A huge majority of the 57 million people estimated to need palliative care live and die in Low- and Middle-Income Countries. Despite attempts from various corners over more than five decades, most of these people in LMIC and a huge number of poor and marginalised people in High Income Countries do not have access to palliative care.
Since the issue under consideration is quality of life, death, and dying, existing social ecology of the person is a major factor in accessibility and availability of care. Universalising a single solution or projecting one future for end-of-life care for all will not work.
We see well-meaning experts and institutions from Global North advocating translation of their ‘successful’ palliative care models to the rest of the world. The main problem with this currently dominant discourse from a class better placed in global socio-political hierarchy is that it often fails to notice the social and structural inequities that profoundly shape health, illness, and dying experiences.
We need to know that income poverty does not mean poverty of community supports and relationships. Most of the LMIC communities are rich in social capital. Informal caring is the fundamental building block for health and social care in these communities. The way forward can only be through strengthening this existing informal care system in numbers and capacity. Instead, and in spite of all the rhetoric about total pain and holistic approach in palliative care, current attempts are at exporting and translating the so-called successful models from the North which focusses almost entirely on clinical care and promotes specialized clinical care as the ideal final solution.
We need to realise that we are unlikely to achieve any meaningful coverage ever if we continue to take this track.