sclerosis 0.05% Parkinson disease 0.30% Hepatiti s B 0.31% Alzheimer and other dementias 1.49% Nephritis and nephrosis 2.08% Cirrhosis of the liver 2.29% Tuberculosis 3.44% Diabetes mellitus 3.45% HIV/AIDS 3.72% Cardiovascular diseases 47.62% Malignant neoplasms 25.93% Chronic obstructive pulmonary disease 9.05% N = Source: WHO estimates based on mortality (GBD 2008)

8 Adults in need of palliative care at the end of life by World Bank income category Low income 9% High income 22% Lower middle income 53% Upper middle income 16% N = Source: WHO estimates based on mortality (GBD 2008)

9 Community health approach to pallia1ve care Botswana, Ethiopia, India, Tanzania, Uganda, Zimbabwe, and others Needs of patients and caregivers Accessibility to affordable medications (pain and other symptoms) Financial support Psychosocial and spiritual support Cope with stigma Adequate training for caregivers Source: WHO 2003

10 WHO's global road map on NCDs 2000 Global Strategy for the Prevention and Control of Noncommunicable Diseases Global Strategy on Diet, Physical Activity and Health Action Plan on the Global Strategy for the Prevention and Control of NCDs Global Strategy to Reduce the Harmful Use of Alcohol WHO Global Status Report on NCDs 2011 Political Declaration on NCDs Realizing the commitments made in the Poli1cal Declara1on

11 UN Declara1on: Specific assignments given to WHO To reaffirm WHO's leadership and coordination role in promoting and monitoring global action against NCDs (13) To intensify efforts to assist Member States in implementing, Global Strategy on NCDs and its Action Plan (45, 52, 54) To work together with other UN Agencies in a coordinated manner to support national efforts (13) To develop a comprehensive global monitoring framework and recommendations for a set of voluntary global targets (61, 62) To provide input to Secretary-General's report to the UNGA on options for strengthening multisectoral action / partnership (64)

12 Palliative Care How to deliver? Large numbers of people in need Great majority suffer from NCDs and live in lower resource settings Innovative approaches (community based, PHC, partnerships) Reduce demand / Public health approaches

13 Advance the public health approach to palliative care 1. Advocacy and awareness raising 2. Technical assistance to countries 3. Integration of palliative care in PHC 4. Access to pain relief 5. Dissemination of best practices 6. Reduce demand 7. Evaluation of models in resource constrained settings 8. Monitoring ( palliative care indicator)

14 Thank you