Closing the pain divide: the quest for effective universal health coverage

Background: More than 5·5 billion people, most in low-income and middle-income income countries (LMICs), live with limited or no access to pain control and palliative care. This inequality—the pain divide—is a grave injustice. As a result, many patients around the world, especially those with chronic diseases, needlessly suffer pain. The Harvard Global Equity Initiative–Lancet Commission on Global Access to Pain Control and Palliative Care (GAPCPC) aims to address the pain divide through the promotion of effective universal health coverage (UHC) and by harnessing existing platforms for health systems strengthening. Methods: The Commission has convened experts from the health systems, global health, and palliative care communities. It merges efforts between research, policy, and implementation partners at the global and national levels for policy-oriented research and evidence-based policy-making. The Commission is reviewing country cases of innovative reform and policy-making on palliative care in Mexico, Colombia, and Costa Rica, to identify the greatest opportunities and challenges for UHC. Findings: The Commission noted examples of reforms in legislature, education, and health systems to improve access to pain relief in Mexico, Colombia, and Costa Rica. Such reforms include the development of palliative care curricula for undergraduate and post-graduate courses to expand protocols for prescription of opioids for pain control. The Commission focuses on the impact of contextual and enabling factors to producing equitable, effective, and affordable pain control and palliative care services in various LMICs, including these three Latin American countries. Further, it examines the policy, regulatory, and training barriers to achieving effective UHC and strategies for future reform. It aims to enhance knowledge exchange between experts and policy-makers in LMICs on pain policy, as well as on the training of different cadres of the health workforce and models of service delivery to meet palliative care needs across diseases, and throughout the life course. Interpretation: Policy-makers require guidelines for action and effective planning at the country level. A systematic guide and tool for drafting national pain and palliative care plans in LMICs is missing. Documenting the process and the development of guiding tools based on country cases of effective strategies can help other LMICs along their trajectories in making pain control and palliative care for all a reality. Funding: The HGEI-Lancet Commission on GAPCPC is primarily supported by Harvard University