Assessing the Quality of Death in 80 Countries Across the World

Credit: economistinsights.com

The 2015 Quality of Death Index, developed by the Economist Intelligence Unit, measures the availability, affordability and quality of palliative care available to adults across 80 countries around the world.  The Quality of Death Index was commissioned by a Singaporean philanthropic organization called the Lien Foundation and is based on research and interviews with over 120 palliative care experts in the 80 countries assessed. 

Countries were ranked based on their scores in five categories: palliative and healthcare environment (general palliative care framework); human resources (availability and training of medical care professionals and support staff); affordability of care (the amount of public funding available for palliative care, the financial burden to patients); quality of care (looks at whether or not monitoring guidelines are present, assesses availability of opioids for pain management and evaluates the degree to which healthcare professionals and patients are partners in care); community engagement (evaluates availability of volunteers and measures public awareness of palliative care.)

The rankings showed a correlation between income and quality of palliative care, with wealthy countries clustered at the top of the list.

The rankings showed a correlation between income and quality of palliative care, with wealthy countries clustered at the top of the list. The United Kingdom was ranked No. 1, with Australia and New Zealand taking second and third places. The United States was in ninth place and Canada in eleventh. 

While a dearth of doctors and limitations in basic infrastructure make it difficult for some developing countries to provide basic pain management, some developing countries have made innovative strides in certain areas. For example, for the past 22 years, Uganda (ranked 35th) has used a formula to craft liquid morphine from pure morphine powder. This means that liquid morphine can be made cheaply, and Uganda can meet the needs of its citizens far better than it could in the 1990s. Panama (which came in 31st) is  incorporating palliative care into its primary care services.

Credit: nursestogether.com

Government-funded healthcare systems fare well in the affordability of care category: Australia, Belgium, Denmark, Ireland and the United Kingdom are ranked highest. Some lower-income countries do well due to charitable donations. Cuba ranks highly in this category, with its long-running national health program. China is ranked 71st; its adoption of palliative care has been slow and the country is facing challenges with its rapidly aging population and rising incidence of conditions like cardiovascular disease. Malawi is ranked 66, though it leads less developed nations in terms of children’s palliative care.

While the overall Quality of Death Index score shows the supply of palliative care available in each country, the Economist Intelligence Unit also analyzed the demand (or need) for palliative care in each country based on three factors: burden of diseases necessitating palliative care, old-age dependency ration, and speed of aging of the country’s population between the years 2015 and 2030. The research reveals that the demand for palliative care is set to rise in developing countries due to larger populations, populations aging more rapidly and the increasing incidence of non-communicable diseases.