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Times of India
16 July 2010

Stands Even Below Uganda; UK Found To Have Best Services: Study
‘India worst in end-of-life care’
India doesn’t just have a poor quality of life, as reflected in its poor human development index (HDI), it also has a particularly poor ‘quality of death’. That’s the depressing message from a new index developed by the Economist Intelligence Unit to measure end-of-life care services in 40 countries.

India finishes at the bottom of the list, which includes 30 OECD nations and 10 developing countries for which data was available. While finishing below the developed world may come as no surprise, what’s revealing is that even Uganda is a notch above India. The UK was found to have the best end-of-life care (despite a far from perfect healthcare system), followed by Australia and New Zealand. The countries that fared the worst in the Quality of Death Index released on Thursday included countries such as India, Uganda, Brazil and China in that order from the bottom.

The report noted that these countries fared badly as progress on providing end–oflife care was slow despite notable exceptions of excellence such as the state of Kerala in India and the services delivered through Hospice Africa in Uganda. In Asia, Taiwan (14), Singapore (18) and Hong Kong (20) were ranked much higher than Japan (23), where over a fifth of the population is over 60 years.

The study noted that many rich nations lagged in the overall score, including Denmark (22), Italy (24) and South Korea (32). The US and Canada were ranked at 9th place in the list, while many countries known to have excellent health systems scored poorly including France (12), Norway (13), Sweden (16), Switzerland (19) and Iceland (25). According to the Worldwide Palliative Care Alliance, while more than 100 million patients and family care–givers worldwide needed palliative care annually, less than 8% of them actually received it.

Experts on end–of–life care identified access to drugs, especially the availability of opioids to manage pain, and availability of carers as the most important practical issues. They also pointed out that state funded end–of–life care tended to prioritise conventional treatment over palliative care. Even well funded health systems relied mostly on charities and philanthropic bodies to offer care to patients, noted the experts.

“In many nations, standards of end–of–life care suffer from inadequate policy, high costs, cultural barriers and poor access to painkillers. Too many people, even in countries that have excellent healthcare systems, suffer a poor quality of death– even when death comes naturally. This is despite the fact that in many of these countries, increasing longevity and ageing populations mean demand for end–of–life care is likely to rise sharply,”observed the study.

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