Dr  Cecilia  Sepulveda  Senior  Adviser  Cancer  Control    Chronic  Disease  Preven6on  and  Management  World  Health  Organiza6on    Geneva  Switzerland      

Palliative Care in WHO's Approach

to Noncommunicable Diseases

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  

WHO's definition of palliative care

Source: National Cancer Control Programmes, Policies and Managerial Guidelines, 2nd edition 2002

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Early detection

Exposed to risk factors

Early disease

Advanced disease

Primary prevention

Diagnosis

Treatment

Palliative care

Comprehensive NCD Prevention and Contrrol

Healthy population

Health Promotion

Terminal disease

Health-disease continuum

Major causes of death worldwide

Source: GBD 2008

Adults 60+66%

Adults 15-5924%

Children 0-1410%

N  =  26 835  386

People in need of palliative care at the end of life 26.8 Million

Source: WHO estimates based on mortality (GBD 2008)

     

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  

Multiple  sclerosis0.05%

Rheumatoid  arthritis0.10%

Hepatitis  C  0.17%

Parkinson  disease0.30%

Hepatitis  B  

0.31%

Alzheimer  and  other  dementias1.49%

Nephritis  and  nephrosis2.08% Cirrhosis  of  the  

liver2.29%

Tuberculosis3.44%

Diabetes  mellitus3.45%

HIV/AIDS  3.72%

Chronic  obstructive  pulmonary  disease9.05%

Malignant  neoplasms25.93%

Cardiovascular  diseases47.62%

N  =  24  260  081  

Source: WHO estimates based on mortality (GBD 2008)

Adults in need of palliative care at the end of life by diseases groups

High income22%

Upper middle income

16%Lower middle income

53%

Low income9%

N  =  24  260  081  

Adults in need of palliative care at the end of life by World Bank income category

Source: WHO estimates based on mortality (GBD 2008)

Community  health  approach  to  pallia1ve  care  

 

Botswana, Ethiopia, India, Tanzania, Uganda, Zimbabwe, and others

§ Accessibility to affordable medications (pain and other symptoms)

§ Financial support

§ Psychosocial and spiritual support

§ Cope with stigma

§ Adequate training for caregivers

Needs of patients and caregivers

Source: WHO 2003

2000

2003

2004

2008

Global Strategy for the Prevention and Control of Noncommunicable Diseases

Global Strategy on Diet, Physical Activity and Health

Action Plan 2008-2013 on the Global Strategy for the Prevention and Control of NCDs

2010

2009

2011

Global Strategy to Reduce the Harmful Use of Alcohol

WHO Global Status Report on NCDs

Political Declaration on NCDs

WHO's  global  road  map  on  NCDs  

2012+ Realizing  the  commitments  made  in  the  Poli1cal  Declara1on  

•  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)

UN  Declara1on:  Specific  assignments  given  to  WHO  

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

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)

Advance the public health approach to palliative care

Thank  you