Outcome progress
Has the situation improved in the real world?
LowSerious health-related suffering rose 74% between 1990 and 2021 to about 73.5 million people, and only about 14% of those who need palliative care receive it.
No One Dies in Pain
Around 73 million people a year live with serious suffering linked to illness that palliative care could ease, eight in ten of them in low- and middle-income countries, yet only a small minority receive such care and essential pain medicines such as oral morphine remain scarce in much of the world.
Updated October 15, 2026. Written from the sources listed below, not independently peer-reviewed.
Take a guess first
Palliative care relieves pain and other suffering caused by serious illness. Out of every 100 people worldwide who need it, how many does WHO estimate actually receive it?
73.5 million
People with serious health-related suffering
Modelled estimate of people whose suffering from illness or injury could be relieved by palliative care, up 74% since 1990. 80% live in low- and middle-income countries.
Data year 2021. Source: Knaul F.M. et al., The Lancet Global Health 13(3):e422–e436, 2025
About 14%
People in need who receive palliative care
WHO estimate published in its 2020 fact sheet; the number of people who need palliative care each year is put at 56.8 million.
Data year 2020. Source: World Health Organization, 2020
29 of 201
Countries with advanced palliative care
Countries and territories rated at the highest of four development levels in the 2025 World Map of palliative care (14%). 40% are at the lowest, Emerging, level.
Data year 2025. Source: Tripodoro V.A. et al., Journal of Pain and Symptom Management 70(5):447–458, 2025
The numbers
Unit: million people
* Projection, not a measurement. Modelled estimate for 2016 and projection for 2060, based on WHO mortality projections for 20 conditions; the 2060 value is a projection, not a measurement. It counts only people who die with such suffering, not those who live with it.
No numerical target, but part of universal health coverage
SDG target 3.8 calls for universal health coverage, and palliative care is recognised as part of the human right to health. In 2014 the World Health Assembly adopted its first resolution on palliative care (WHA67.19), asking countries to make it a core part of their health systems with an emphasis on primary and home-based care. There is no global target for coverage. In a 2019 WHO survey of its 194 Member States, 68% of countries reported funding for palliative care, but only 40% said services reached at least half of the patients who need them.
Who is left behind
Between 1990 and 2021, serious health-related suffering grew by 83% in low- and middle-income countries, compared with 46% in high-income countries.
Source: Knaul F.M. et al., The Lancet Global Health 13(3):e422–e436, 2025Children made up 14% of people with serious health-related suffering worldwide in 2021, but 33% in low-income countries and only 2% in high-income countries.
Source: Knaul F.M. et al., The Lancet Global Health 13(3):e422–e436, 2025Low-income countries receive about 0.03% of the roughly 298 tonnes of morphine-equivalent opioids distributed worldwide each year, and the poorest half of the world's population receives about 1% of opioid pain medicines.
Source: Bhadelia A. et al., American Journal of Public Health 109(1):58–60, 2019In Africa, 26 of 47 countries (55%) are at the lowest, Emerging, level of palliative care development, and only one, Uganda, is rated Advanced.
Source: Tripodoro V.A. et al., Journal of Pain and Symptom Management 70(5):447–458, 2025
Are we making progress?
Instead of one “percent solved” score, DO GOOD rates three separate dimensions. A problem can have mature solutions that still reach too few people. These ratings are an editorial reading of the sources on this page, not a measured index.
Solution maturity
How mature and validated are the available solutions?
HighThe approach and its essential medicines are well established and inexpensive: the Lancet Commission described an essential package built on off-patent oral and injectable morphine costing slightly more than US$3 per person.
Implementation reach
How widely are effective solutions actually used?
LowOnly 40% of countries told WHO that services reach at least half of patients in need, and countries home to 79% of the world's population used only 13% of the morphine consumed for pain and suffering in 2018.
Confidence in the data
LowNeed is modelled from disease data, the coverage figure dates from 2020 (in 2021 WHO described it as about one in ten), and national development ratings rely mainly on expert informants, with limited comparability to earlier maps.
Current trajectory
MixedSome countries have made clear progress, and the share of morphine used by the roughly 80% of people in mostly poorer countries rose from 9.5% in 2014 to 13% in 2018. But need is growing quickly, and the number of countries rated Advanced is the same as in 2017.
Why this matters
Palliative care aims to improve the quality of life of adults and children with life-threatening illness and of their families, by preventing and relieving pain and other physical, psychological, social and spiritual problems. It is needed not only at the end of life: WHO estimates that 56.8 million people need it each year, of whom 25.7 million are in their last year of life. Most adults who need it have cardiovascular disease (38.5%) or cancer (34%), followed by chronic respiratory diseases, AIDS and diabetes, and many others live with kidney failure, dementia or other neurological conditions. Pain is common and often severe: 80% of people with AIDS or cancer, and 67% of those with cardiovascular disease or chronic obstructive pulmonary disease, will have moderate to severe pain at the end of life. WHO recognises palliative care as part of the human right to health, yet only about 14% of the people who need it receive it.
The gap is widest in low- and middle-income countries, which carried 80% of the 73.5 million cases of serious health-related suffering estimated for 2021. Children are a much larger share of those in need in poorer countries, and 98% of children who need palliative care live in low- and middle-income countries, almost half of them in Africa. Access to pain relief is especially unequal: in 2018, countries home to 79% of the world's population, mostly low- and middle-income, used only 13% of the morphine consumed for pain and suffering. As populations age and chronic diseases spread, researchers project that the number of people dying each year with serious suffering will nearly double between 2016 and 2060, with the steepest rise in low-income countries.
How the need for palliative care is measured
There is no single survey that counts who receives palliative care. Global figures come from models that estimate need from disease data, from records of medicine use, and from expert assessments of national services. The main measures are:
Serious health-related suffering
Introduced by the Lancet Commission on palliative care and pain relief, this measure estimates how many people experience severe physical, psychological or social suffering linked to illness or injury that cannot be relieved without medical care. The 2025 update estimates it from Global Burden of Disease prevalence data for conditions such as cancer, HIV, dementia and stroke, and counts both people who die and people who live with such suffering during the year.
People in need of palliative care
WHO's estimate of 56.8 million people a year, including 25.7 million in their last year of life, is based on deaths and illness from conditions that commonly require palliative care. It is a modelled estimate of need, not a count of patients, and it is several years old.
Availability of opioid pain relief
The amount of morphine and other opioid medicines a country consumes, reported each year to the International Narcotics Control Board, is the most widely used proxy for access to pain relief. It shows whether medicines reach a country, but not whether they reach the patients who need them.
Level of palliative care development
The 2025 World Map of palliative care rates 201 countries and territories on 14 indicators in six areas defined by WHO: policies, essential medicines, services, education, research and community empowerment. Countries are grouped as Emerging, Progressing, Established or Advanced. The ratings rest largely on reports from national experts, collected between December 2023 and March 2025.
What already works, and its limits
Palliative care in primary health care and at home
What works
WHO recommends integrating palliative care into primary health care, community and home-based care, with specialist teams as one part of the system. Care close to home lets people stay with their families, who are supported as well. Kerala in India adopted a state palliative care policy in 2008 based on a community model that other Indian states use as a benchmark.
Limits
Primary care teams need training, medicines and supervision, and family carers and volunteers carry much of the load. Few low-income countries have the funding and staff to provide such care nationwide.
Affordable essential medicines, including oral morphine
What works
Most pain and other distressing symptoms can be relieved with low-cost, off-patent medicines. The Lancet Commission built its essential package around immediate-release oral and injectable morphine, which it costed at slightly more than US$3 per person. Uganda reconstitutes imported morphine powder into affordable liquid oral morphine.
Limits
Low-income countries receive about 0.03% of distributed morphine-equivalent opioids. Medicines must be available at every level of care, not only in a few city hospitals.
Balanced regulation of controlled medicines
What works
Rules that ensure patients can get opioid medicines while preventing misuse can coexist: Germany and the United Kingdom combine high medical use with training, safety protocols and monitoring, and report little or no non-medical use. WHO calls for removing unnecessarily restrictive rules on morphine and other controlled palliative medicines.
Limits
Fear of misuse, partly fuelled by the opioid crisis in a few high-income countries, makes governments cautious. Changing laws, estimates of national need and prescribing rules takes years.
Training doctors and nurses
What works
WHO recommends that palliative care be part of the core training of every new health worker. In Uganda, nurses have been trained to prescribe morphine legally and safely, which brings pain relief to places without enough doctors.
Limits
Training is still limited or missing in many countries, and new skills only help if medicines and services are also in place.
National policies and funding within universal health coverage
What works
National plans, a coordinating unit in the ministry of health and public funding make palliative care a regular health service rather than a charity. Costa Rica runs an integrated national palliative care programme as part of its universal health coverage.
Limits
In a 2019 WHO survey only 68% of countries reported funding for palliative care, and policies on paper do not guarantee services in practice.
Innovations to watch
Promising, but not proven at scale. The stage shows how far each approach has come; it is not a recommendation.
Early deployment
Measuring suffering, not only deaths
The serious health-related suffering measure, updated in 2025, includes people who live with severe suffering as well as those who die, and by 2021 the former were 63% of the total. It is meant to help governments plan services and medicines, but few yet use it for budgeting.
Early deployment
A global ranking of national development
The 2025 World Map is the first to score countries on WHO's palliative care indicators with a common method, giving each a development score that can be tracked over time. Its value for monitoring will depend on repeating the assessment and improving data from countries without expert informants.
Pilots
Better measures of opioid availability
Researchers linked to the Lancet Commission have proposed distributed opioids in morphine equivalent as a global measure of how much opioid pain relief is available for palliative care, as an alternative to raw consumption figures. Whether it will be taken up in official monitoring is not yet clear.
What is holding progress back
- Coordination gap:
- Actors are not aligned. Needs standards, partnerships and better incentives.
- Implementation gap:
- Solutions work but reach too few people. Needs infrastructure, funding and organisation.
- Knowledge gap:
- Cause or mechanism not understood. Needs basic research.
Coordination gap
Not part of health systems
National health policies and systems often leave palliative care out entirely, so services depend on hospices, charities and individual champions. Only 40% of countries reported that services reached at least half of the patients who need them.
Implementation gap
Restrictive rules on controlled medicines
Unnecessarily strict regulations, prescribing limits and supply procedures for morphine and other controlled medicines keep pain relief from patients, even though the medicines are cheap and off-patent.
Implementation gap
Fear and misinformation about opioids
Prejudice among prescribers, sometimes called opiophobia, and wider social fears about opioids lead to under-treatment of pain. The opioid crisis in a few high-income countries has strengthened these fears elsewhere.
Implementation gap
Too few trained health workers
Palliative care training for doctors and nurses is limited or absent in many countries, and medicine access and research are the weakest of the six areas scored in the 2025 World Map.
Knowledge gap
Little data on who actually receives care
There is no routine global count of people receiving palliative care. Opioid consumption shows what reaches a country but not who benefits, and existing data cannot show inequalities within countries.
Implementation gap
Too few services for children
Children are a third of people with serious health-related suffering in low-income countries, against 2% in high-income countries, so the need for children's palliative care is greatest where services are least developed.
Questions nobody has answered yet
Unresolved questions, not vetted breakthroughs. Answering any of them would change what is possible.
How many people actually receive care
How can countries count the people who receive palliative care, including at home and in primary care, so that coverage can be tracked as part of universal health coverage?
What works best in low-income settings
Which models of community and primary-care palliative care relieve the most suffering at a cost low-income countries can sustain, and how can they reach rural areas?
Access without misuse
Which combinations of regulation, training and monitoring allow countries to raise access to opioid pain relief quickly while keeping non-medical use low?
Suffering beyond pain
How can services measure and relieve the psychological, social and spiritual suffering of patients and families, and the burden on family carers, which are harder to count than pain?
What you can do
Talk about care wishes early
Discuss with your family and doctor what matters to you if you become seriously ill, and ask about palliative care as soon as a serious diagnosis is made, not only at the very end of life.
Support carers around you
Offer practical help or a break to a friend or relative caring for someone who is seriously ill. Many hospices and palliative care services also train volunteers.
Support palliative care organisations
Donate to or volunteer with a local hospice, or support organisations that train health workers and widen access to pain relief in low- and middle-income countries.
Ask for it to be part of health coverage
When health services and budgets are debated, ask local representatives whether palliative care and essential pain medicines are included.
Ideas from the community
Ideas visitors sent in for this challenge, read by the DO GOOD team and pinned with permission. The colour shows the kind of contribution.
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Connected challenges
- Surviving Cancer Wherever You LiveCancer accounts for about a third of adults who need palliative care, and 80% of people with cancer or AIDS have moderate to severe pain at the end of life.
- Ending AIDSAIDS accounts for 5.7% of adults who need palliative care, and HIV remains a major cause of serious health-related suffering in sub-Saharan Africa.
- Health Care Everyone Can AffordWHO and the Lancet Commission call for palliative care to be a core part of universal health coverage, yet many national health systems still leave it out.
- Alzheimer's Disease and DementiaThe number of people with dementia dying with serious health-related suffering is projected to rise by 264% between 2016 and 2060, the largest relative increase of any condition.
- Ageing with DignityDeaths with serious health-related suffering among people aged 70 and older are projected to rise by 183% between 2016 and 2060.
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Sources
- [1]Palliative care (fact sheet)
World Health Organization (5 August 2020), published 2020
WHO's current fact sheet, based on the Global Atlas of Palliative Care (2nd edition, 2020), a 2019 WHO survey of 194 Member States and INCB data. Source of the 14% coverage figure, the 56.8 million in need, disease shares, pain prevalence, children's need, morphine consumption shares for 2014 and 2018, resolution WHA67.19 and the main barriers.
- [2]WHO takes steps to address glaring shortage of quality palliative care services
World Health Organization (news release, 5 October 2021), published 2021
WHO release of its palliative care indicators; describes coverage as about 1 in 10 people in need, says 78% of people in need live in low- and middle-income countries, and notes that monitoring has mostly relied on opioid consumption.
- [3]The evolution of serious health-related suffering from 1990 to 2021: an update to The Lancet Commission on global access to palliative care and pain relief
Knaul F.M. et al., The Lancet Global Health 13(3):e422–e436 (abstract record, MSK Synapse), published 2025
Peer-reviewed update of the Lancet Commission estimates (DOI 10.1016/S2214-109X(24)00476-5). Source of the 73.5 million people with serious health-related suffering in 2021, the 74% rise since 1990, the 80% share in low- and middle-income countries, growth by income group and the shares of children.
- [4]The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions
Sleeman K.E. et al., The Lancet Global Health 7(7):e883–e892 (DOAJ record), published 2019
Peer-reviewed projection based on WHO mortality projections for 20 conditions. Source of the trend from about 26 million deaths with serious health-related suffering in 2016 to 48 million projected for 2060, and the projected increases for low-income countries, people aged 70 and over and dementia.
- [5]First-Ever Global Ranking of Palliative Care: 2025 World Map Under the New WHO Framework
Tripodoro V.A. et al., Journal of Pain and Symptom Management 70(5):447–458, published 2025
Open-access paper (CC BY-NC-ND 4.0) rating 201 countries and territories on 14 WHO indicators, with data collected December 2023 to March 2025. Source of the development levels, the 29 Advanced countries, the African figures and the weakest areas.
- [6]Solving the Global Crisis in Access to Pain Relief: Lessons From Country Actions
Bhadelia A. et al., American Journal of Public Health 109(1):58–60, published 2019
Peer-reviewed summary by members of the Lancet Commission on Palliative Care and Pain Relief (2017/2018) and its recommendations. Source of the 61 million people in need, the distribution of morphine-equivalent opioids, the essential package cost, and the country examples of Uganda, Kerala, Costa Rica, Germany and the United Kingdom.