First-Ever Global Ranking of Palliative Care: 2025 World Map Under the New WHO Framework

Vilma A Tripodoro; Jesús Fernando López Fidalgo; Juan José Pons; Stephen R Connor; Eduardo Garralda; Fernanda Bastos; Álvaro Montero; Laura Monzón Llamas; Ana Cristina Béjar; Daniela Suárez; Carlos Centeno

doi:10.1016/j.jpainsymman.2025.07.026

First-Ever Global Ranking of Palliative Care: 2025 World Map Under the New WHO Framework

J Pain Symptom Manage. 2025 Nov;70(5):447-458. doi: 10.1016/j.jpainsymman.2025.07.026. Epub 2025 Aug 7.

Affiliations

¹ ATLANTES 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. Electronic address: vtripodoro@unav.es.
² Institute for Data Science and Artificial Intelligence (DATAI) (J.F.L.F.), University of Navarra, Pamplona, Spain.
³ Department of Geography (J.J.P.), University of Navarra, Pamplona, Spain.
⁴ Worldwide Hospice Palliative Care Alliance (WHPCA) (S.R.C.), London, United Kingdom.
⁵ ATLANTES 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.

PMID: 40782892
DOI: 10.1016/j.jpainsymman.2025.07.026

Abstract

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.

Keywords: Palliative care; global development; hospice; indicators; mapping; public health.

MeSH terms

Cross-Sectional Studies
Global Health*
Health Services Accessibility
Humans
Palliative Care*
World Health Organization