{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:46:03Z","timestamp":1792014363932,"version":"4.4.0"},"reference-count":65,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T00:00:00Z","timestamp":1749427200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T00:00:00Z","timestamp":1749427200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliat&amp;#65533;Care"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:p>The higher prevalence and incidents of chronic and life-threatening illnesses and the aging population living with morbidity and life-limiting conditions necessitate the need for care provisions like palliative care globally. Palliative care strives for the quality of life of patients with terminal illnesses and serious health conditions and their families. However, globally, access to palliative care remains very limited. The situation is similar in India, except for Kerala, where palliative care access to the needy population is almost universal. Kerala\u2019s community palliative care model is globally acclaimed for its operation, which includes community participation and sustainability. The palliative care policy of Kerala, which was the first one in Asia, was a significant milestone in the palliative care movement of Kerala, as it mandated the interventions from government measures and further strengthened the community-managed palliative care interventions. The palliative care efforts in Kerala have significantly influenced the health scenario. However, discussion on the role of palliative care in achieving sustainable development goals (SDGs) is minimal. In this context, this article explores the policy and practices of palliative care in Kerala and its contribution to SDG-3, health and well-being. We have surrounded the discussion on the context of palliative care interventions and Sustainable Development Goal 3 through the unique features of the Kerala model of palliative care and its contribution to the healthcare scenario of the state. Through available literature and from the researchers\u2019 first-hand experience, this article explores the reciprocity of palliative care interventions, policy, healthcare programs, and SDG-3. Documenting the potential of Kerala\u2019s community-based palliative care for SDG-3 has implications for replications of this model in similar contexts.<\/jats:p>","DOI":"10.1177\/26323524251344312","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T08:27:58Z","timestamp":1749457678000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Palliative care policy and practice in Kerala, India: Implications for Sustainable Development Goal 3\u2014Health and well-being"],"prefix":"10.1177","volume":"19","author":[{"given":"S.","family":"Gowri","sequence":"first","affiliation":[{"name":"School of Social Sciences and Languages, Vellore Institute of Technology, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4627-6550","authenticated-orcid":false,"given":"E. 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Oxford: Oxford University Press, 2006, pp. 91\u2013114."},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.4103\/0973-1075.78442"},{"key":"e_1_3_2_24_2","unstructured":"Burn K. Overview of palliative care. In: Kelly M editor. Supporting patients who opt not to have dialysis or stop dialysis: guidelines for nurses. Hergiswil: European Dialysis and Transplant Nurses Association\/European Renal Care Association (EDTNA\/ERCA) pp. 8\u201315. http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK599374\/ (2021 accessed 20 November 2024)."},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.25259\/IJPC_140_2023"},{"key":"e_1_3_2_26_2","unstructured":"WHO. Universal health coverage (UHC) [Internet] https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/universal-health-coverage-(uhc) (2023 accessed 5 November 2024)."},{"key":"e_1_3_2_27_2","unstructured":"Dey S Nambiar D Lakshmi JK et al. Health of the elderly in India: challenges of access and affordability. 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Revisiting the prospects of social entrepreneurship on social development: an analysis https:\/\/www.academia.edu\/28338390\/Revisiting_the_Prospects_of_Social_Entrepreneurship_on_Social_Development_An_Analysis (2014 accessed 5 November 2024)."},{"key":"e_1_3_2_53_2","doi-asserted-by":"publisher","DOI":"10.5588\/pha.22.0034"},{"key":"e_1_3_2_54_2","unstructured":"Government of Kerala. Kerala state palliative care policy https:\/\/palliumindia.org\/wp-content\/uploads\/2020\/05\/Kerala-State-Palliative-Care-Policy-2019.pdf\u2009\u2009(2019 accessed 28 June 2024)."},{"key":"e_1_3_2_55_2","first-page":"1329","article-title":"Poisedness for social innovation: the genesis and propagation of community-based palliative care in Kerala (India)","volume":"21","author":"Vijay D","year":"2018","unstructured":"Vijay D, Monin P. Poisedness for social innovation: the genesis and propagation of community-based palliative care in Kerala (India). 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