Palliative care primarily focuses on non-contagious causes of death, as noncontagious diseases represent a significant majority of worldwide deaths according to the World Health Organization.10 Most adult patients needing palliative care suffer from progressive, non-cancerous diseases, followed by patients that suffer from cancerous diseases. However, an exception is made for Africa, where the vast majority of patients needing palliative care suffer terminal illness related to HIV/AIDS.9
The WHO estimates that 78% of adults and 98% of children needing palliative care live in low to middle-income countries. However, palliative care availability and utilization are highest among adults who are in higher-income countries.
Studies have been performed to evaluate the international availability of palliative care. One study found that 58% of the 230 countries evaluated had one or more palliative care systems available.11 Other studies indicate that specialty-level palliative care was only available in 30-45% of countries.9, 12 It was also noted in another study that up to 83% of the world’s population live in countries with limited or no access to opioid medications that are critical in addressing end of life pain relief.13
The WHO has identified the most common illnesses that require palliative care for adults and children:10
Alzheimer and miscellaneous dementias, cancer, cardiovascular diseases, liver cirrhosis, chronic obstructive pulmonary diseases (COPD), diabetes, HIV/AIDS, kidney failure, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, and drug-resistant tuberculosis (TB).
Cancer, cardiovascular diseases, liver cirrhosis, congenital anomalies (excluding heart abnormalities), blood and immune disorders, HIV/AIDS, meningitis, kidney diseases, neurological disorders, and neonatal conditions.
The WHO also identified that the ratio of palliative care services to population ranges from 1:1000 (in Niue, a South Pacific Ocean island country) to 1:90 million (in Pakistan). An international trend is that access to medical care, including palliative care, varies by the socioeconomic status of individual countries. Access varies by whether a country is considered to be a high or low income country. As expected, greater access is seen in higher income countries.10
The stratification of a country’s income is the WHO utilizes is based upon the World Bank and their usage of the World Bank Atlas method to determine high, middle, or low income country status. Examples of high income countries include the United States, European countries, and other Asian countries, such as South Korea. Low income countries include developing countries, such as some African nations, and India.10