Relief from pain: Relief from pain, for everyone who needs it.
Pain relief can be cheap, yet most of the world goes without it. Only about 14% of people who need palliative care receive it. A full package of care costs about $182 a person a year in Rwanda.
Ryan K. Hertel · heyitskenton
The problem
What we're up against.
Suffering on a vast scale.
In 2023, about 73.6 million people lived with serious health-related suffering, and 76.2% of it fell in low- and middle-income countries.
Most people go without.
Only about 14% of people who need palliative care receive it, and in 2017, 47 countries had no known palliative care at all.
Pain, and no medicine for it.
Around 80% of people with AIDS or cancer will have moderate to severe pain. Yet South Asia, Africa, Central America and the Caribbean together use less than 2% of the world's opioid pain medicine, and in low-income countries the supply meets less than 0.5% of the medical need.
Children most of all.
Of the children who need palliative care, 98% live in low- and middle-income countries.
In America, care often comes late.
Hospice is widely used in America: 51.7% of people on Medicare who died in 2023 had it. But the median stay was just 18 days.
What works
Proven, and ready to grow.
Comfort and treatment, together.
In a randomized trial of patients with advanced lung cancer, adding early palliative care to standard treatment gave them a better quality of life, and they lived longer: a median of 11.6 months, against 8.9.
Across many trials.
Across 43 randomized trials, palliative care improved patients' quality of life and eased their symptoms.
Care at home.
Home palliative care more than doubled the odds of dying at home rather than in a hospital.
Built into African hospitals.
In 12 public hospitals in Kenya, Rwanda, Uganda and Zambia, a program to build in palliative care raised the number of patients identified for it by a factor of 2.7, and morphine use by a factor of 2.4. It wasn't a randomized trial.
It can save money.
In American hospitals, a palliative care consult within three days of admission was linked to costs about $3,237 lower per stay, though the studies were observational.
What a family could fund
Where the money goes furthest.
A full package, priced.
The Lancet Commission priced a full public package of palliative care for Rwanda at $15.7 million a year, about $182 per patient. Staff are 66% of the cost, and medicine just 10%.
Closing the morphine gap.
At the best international prices, about $145 million a year would close the world's gap in pain medicine for palliative care. For children in low-income countries, it comes to about 63 cents a child. These are the Commission's first estimates.
Morphine made locally.
Hospice Africa Uganda makes all of Uganda's oral liquid morphine, under license from the Ministry of Health, by its own account. Its founder writes that a bottle costs about as much as a loaf of bread.
Care by neighbors.
Kerala's community-owned network grew to more than 60 units covering more than 12 million people. Kerala now has near-universal access, while across India less than 4% of those who need palliative care can get it, so the model has plenty of room to spread.
American hospices, African partners.
Global Partners in Care pairs American hospices with African ones. In 2023 it supported 38 organizations in 10 African countries, which reached more than 250,000 patients, by its own count.
Honest limits
What money can't promise.
Opioid risks are real.
The World Health Organization says concerns about the harms of opioids are valid. Among people with cancer, the pooled risk of opioid misuse was 12.3%, from only a handful of studies that varied widely.
Rules money can't rewrite.
Many countries still struggle to get morphine because of regulatory barriers, low estimates of need and too little training, and the world's morphine manufacture fell from 420 tons in 2015 to 144 in 2024.
Too few trained people.
Early palliative care isn't widely used, partly because there aren't enough specialists. One partial answer: in a trial of 1,250 patients, video visits worked as well as visits in person.
The gains are real, but modest.
Across trials, palliative care wasn't linked to longer survival, a Cochrane review rates the evidence as low or very low certainty, and in a Kenyan trial, nurse-led palliative care didn't reduce pain.
Free care doesn't end money worries.
Among families getting free home care in Kerala, 31.3% were in debt, and 66.8% of patients couldn't afford their medicines.
Hard questions
Asked and answered.
You might ask
Won't more morphine fuel an opioid crisis?
Ryan
The risk is real, so the model is tight control: oral morphine, prescribed by trained staff for people who are very sick. An evaluation of Uganda's program found its rules had prevented misuse and leakage from the supply chain. In America, commonly prescribed opioids are no longer what drives overdose deaths.
You might ask
Isn't treatment better than comfort?
Ryan
It isn't either-or. In the landmark trial, palliative care was added to cancer treatment, and patients lived longer, not shorter.
You might ask
Why fund this abroad when Americans need it too?
Ryan
Both matter, and a family chooses. Medicare already spends $25.7 billion a year on hospice, while 76.2% of serious suffering falls in low- and middle-income countries, where full care can cost about $182 a person a year.
In the slider
See what your fortune could do here.
Relief from pain
The slider prices this cause with these numbers:
- About $182 a year gives a person palliative care, pain relief included, by the Lancet Commission's costing for Rwanda.
- The whole need is everyone living with serious health-related suffering, 73.6 million people in 2023.
- Only about 14% of people who need palliative care get it, and money isn't the only barrier: restrictive rules on morphine keep relief from many.
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Sources
Every number in this chapter, and where it came from.
Source 1: Palliative care: fact sheet (opens in a new tab)
World Health Organization, 5 August 2020. Checked 16 October 2026.
Source 2: Rwanda Policy Brief (opens in a new tab)
Lancet Commission on Global Access to Palliative Care and Pain Relief. Checked 16 October 2026.
The Commission's essential package of palliative care, costed with 2015 data at the lowest international medicine prices.
Journal of Pain and Symptom Management, 15 July 2026. Checked 16 October 2026.
Serious health-related suffering: suffering from illness that can't be relieved without medical care.
Journal of Pain and Symptom Management, 22 November 2019. Checked 16 October 2026.
An expert survey of palliative care in 198 countries.
International Narcotics Control Board, 9 March 2026. Checked 16 October 2026.
The UN treaty body that monitors the world's supply of controlled medicines.
Source 6: Key Facts (opens in a new tab)
Lancet Commission on Global Access to Palliative Care and Pain Relief. Checked 16 October 2026.
From the Commission's first report, published in 2017.
Source 7: Report to the Congress: Medicare Payment Policy, Chapter 9: Hospice services (opens in a new tab)
Medicare Payment Advisory Commission, March 2025. Checked 16 October 2026.
The independent agency that advises Congress on Medicare, from Medicare's own claims.
New England Journal of Medicine, August 2010. Checked 16 October 2026.
A randomized trial with 151 patients at one American hospital.
JAMA, November 2016. Checked 16 October 2026.
Cochrane Database of Systematic Reviews, 6 June 2013. Checked 16 October 2026.
A Cochrane review of 23 studies, 16 of them randomized trials.
Journal of Global Health, June 2017. Checked 16 October 2026.
Not randomized: twelve hospitals measured before and after.
JAMA Internal Medicine, June 2018. Checked 16 October 2026.
Pools six observational samples of hospital patients.
Source 13: Hospice Africa Uganda (opens in a new tab)
Hospice Africa Uganda. Checked 16 October 2026.
The organization's own account.
Philosophy, Ethics, and Humanities in Medicine, 8 July 2010. Checked 16 October 2026.
Written by Hospice Africa Uganda's founder.
Source 15: Kerala, India: a regional community-based palliative care model (Kumar) (opens in a new tab)
Journal of Pain and Symptom Management, May 2007. Checked 16 October 2026.
ecancermedicalscience, 19 November 2025. Checked 16 October 2026.
Source 17: 2023 Annual Report (opens in a new tab)
Global Partners in Care, August 2024. Checked 16 October 2026.
The organization's own report.
Source 18: People with medical needs are left behind in pain, reveals new report (opens in a new tab)
World Health Organization, 16 June 2023. Checked 16 October 2026.
British Journal of Cancer, 26 July 2024. Checked 16 October 2026.
Only six studies, with results ranging widely.
JAMA, August 2024. Checked 16 October 2026.
JAMA, 11 September 2024. Checked 16 October 2026.
Source 22: Early palliative care for adults with advanced cancer (Haun and others) (opens in a new tab)
Cochrane Database of Systematic Reviews, 12 June 2017. Checked 16 October 2026.
The Lancet HIV, 15 June 2015. Checked 16 October 2026.
BMC Palliative Care, 2 July 2025. Checked 16 October 2026.
BMC Public Health, 10 August 2005. Checked 16 October 2026.
Source 26: Drug Overdose Deaths: Facts and Figures (opens in a new tab)
National Institute on Drug Abuse, 21 August 2024. Checked 16 October 2026.