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Convocation Review: Health economist Felicia Knaul discusses palliative care

On Friday, January 24, international health economist Dr. Felicia Knaul delivered a convocation talk focused on access to palliative care in developing countries. Knaul is an expert on Latin American healthcare systems and serves as Director of the University of Miami Institute for the Advanced Study of the Americas. Her presentation offered an insightful and sobering look at the global state of pain-related healthcare, along with important recommendations for the future.

Palliative care, according to Knaul, is a field of medicine focused on addressing the needs of patients with severe “complex, chronic, or acute” health conditions that are “life-threatening or life-limiting.” It is closely tied to the issues of pain relief and end-of-life care.

Knaul opened her presentation by reading a passage from Leo Tolstoy’s The Death of Ivan Ilyich describing the incredible suffering of a dying man. She pointed out that the passage may sound foreign to Americans, for whom pain medication is generally available—but for many people around the world, extreme suffering is the reality of death.

Knaul’s presentation focused on a 2017 report that her team published in the medical journal The Lancet, entitled “Alleviating the Access Abyss in Palliative Care and Pain Relief: An Imperative of Universal Health Coverage.” Knaul served as chair of the Lancet commission that produced the report.

The report found that over 61 million people worldwide experience “serious health-related suffering” each year, with about 80 percent of these people living in low-income countries. Almost 50 percent of deaths each year fall into this serious-suffering category. Despite the vast scale of this issue, it is often overlooked. Traditional health measures, which focus on mortality and morbidity statistics, typically fail to measure suffering.

Knaul described how global access to basic pain-relief medications, such as morphine, is highly inequitable, with many low-income countries having essentially no access. These countries generally have little negotiating capacity and rely on smaller local markets, which means they cannot access the lower morphine prices that are available in the United States.

However, Knaul argued that closing the access abyss for morphine would in fact be a relatively inexpensive endeavor. A key piece is advocacy and awareness: palliative care tends to be ignored as countries build up their healthcare systems.

Knaul also shared experiences from her advocacy work in Latin America, especially in Mexico, where she collaborated with government figures and non-profit organizations. In the Lancet report, Knaul and her colleagues recommend a universal palliative care package and urge countries to develop plans to address this area of healthcare.

Interestingly, Knaul also looked at the “access abyss” in the context of the current United States opioid epidemic. She explained that palliative care advocacy is sometimes criticized as a risk factor for a potential opioid epidemic in developing countries. However, Knaul argued that this sentiment has unfairly hindered citizens of low-income countries from accessing even the most basic pain relief that Americans take for granted.

Knaul finished by responding insightfully to student questions dealing with issues such as varied cultural constructions of pain. Overall, she delivered a powerful and informative presentation that combined statistics with empathy to discuss a critical but overlooked issue in global healthcare.

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