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Palliative care and hospice outside of the United States

Suresh Kumar, MBBS, DA, Dip Palmed, MA
Section Editor
Robert M Arnold, MD
Deputy Editor
Diane MF Savarese, MD


Palliative care is an interdisciplinary medical specialty that focuses on preventing and relieving suffering and on supporting the best possible quality of life for patients and their families facing serious illness. The primary tenets of palliative care are symptom management; establishing goals of care that are in keeping with the patient’s values and preferences; consistent and sustained communication between the patient and all those involved in his or her care; psychosocial, spiritual, and practical support, both to patients and their family caregivers; and coordination across sites of care.

Hospice and Palliative Medicine is a recognized medical subspecialty in the United States and internationally, including in Canada, England, Ireland, Australia, and New Zealand. Many European countries are also in the process of developing certification for palliative care. Unfortunately, in other parts of the world, access to quality palliative care is very limited. Only 14 percent of the needy have access to palliative care [1].

This may be changing. The 2014 World Health Assembly passed a resolution appealing to member countries to incorporate palliative care services into the mainstream health care system [2]. At the global policy level, in addition to this, two more important developments bear mention. First, in 2000, palliative care was included in the United Nation’s International Covenant on Economic, Social, and Cultural Rights, which states: “States are under the obligation to respect the right to health by, inter alia, refraining from denying or limiting equal access for all persons…to preventive, curative, and palliative health services.” Second, essential medicines for palliative care were included in the 18th World Health Organization essential medicines list in 2013 [3].

This topic will discuss palliative care and hospice services outside of the United States. A more comprehensive overview of palliative care is available separately. (See "Benefits, services, and models of subspecialty palliative care".)


Palliative care services focus mainly on noncommunicable causes of death, which bring about the great majority of deaths worldwide [4]. Globally, it is estimated that 40 million people are in need of palliative care at any point of time [1]; 39 percent have cardiovascular disease, 34 percent have cancer, 10 percent have chronic respiratory conditions, 6 percent have HIV, and 5 percent have diabetes. Adults in need of palliative care for progressive nonmalignant disease represent the highest proportion of cases for all regions, followed by cancer. One exception to this is in Africa, where people with HIV/AIDS are the largest group of patients in need of palliative care [5]. The World Health Organization (WHO) estimates that the great majority (78 percent) of adults in need of end of life care live in low- and middle-income countries [5]. Similarly, the vast majority of children (98 percent) in need of palliative care at the end of life live in low- and middle-income countries [5]. However, the highest rates of palliative care availability and utilization among adults are in higher-income countries. Only 9 percent of the world’s countries, all of relatively high income, are considered to have advanced levels of palliative care integration into mainstream health services [6].

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Literature review current through: Dec 2017. | This topic last updated: Jun 15, 2017.
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