For a study, researchers sought to explain progress accomplished in three important areas throughout those 20 years: palliative care integration into public health systems, access to controlled pharmaceuticals, and pediatric palliative care.

Activities and advancements in worldwide palliative care integration into health systems, access to and availability of controlled pharmaceuticals, and pediatric palliative care were documented and assessed between 2000 and 2020.

Each region had seen significant growth. Whereas in 2000, only a few pioneering countries were integrating palliative care into public healthcare systems, by 2020, a global consensus had emerged that palliative care should be integrated into all health systems, including universal health coverage, and countries were increasingly taking steps to integrate it into national health systems. While the low availability of these drugs was scarcely acknowledged as a public health or drug control concern in 2000, it had become an important focus in global drug policy debates by 2020, with various governments taking initiatives to enhance access. Pediatric palliative care, largely available in a few rich nations in the 1990s, has witnessed fast expansion, particularly in low- and middle-income countries, and now has a firm presence in all geographical regions.

Despite the progress, significant challenges remained, such as limited funding for palliative care advocacy, the recent overdose crisis in the United States chilling efforts to improve opioid analgesic availability, and economic crises related to the COVID-19 pandemic creating uncertainty about the future of universal health coverage.