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First-Ever Global Ranking of Palliative Care: 2025 World Map Under the New WHO Framework
Vilma A Tripodoro1, Jesús Fernando López Fidalgo2, Juan José Pons3
1ATLANTES Global Observatory of Palliative Care (V.A.T., E.G., F.B., A.M., L.M.L., A.C.B., D.S., C.C.), Institute for Culture and Society, University of Navarra, Pamplona, Spain; IdiSNA - Navarre Health Research Institute (V.A.T., E.G., F.B., A.M., L.M.L., A.C.B., D.S., C.C.), Pamplona, Spain.
Context:
Despite progress in policy and advocacy, global palliative care development remains highly uneven, with large segments of the population lacking access to quality services. A new WHO framework has provided an updated methodology for assessing national palliative care systems.
Objectives:
To assess the current state of palliative care development worldwide using the WHO framework and to produce the first global ranking of countries based on their performance across 14 indicators.
Methods:
A cross-sectional, mixed-methods study was conducted across 201 countries and territories between 2023 and 2025. Trained national consultants conducted a structured survey based on WHO indicators. Scores were assigned across six domains: policy, essential medicines, service delivery, education, research, and community empowerment. Responses were validated and analyzed to produce a Global Development Score and to classify countries into four development levels: Emerging, Progressing, Established, and Advanced.
Results:
Of the 201 countries assessed, 40% were classified as Emerging and 28% as Progressing, representing half the global population. Only 14% reached the Advanced level, and 17% were classified as Established. Significant gaps in access to essential medicines and specialized education persist-even in some high-income settings. Despite limited resources Thailand, Uganda,Chile, and Uruguay stand out as regional examples of advanced development.
Conclusion:
This study presents the first global ranking of palliative care development based on WHO indicators. The results highlight persistent disparities and offer a tool for targeted improvement. The Global Development Score enables countries to benchmark progress, identify gaps, and develop strategic responses to expand access and alleviate serious health-related suffering.
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