Reducing the Burden of Serious Health-related Suffering: An evidence base to close national divides in access to palliative care and pain relief

全世界每年有6 000多万人因患有严重疾病或死于严重疾病而遭受与健康有关的严重疼痛和痛苦。姑息治疗和疼痛缓解（PCPR）是一种廉价，必要和有效的干预措施，许多患者被剥夺了，特别是在低收入和中等收入国家（LMIC）。在每个国家，受苦最多的人是最需要帮助的人。世界上最贫穷的一半是50%的人，他们生活在只有1%的吗啡等效药物的国家，这些药物是缓解疼痛所必需的。与全球卫生领域的许多其他优先事项不同，负担能力通常不是获得的最大障碍。缺乏使卫生部能够将所需服务纳入卫生系统所需的工具、财务信息和证据。PCPR可以加强整个卫生系统，并释放稀缺资源用于治疗其他患者，这一认识也是如此。各国致力于实现可持续发展目标，包括全民健康覆盖，而PCPR是必不可少的组成部分，特别是考虑到COVID-19带来的卫生系统挑战。我们的研究以哥伦比亚、萨尔瓦多和墨西哥这三个拉丁美洲国家为基地，为了解资源有限地区的PCPR现实提供了基础，并引发了必要的变革，以确保普及。政策制定者寻求问题的答案，如：鉴于他们国家的疾病和疾病的不同情况，应该优先考虑哪些PCPR服务？每个卫生系统有什么能力提供PCPR？什么是最好和最安全的方式，包括需要哪些人力资源，以及在社区一级可以提供什么，以最低的成本和最有效的方式提供PCPR服务？而且，一个国家如何在所有患者和家庭需要的时候，以不减损其他人可能需要的卫生服务的方式，向他们提供PCPR？我们的研究重点是提供工具和知识来回答这些问题。我们将与来自伙伴国家、美洲地区和全球的姑息治疗、卫生经济学、社会学、人类学、卫生系统设计、宣传和有效信息传递方面的领先专家和机构合作，以：1.确定在每个国家提供PCPR的适当途径。提供证据，证明需要基本药品、设备以及卫生工作者的类型和人数，以便以加强卫生系统的方式提供综合的预防和应对措施。以现行价格计算PCPR套餐的成本，并与最佳国际价格进行比较，以促进公平和更具成本效益的获得，特别是获得药品。与卫生系统的不同部门-那些负责服务组织、服务提供、服务筹资和劳动力培训的部门-合作，以确定每个部门如何能够为整合预防和应对艾滋病毒/艾滋病方案作出贡献，并惠及最贫困者。根据基于共识的PCPR指标评估研究的潜在影响。与国家和国家以下各级政府的决策者合作，分享调查结果，展示政策的相关性，并支持制定国家行动计划。与PCPR和整个拉丁美洲地区其他社区的领导人接触，分享这些发现，并找出每一项发现与其社区的相关性。我们的最终目标是确保没有人在痛苦中生活和死亡，这些痛苦可以通过及时获得姑息治疗来改善，以确保最佳的生活质量，直到死亡。这是医学的核心，也是建立一个更加公正和人道的世界的关键。

Across the world over 60 million people experience serious health-related pain and suffering as a result of living with and dying from severe illness and disease every year. Access to palliative care and pain relief (PCPR) - an inexpensive, essential, and effective set of interventions - is denied to many patients especially in low-income and middle-income countries (LMICs). Those who suffer the most are those who are in the most need - in every country. The poorest half of our world are the 50% who live in countries that have only 1% of the distributed morphine equivalent medication that is essential to alleviating pain.Unlike so many other priorities in global health, affordability is often not the greatest barrier to access. The tools, financial information and evidence required to enable Ministries of Health to integrate needed services into the health systems are lacking. So is the knowledge that PCPR can strengthen health systems overall and free-up scarce resources for treatment of other patients.Our research comes at a key juncture in global health. Countries have committed to achieving the SDGs, including Universal Health Coverage, and PCPR is as essential component, especially in light of the health system challenges imposed by COVID-19. Our research is anchored and based in Colombia, El Salvador and Mexico, three Latin American countries that provide the basis of understanding the reality of PCPR in regions with limited resources and evoking the necessary change to ensure universal access. Policy makers seek answers to questions such as: What PCPR services should be prioritized given the different profiles of disease and illness in their country? What capacity does each health system have to deliver PCPR? What is the best and safest way, including what human resources are required and what can be offered at community level, to provide PCPR services at lowest cost and most efficiently? And, how can a country provide access to PCPR to all patients and families at their time of need in ways that do not detract from health services that may be needed by others? Our research is focused on providing the tools and knowledge to answer these questions. We will work with leading experts and institutions in palliative care, health economics, sociology, anthropology, health system design, advocacy and effective messaging from partner countries, the Americas region and globally, to:1. identify appropriate route(s) of providing PCPR in each country.2. provide evidence of the need for the essential medicines, equipment and type and number of health workers for delivering integrated PCPR packages in ways that strengthen health systems.3. cost PCPR packages at current prices and compare to the best international prices to promote fair and more cost-effective access, especially to medicines.4. work with the different parts of the health system - those who deal with the organization of services, the delivery of services, their financing, and workforce training - to identify how each can contribute to integrating PCPR and reach the poorest.5. assess potential impact of the research based on concensus-based PCPR indicators.6. work with policy makers from national and sub-national governments to share findings, demonstrate policy relevance and support the development of national action plans.7. reach out to leaders in PCPR and from other communities throughout the Latin America region to share the discoveries and work out how each is relevant to their communities.8. publish the research in leading journals in English/Spanish, and disseminate via an integrated communication and outreach strategy to inform policy makers, academics and civil society.Our ultimate goal is to ensure that no one lives and dies with suffering that could be ameliorated with timely access to the palliative care to ensure the best quality of life until death. This is at the heart of medicine and is key to a more just and humane world.