'Unfortunately, the mortality rate for all of us here remains 100%.'
So spoke Dr Stephen Connor, Senior Executive of the Worldwide Palliative Care Alliance in preparation for a high-level UN General Assembly meeting on non-communicable diseases (NCDs) planned for September 2011.
No need to quibble over semantics on Connor's statement, irrespective of how unpalatable the truth is. We are all going to die. It's just one of those disarming, irrefutable truths. No uncertainty. No ambiguity.
Palliative care has historically been perceived as an end-stage package of interventions, introduced when a cure is no longer possible, addressing the holistic (that is, physical, social, emotional and spiritual) needs of patients and their families as they face the inevitable.
In sub-Saharan Africa, unlike in many parts of the world, HIV and AIDS has been the primary diagnosis addressed by palliative care services, in part influenced by the funding priorities of the international donor community. But NCDs (e.g. cardiovascular diseases, mental illnesses, trauma, cancers, chronic respiratory diseases and diabetes) are increasingly becoming a cause for concern.
Important to note -- such chronic conditions are not solely a problem for those rich countries where lifestyle, work patterns and societal factors can impact negatively upon the public's health.
NCDs are a significant source of morbidity and mortality and are the leading cause of deaths globally -- and are on the rise. According to a recent WHO report, of the 57 million global deaths in 2008, 36 million (63%) were due to NCDs, with nearly 80% of these deaths occurring in low- and middle-income countries.
If we do nothing, it is estimated that NCDs will account for 52 million deceased people annually by 2030. That nearly equates to the entire population of the United Kingdom – every year!
And palliative care's role in addressing these challenges?
For many years, it's felt like palliative care is the relative at a familial gathering that people tend to ignore, side-line, or avoid with (sometimes) unconcealed contempt.
True -- in recent years, palliative care has received funding. But disproportionately less so compared with prevention and cure programmes. Palliative care was also redefined in such a way that its rich, individual- rather than disease- focussed holistic approach was rendered into an anodyne form of supportive care.
And, let's be honest, palliative care isn't 'sexy enough', apparently. People die, often in terrible untreated pain … It's not a great celebrity cause to promote; the dying tend not to be as photogenic as vulnerable, orphaned infants.
But palliative care needs to be an integral and valued member of the family that addresses both infectious diseases and NCDs. In short, it has to be a respected partner in the continuum of care. After all, and based on WHO estimates for 2005 (i.e. one percent of a country's total population), nearly 10 million people need palliative care for life-limiting illnesses across Africa. We are not dealing with small numbers here!
As Dr Connor remarked in New York: 'We need a full spectrum of responses to non-communicable diseases, from prevention to palliation'.
The months ahead will determine if the global care community has meaningfully embraced palliative care or maintained it at an unhelpful and dysfunctional family distance.