# Inequity in access to palliative care services worldwide and in Slovenia

## TL;DR

Palliative care access is highly unequal globally and in Slovenia, with limited availability in low-income regions and challenges like opioid shortages and policy gaps.

## Contribution

This paper highlights global and national inequities in palliative care access, focusing on Slovenia’s underdevelopment despite recent progress.

## Key findings

- Only 14% of people who need palliative care globally receive it, with disparities between high- and low-income countries.
- Slovenia’s palliative care remains underdeveloped due to workforce shortages, regional disparities, and outdated policies.
- Opioid availability in Slovenia is below the European average and declining, worsening access issues.

## Abstract

Palliative care aims to enhance the quality of life of patients and their families facing progressive and incurable disease by addressing physical, psychological, social, and spiritual challenges. Despite being recognized as a human right, palliative care remains out of reach for most people worldwide, with only about 14% of those who need it receiving it. Global demand for palliative care is rising due to aging populations and the increasing burden of chronic diseases. While high-income countries focus on expanding access and inclusivity to this care, low-income countries face severe shortages in prevention, diagnostics and treatment of underlying diseases, which creates an urgent need for palliative care services. Cultural differences, a lack of trained professionals, limited opioid availability, and weak policy further deepen inequities.

Historically rooted in religious and charitable care, modern palliative care emerged with Dame Cicely Saunders’ hospice movement, evolving into a medical specialty. Access varies widely – Europe has high integration in some countries but significant disparities in service distribution and opioid use. Africa, Latin America, and parts of Asia still lack widespread provision. In Slovenia, palliative care development began in the 1980s and has recently expanded to include some specialized palliative care services across the country. Despite this progress, palliative care in Slovenia remains underdeveloped due to limited coverage, regional disparities, workforce shortages, insufficient formal education, and an old and ineffective national policy. Opioid availability is slightly below the European average, and its use is declining, which raises concerns about further unmet needs.