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.

Summary

Applying the SHS 2.0 method to GBD data, the authors estimate that serious health-related suffering rose 74% from 1990 to 2021 to nearly 73.5 million individuals, with 80% occurring in LMICs and a growing share among non-decedents (63% by 2021). Drivers shifted toward non-communicable diseases, with marked sex- and age-specific patterns that inform targeted palliative care expansion.

Key Findings

• Global SHS increased 74% from 1990 to 2021, reaching nearly 73.5 million individuals.
• LMICs accounted for 80% of SHS; non-decedent SHS more than doubled to 63% by 2021.
• Burden shifted toward non-communicable diseases; child SHS share fell from 25% to 14%; female 20–49 years in LICs and ≥70 years in HICs were most affected.

Clinical Implications

Encourages earlier integration of palliative care, prioritization of non-decedent populations, and targeted services for women in specific age bands across income settings. Supports national planning for essential palliative medicines and workforce.

Limitations

• Model-based estimates rely on GBD inputs and assumptions, which may vary in quality across countries.
• Lack of patient-level validation limits inference on service delivery effectiveness.

Future Directions

Link SHS estimates to health system capacity mapping, prospective monitoring of palliative care access, and evaluation of interventions reducing non-decedent suffering.