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The 2015 Quality of Death Index: Ranking palliative care across the world

A report by The Economist Intelligence Unit

Everyone hopes for a good death, or rather, “a good life to the very end”, but until recently there was little dedicated effort and investment to provide the resources and education that would make that possible. Public engagement and policy interventions to improve the quality of death through the provision of high-quality palliative care have gained momentum in recent years, and some countries have made great strides in improving affordable access to palliative care. The Economist Intelligence Unit’s Quality of Death Index, commissioned by the Lien Foundation, highlights those advances as well as the remaining challenges and gaps in policy and infrastructure.

This is the second edition of the Index, updating and expanding upon the first iteration, which was published in 2010. The new and expanded 2015 Index evaluates 80 countries using 20 quantitative and qualitative indicators across five categories: the palliative and healthcare environment, human resources, the affordability of care, the quality of care and the level of community engagement. To build the Index the EIU used official data and existing research for each country, and also interviewed palliative care experts from around the world.

In many countries, the proportion of older people in the population is growing and noncommunicable diseases such as heart disease and cancer are on the rise. The need for palliative care is also therefore set to rise significantly. In supplementary analysis we compare expected growth in the “demand” for palliative care to the existing “supply” for each country (as shown in their Index rankings). The demand analysis is based on forecasts of the burden of disease, oldage dependency ratio, and rate of population ageing over the next 15 years.

Despite the improvements this research reveals, much more remains to be done. Even top-ranked nations currently struggle to provide adequate palliative care services for every citizen. Cultural shifts are needed as well, from a mindset that prioritises curative treatments to one which values palliative care approaches that regard dying as a normal process, and which seeks to enhance quality of life for dying patients and their families.