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
Bibliographic record
Abstract
The purpose of this initiative is to provide public access to estimates of the evolution of severe health-related suffering (SHS) for the years 1990, 2000, 2010, 2019, 2020 and 2021, as well as annual opioid data distributed in morphine equivalent (DOME) between 1990 and 2022 in 183 countries. These data support the analyses presented in the following scientific papers: 1. Knaul, F. M., Arreola-Ornelas, H., Kwete, X. J., Bhadelia, A., Rosa, W. E., Michael Touchton, M., … Radbruch, L. (2025). 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. The Lancet Global Health. 2. Knaul, F. M., Arreola-Ornelas, H., Kwete, X. J., Bhadelia, A., Berterame, S., Connor, S. R., … Radbruch, L. (2025). Distributed Opioids in Morphine Equivalent: A Global Measure of Availability for Palliative Care. Journal of Pain and Symptom Management, Volume 69, Issue 2, 2025. DOI. 3. Kwete, X. J., Bhadelia, A., Arreola-Ornelas, H., Mendez, O., Rosa, W. E., Connor, S., … Knaul, F. M. (2024). Global Assessment of Palliative Care Need: Serious Health-Related Suffering Measurement Methodology. Journal of Pain and Symptom Management, Volume 68, Issue 2, 2024. DOI. Documents corresponding to an update to the report of the Lancet Global Commission on Pain Relief and Palliative Care published in 2018: Knaul, F.M., Farmer, P.E., Krakauer, E.L., De Lima, L., Bhadelia, A., Kwete, X.J., Arreola-Ornelas, H., et al. Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report Lancet, 391 (2018), pp. 1391-1454. DOI: 10.1016/S0140-6736(17)32513-8 This database seeks to promote transparency in research and provide fundamental tools for the global analysis of health-related suffering and access to opioids for palliative care. It also facilitates the formulation of evidence-based public policies, with the aim of improving equity and access to palliative care and pain management worldwide.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.024 | 0.062 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.006 | 0.014 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.006 | 0.009 |
| Open science | 0.003 | 0.005 |
| Research integrity | 0.005 | 0.009 |
| Insufficient payload (model declined to judge) | 0.009 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".