Advocating for the democratization of palliative care through its implementation in the Universal Health Coverage

This article was exclusively written for The European Sting by Mr. Natan Viana Medeiros and Ms. Isabela Thomé Heleno, two 1st year medical students from the Universidade Federal de Juiz de Fora (UFJF) in Juiz de Fora, Brazil. They are affiliated with 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.

According to the World Health Organization, Universal Health Coverage (UHC) assures the access to health services, from health promotion to prevention, treatment, rehabilitation and palliative care, without setting the users into financial troubles. Although it does not mean that all varieties of treatments will be available, the UHC offers a basic range of services to the citizens – focusing especially on Primary Health Care (PHC), as they represent an effective way of offering better assistance to the population. The PHC provides different health services, including palliative care. This interdisciplinary type of medical care consists in managing the suffering and the pain of patients with life-threatening diseases, as well as their families, which could improve not only their quality of life, but also their response to the treatments. In the context of increasing rates of noncommunicable diseases throughout the world, the number of people in need of palliative care is also rising – which results in the necessity of implementing it in an accessible way to everyone, not only to those able to afford private assistance.

            It would not be amiss to say that the majority of adults that requires palliative care come from middle-income countries, that are facing an epidemiological transition (from a prevalence of acute diseases to a predominance of chronic illness). For this reason, these areas are the ones whose populations are urging for palliative care. However, in these places, this service is not seen as an essential part of the health system, but as an additional service. Thus, it is often under the responsibility of the supplementary health system, which is restricted to citizens who have the expensive private health insurance. Consequently, just a minority will make use of its benefits – taking as an example, only few patients have the opportunity to receive physical and psychological support from this caregiving team, which increases their chance to live as actively and comfortably as possible. In order to allow all citizens to have access to these fundamental assistances, palliative care should be effectively included in the UHC.

Its implementation is feasible, because palliative care can be provided almost everywhere – in a hospital or even in the patient’s own house – and it can be done by either specially trained primary health care professionals or specialists in the area. Moreover, some studies have shown that its accomplishment could even reduce medical costs, not only from the patients itselves, but also from the Government⁽¹⁾. This implies that this kind of care, instead of being an unnecessary expenditure, should be considered as an investment in the health sector, given that it would bring improvements to the patient’s condition as well as to the allocation of resources from health management organizations. Therefore, it is needless to attest that palliative care should be implemented in the Universal Health Coverage. By doing so, the effects of the growing incidence of noncommunicable diseases and the spendings they cause to the health system of many countries could be diminished and the democratization of palliative care could finally be achieved.

References

• https://www.who.int/nmh/Global_Atlas_of_Palliative_Care.pdf
• https://www.who.int/health-topics/universal-health-coverage#tab=tab_1
• Sher DJ. Economic Benefits of Palliative Care Consultation Continue to Unfold. J Clin Oncol. 2015 Sep 1;33(25):2723-4. doi: 10.1200/JCO.2015.62.1557. Epub 2015 Jul 20. PMID: 26195704.
• Mendes EV. As redes de atenção à saúde [Health care networks]. Cien Saude Colet. 2010 Aug;15(5):2297-305. Portuguese. doi: 10.1590/s1413-81232010000500005. PMID: 20802863.

About the authors

Natan Viana Medeiros is a 1st-year medical student at Universidade Federal de Juiz de Fora (UFJF) in Juiz de Fora, Brazil. He is a member of the International Federation of Medical Students Associations of Brazil (IFMSA-Brazil), a national member organization of IFMSA. Isabela Thomé Heleno is a 1st-year medical student at Universidade Federal de Juiz de Fora (UFJF) in Juiz de Fora, Brazil. She is a member of the International Federation of Medical Students Associations of Brazil (IFMSA-Brazil).