LAUSR

Universal health coverage (UHC) has assumed an iconic place in work to achieve the Sustainable Development Goals (SDGs). Its central importance for achieving SDG 3—ensuring healthy lives for all—is proven by the increasingly sophisticated efforts to measure UHC and to estimate to what extent UHC can be achieved by 2030. An example is the Global Burden of Disease (GBD). The GBD team constructed a UHC Index by beginning with the idea of access to quality essential health-care services and access to safe, effective, quality, and affordable essential medicines and vaccines. They then took a collection of tracer indicators, including for vaccines, antenatal care, skilled birth attendance, facility births, antiretroviral coverage, and treatments for several diseases amenable to personal health care. The GBD’s UHC Index was based on a comprehensive assessment of these components. Palliative care and pain relief were not among these measures. Palliative care and pain relief are some of the most neglected dimensions of global health today. They are barely even afterthoughts in discussions about the scope of UHC. The Lancet Commission on palliative care and pain relief seeks to redress these perilous omissions. Why have palliative care and pain relief been so ignored in global health? Two reasons might be considered. First, palliative care and pain relief are often seen as luxuries for health-care systems. Even high-income countries with advanced health services struggle to provide access to comprehensive palliative care programmes. It would be unreasonable, some may argue, to include palliative care and pain relief as core services for UHC. Second, in those high-income countries where palliative care and pain relief are available, there is often vigorous and passionate disagreement about the role of palliative care services in end-of-life settings. If the professional, public, and political communities cannot agree on the place of palliative care in society, introducing this element into discussions of what should be included within UHC is unlikely to be helpful or productive. This Lancet Commission shows that these arguments and assumptions are entirely fallacious. Felicia Knaul, who chaired our Commission, and a team of diverse experts have produced nothing less than a landmark report: • The Commission describes a new measure of serious health-related suffering, which captures for the first time the crisis that must be addressed. • It makes a clear call to take more seriously the alleviation of the burden of pain, suffering, and severe distress associated with life-threatening or lifelimiting conditions. • It identifies a cost-effective essential package of interventions for palliative care and pain relief. • It sets out feasible actions to “remedy the access abyss”. • It proposes international collective action to advance the goals of the Commission. The Commission’s work does not end with publication of this report. The Commission will establish a Working Group to track progress on the delivery of its recommendations. As WHO, the World Bank, and other global health institutions continue to grapple with the task of implementing policies to accelerate progress towards UHC, palliative care and pain relief should be included within their vision. Death and disability are important metrics for describing the state of the world’s health. But suffering is important too. Measures of suffering have been absent, and so the need for palliative care and pain relief services has been easy to miss. That excuse no longer holds. The scale of human suffering is massive—61 million people in 2015 and 6 billion physical and psychological symptom days annually (4 out of 5 of these days being accumulated in low-income and middle-income Published Online October 12, 2017 http://dx.doi.org/10.1016/ S0140-6736(17)32560-6