In all world regions, informal care provided by family, friends and the community is the cornerstone of the care system. In LAMIC (low and middle income) these informal care costs predominate, accounting for 58% of all costs in low-income and 65% of all costs in middle-income countries, compared with 40% in high-income countries. Conversely, in high-income countries, the direct costs of social care (professional care in the community, and the costs of residential and nursing home care) account for the largest element of costs – 42%, compared with only 4% in LAMIC where such services are not generally available. In LAMIC, despite larger, extended families, the economic strain on family caregivers is substantial. Typically, around a fifth of caregivers have cut back on paid work, and paid care workers are becoming common in some cities, adding to the economic burden. Moreover, compensatory benefits are practically non-existent.