Mapping levels of palliative care development in 198 countries: the situation

Clark, D. , Baur, N., Clelland, D., Garralda, E., López-Fidalgo, J., Connor, S. and Centeno, C. (2020) Mapping levels of palliative care development in 198 countries: the situation. Journal of Pain and Symptom Management, 59(4), 794-807.e4. (doi: 10.1016/j.jpainsymman.2019.11.009) (PMID:31760142) (PMCID:PMC7105817)

203906.pdf - Published Version
Available under License Creative Commons Attribution.



Context: Palliative care is gaining ground globally and is endorsed in high level policy commitments, but service provision, supporting policies, education and funding are incommensurate with rapidly growing need. Objectives: To describe current levels of global palliative care development and report on changes since 2006. Methods: An online survey of experts in 198 countries generated 2017 data on 10 indicators of palliative care provision, fitted to six categories of development. Factor analysis and discriminant analysis showed the validity of the categorization. Spearman correlation analyses assessed the relationship with World Bank Income Level (WBIL), Human Development Index (HDI) and Universal Health Coverage (UHC). Results: Numbers (percentages) of countries in each development category were: 1) no known palliative care activity 47 (24%); 2) capacity-building 13 (7%); 3a) isolated provision 65 (33%); 3b) generalized provision 22 (11%); 4a) preliminary integration into mainstream provision 21 (11%); 4b) advanced integration 30 (15%). Development levels were significantly associated with WBIL (rS= 0·4785), UHC (rS=0·5558) and HDI (rS=0·5426) with p < 0.001. Net improvement between 2006-2017 saw 32 fewer countries in categories 1/2, 16 more countries in 3a/3b, and 17 more countries in 4a/4b. Conclusion: Palliative care at the highest level of provision is available for only 14% of the global population and is concentrated in European countries. An 87% global increase in serious health related suffering amenable to palliative care interventions is predicted by 2060. With need rising, palliative care is not reaching the levels required by at least half the global population.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Clark, Professor David and Clelland, Mr David and Baur, Dr Nicole
Creator Roles:
Clark, D.Funding acquisition, Conceptualization, Formal analysis, Writing – original draft, Writing – review and editing
Baur, N.Data curation, Formal analysis
Clelland, D.Formal analysis
Authors: Clark, D., Baur, N., Clelland, D., Garralda, E., López-Fidalgo, J., Connor, S., and Centeno, C.
College/School:College of Social Sciences > School of Interdisciplinary Studies
Journal Name:Journal of Pain and Symptom Management
ISSN (Online):1873-6513
Published Online:22 November 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Journal of Pain and Symptom Management 59(4): 794-807.e4
Publisher Policy:Reproduced under a Creative Commons License

University Staff: Request a correction | Enlighten Editors: Update this record

Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
170345Interventions at the end of life: social, historical and comparative analysis to promote global improvement.David ClarkWellcome Trust (WELLCOTR)103319/Z/13/ZIS - Interdisciplinary Studies