Palliative Care: an approach to comprehensive care in Universal Health Coverage

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This article was exclusively written for The European Sting by Ms. Larissa Sena de Lucena, a 4th year medical student at UNIFAP-Macapá and Ms. Anna Valeska Procópio de Moura Mendonça, a psychologist and professor in the Medicine course at the Federal University of Amapá. They are affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.


Universal Health Coverage (UHC) was shaped by the World Health Organization (WHO), in the period from 2004 to 2011, and constitutes guidelines that prioritize the promotion of health policies¹ aimed mainly at welcoming vulnerable population groups² in health care systems health, seeking to provide access to the services available, as recommended by WHO³.

For the realization of the human right to health, interventions that seek to universalize access and coverage of health in an integral and quality way are necessary to address the social determinants of health4, such as the reduction of poverty and social inequality5. Therefore, it is necessary to reduce barriers to access and offer comprehensive care that meets the health needs of the population, to improve the well-being of individuals, especially those facing progressive diseases that threaten the continuity of life.

In this scenario, considering that palliative care (PC) consists of the ethical responsibility of health systems6, this form of assistance still presents a relevant disparity in health care worldwide7, as few countries have health and health education policies that apply for this support in the face of an incurable disease in an effective way8, making its insertion urgent and immediate, since it build-ups and expands the panorama of coping with clinical conditions that cannot be cured, starting from the diagnosis and following the evolution of the disease9. Also, it acts in solving problems in several axes, such as in the physical, psychosocial and spiritual sphere10 as well as, its actions act in the grieving process and extends the care not only to the patient but also to the family members.

Another important perspective to reinforce the implementation of care is the global epidemiological and age transition. Bearing in mind that the population aging rhythm is accelerated11 with increased life expectancy8 and the most prevalent diseases started to have a chronic-degenerative character or also called non-transmissible chronic diseases (NCDs), such as cardiovascular, respiratory pathologies chronic diseases, cancers, and diabetes, responsible for more than 70% of deaths worldwide. Illnesses in NCDs are the main public health problem12, as progressive and debilitating sequelae may arise, causing varying degrees of dependency in patients. Thereby, PCs play an essential role in the clinical history, showing relevance in the late stages and complications13.

Consequently, the implementation of this comprehensive care proposal is necessary and contributes to the qualification of health care and the promotion of its coverage in the nations of the world. In this sense, it seeks to promote equity in access to resources, as well as vulnerability reduction policies for the full implementation of this fundamental guarantee of life, which is the right of every citizen.

REFERENCES

  1. Giovanella Ligia, Mendoza-Ruiz Adriana, Pilar Aline de Carvalho Amand, Rosa Matheus Cantanhêde da, Martins Gabrieli Branco, Santos Isabela Soares et al . Sistema universal de saúde e cobertura universal: desvendando pressupostos e estratégias. Ciênc. saúde coletiva  [Internet]. 2018  June [cited  2020  Dec  20] ;  23( 6 ): 1763-1776. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232018000601763&lng=en.  http://dx.doi.org/10.1590/1413-81232018236.05562018.
  2. OPAS Brasil. Delegados aprovam resoluções sobre cobertura universal de saúde na Assembleia Mundial da Saúde [homepage on the Internet]. 2019 [cited 2020 Dec 20]. Available from: https://www.paho.org/bra/index.php?option=com_content&view=article&id=5943:delegados-aprovam-resolucoes-sobre-cobertura-universal-de-saude-na-assembleia-mundial-da-saude&Itemid=875.
  3. Noronha José Carvalho de. Cobertura universal de saúde: como misturar conceitos, confundir objetivos, abandonar princípios. Cad. Saúde Pública  [Internet]. 2013 May [cited 2020 Dec 20]; 29 ( 5 ): 847-849. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2013000500003&lng=en.  http://dx.doi.org/10.1590/S0102-311X2013000500003.
  4. OPAS Brasil. Declaração da ONU sobre cobertura universal de saúde: OPAS defende transformação dos sistemas de saúde. [homepage on the Internet]. 2019 [cited 2020 Dec 20]. Available from: https://www.paho.org/bra/index.php?option=com_content&view=article&id=6027:dedeclarac-da-onu-sobre-cobertura-universal-de-saude-opas-defende-transformacao-dos-sistemas-de-saude&Itemid=843.
  5. Malta DC, Bernal RTI, Lima MG, Araújo SSC, Silva MMA, Freitas MIF, et al. Doenças crônicas não transmissíveis e a utilização de serviços de saúde: análise da Pesquisa Nacional de Saúde no Brasil. Rev Saude Publica. 2017; [cited 2020 Dec 21]; 51 Supl 1:4s. Available from: https://www.scielo.br/pdf/rsp/v51s1/pt_0034-8910-rsp-S1518-87872017051000090.pdf.
  • Resolution WHA67.19. Strengthening of palliative care as a component of comprehensive care throughout the life course. In: Sixty-seventh World Health Assembly, Geneva, 19–24 May 2014 (http:// apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R19-en.pdf, accessed 20 March 2018).
  • Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Kwete X et al. On behalf of the Lancet Commission on Palliative Care and Pain Relief Study Group. Alleviating the access abyss in palliative care and pain relief: an imperative of universal health coverage. Lancet. Published online 12 October 2017; pii: S0140-6736(17)32513-8 (http://dx.doi.org/10.1016/S0140-6736(17)32513-8, accessed 20 Dec 2020). Available from: https://pubmed.ncbi.nlm.nih.gov/29032993/.
  1. WHO. Definition of palliative care/WHO Definition of palliative care for children. Geneva: World Health Organization; 2002. Available from: http://www.who.int/cancer/palliative/definition/en/, accessed 20 Dec 2020.
  1. OPAS Brasil. Folha informativa – Envelhecimento e Saúde [homepage on the Internet]. 2018. Available from: https://www.paho.org/bra/index.php?option=com_content&view=article&id=5661:folha-informativa-envelhecimento-e-saude&Itemid=820, accessed 21 Dec 2020.
  1. Barreto, M.da S., Carreira, L., & Marcon, S.S. Envelhecimento populacional e doenças crônicas: Reflexões sobre os desafios para o Sistema de Saúde Pública. Revista Kairós Gerontologia. 2015; [cited 2020  Dec  21]; 18(1), pp. 325-339. ISSN 1516-2567. ISSNe 2176-901X. São Paulo (SP), Brasil: FACHS/NEPE/PEPGG/PUC-SP. Available from: https://revistas.pucsp.br/kairos/article/view/26092.
  1. Fonseca, AC. Cuidados paliativos como modalidade terapêutica para idosos portadores de doenças crônico-degenerativas admitidos em unidade de terapia intensiva. Rio de Janeiro: Escola Nacional de Saúde Pública (ENSP) da Fundação Oswaldo Cruz, 2010. Dissertação de mestrado em Epidemiologia em Saúde Pública. Available from: https://www.arca.fiocruz.br/bitstream/icict/12816/1/595.pdf, accessed 21 Dec 2020.

About the authors

Larissa Sena de Lucena, is a 4th year medical student at UNIFAP-Macapá, from Amapá/AP, affiliated with IFMSA-UNIFAP since 2017. She is a local coordinator of IFMSA-UNIFAP and affiliated with the Academic League of Internal Medicine of Amapá, she is interested in issues about palliative care, humanized medicine, care for terminal patients, besides scientific initiation. 

Anna Valeska Procópio de Moura Mendonça is a psychologist and professor in the Medicine course at the Federal University of Amapá. Coordinator of the Laboratory for the Study of Death and Palliative Care.

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