It is estimated that 40 million people worldwide need palliative care and 80% of that need originates in resource-poor countries. Natalia Arias, a researcher at the Institute for Culture and Society (ICS) of the University of Navarra, mentioned this figure in the context of a colloquium organized by the Institute’s ATLANTES Program.

Taking into account this demand, she believes that "we have to find a way to act. One proposal is to integrate this type of care at the first step of the healthcare system, in primary care." The World Health Organization (WHO) has proposed evaluating the problem on the basis of four pillars: good policies, training for healthcare professionals, the availability of medicine to combat pain, and the implementation of services.

Arias notes that the first proposal is about having "a legal framework that allows us to regulate who, how and when we protect." In the education section, she emphasizes that, "most recently graduated doctors have no knowledge of pain control and do not even know the initial doses associated with morphine," which is why they need training in this discipline.

Regarding the availability of medicine, she mentioned that morphine, which is most commonly administered in pain management treatments, "is not patented, no pharmaceutical has a monopoly on it and its production costs four cents. But it does not reach those who need it because of the difficulty in regulating it, political and economic interests, and a lack of knowledge about how to handle this medication."

Finally, she argues for the importance of having hospitals and healthcare centers with equipment able to provide palliative care, and stresses the importance of designing services that fit the needs of patients, especially in countries where the economic, political and social services require the creation of home services.

"The development of indicators is not an easy task"

According to Natalia Arias, the palliative care community is faced with the task of determining how to measure the development of this type of care in the world. "The ATLANTES Program is a pioneer in this field, developing research projects that, through consultation with and consensus of experts, reviews of scientific literature and think tanks, aims at identifying and elaborating the best indicators applicable to different regions.”

However, "this is not an easy task," she explains, since "the problem lies in the creation of indicators that allow for comparisons between countries with different contexts and realities." Case in point is Europe, a region in which "one might assume that the development and availability of palliative care is homogenous."

However, she states that, "even in this region, we see countries where the lack of policies or services scarcely covers national needs. For example, in some Eastern countries, morphine is scarcely available; consumption thereof is as high as 1: 120 mg of morphine compared to Western Europe."

After elaborating the first atlas of palliative care in Europe, the ATLANTES team realized that there was a pattern in respondents’ answers, an indicator not yet defined. "It's about the level of development of palliative care and its vitality, that is, how many organizations there are, how many volunteer teams, what activities they carry out, etc.,” Arias noted. She points out that this is an example of the fact that "the research sector in palliative care is very dynamic," although she emphasizes that, "much more remains to be done."