A Global Social Policy Analysis of International Palliative Care Development

A global lack of pain and palliative care services means that millions of people each year spend their last weeks and days suffering serious, but avoidable physical and psychological pain. More usually understood as a national issue, this multiple methods study considers why palliative care should be considered an issue for the international development community. Use of Global Social Policy as a theoretical lens to view development reveals opportunities for palliative care to make gains within the incoming global health priority of achieving Universal Health Coverage. It is argued that there is a need to move beyond consideration of palliative care as a moral concern towards new ways of ‘framing’ the issue. Presentation of palliative care as being economically beneficial is therefore encouraged. By doing so may allow the presentation of palliative care as an important element of international development and attract new funding streams. A systematic review reveals a lack of ‘international evidence’ for palliative care, particularly in low and middle income countries. More encouragingly, opportunities are revealed for existing policies and practices to be ‘transferred’ to other similar settings. Yet, an analysis of the national contexts from which palliative care has (and has not) developed shows that countries which have not developed palliative care are likely to face significant challenges in the delivery of basic healthcare. This raises serious questions regarding how such countries can also integrate palliative care into their health systems. International palliative care experts were consulted to find out how they thought the field can move forwards through global advocacy. The far-reaching benefits of palliative care encourage the need for palliative care to be constructed in new ways. However ongoing disunity regarding whether palliative care is a long term approach or an end of life intervention threatens to undermine how activists can construct tractable arguments for palliative care to policymakers.