• UK leads the world in provision of palliative care
• Rich nations tend to perform better but some developing countries have made great progress
• China has among the most severe “demand/supply” gap between need for palliative care and availability of services

The UK ranks first in the 2015 Quality of Death Index, a measure of the quality of palliative care in 80 countries around the world released today by The Economist Intelligence Unit (EIU). Its ranking is due to comprehensive national policies, the extensive integration of palliative care into the National Health Service, a strong hospice movement, and deep community engagement on the issue. The UK also came top in the first Quality of Death Index, produced in 2010.

The Quality of Death Index, commissioned by the Lien Foundation, a Singaporean philanthropic organisation, is based on extensive research and interviews with over 120 palliative care experts from across the world. It shows that in general, income levels are a strong indicator of the availability and quality of palliative care, with wealthy countries clustered at the top. Australia and New Zealand take second and third place, as they did in 2010, while rich European and Asian countries dominate the top 20, along with the US in 9th place and Canada in 11th.

As expected, many developing countries are still unable to provide basic pain management due to limitations in staff and basic infrastructure. Yet some countries with lower income levels demonstrate the power of innovation and individual initiative. For example, Panama (31st) is building palliative care into its primary care services, Mongolia (28th) has seen rapid growth in hospice facilities and teaching programmes, and Uganda (35th) has made huge advances in the availability of opioid painkillers.

For the first time The EIU has also compared the supply of palliative care—as revealed in the Index—with the demand for such care. The demand analysis, based on countries’ demographic profiles and the burden of diseases for which palliative care is necessary, shows China to be among the most vulnerable from population ageing and the rising incidence of conditions such as cardiovascular disease, which accounted for one-third of all deaths in the country in 2012. Many other developing countries will also need to work hard to meet rising future need as the incidence of non-communicable disease increases and their populations grow older.

David Line, the editor of the report, said:

“Since the first Quality of Death Index was published this issue has certainly risen up the global agenda, as shown by the World Health Assembly resolution last year calling for improved standards of palliative care across the world. But much more can be done, even in countries that rank highly in the Index. It is an issue that will affect us all - a good quality of death should be regarded as a human right.”

The 2015 Quality of Death Index and supporting materials are available to download here

Press enquiries:

Hong Kong
David Line, Managing Editor
[email protected]
+852 2585 3873

Trisha Suresh, Lead Analyst
[email protected]
+852 2585 3838

UK
Annie Pannelay, Principal, EIU Healthcare
[email protected]
+44 (0)20 7576 8145

Notes to editors

About the 2015 Quality of Death Index

This is the second edition of the Quality of Death Index, updating and expanding upon the 2010 edition. The number of countries included has been increased from 40 to 80. The Index, which focuses on the quality and availability of palliative care to adults, is also structured differently from the 2010 version (meaning the direct comparison of scores between years is not possible). Now, the Index is composed of scores in 20 quantitative and qualitative indicators across five categories. The categories are:

• Palliative and healthcare environment (20% weighting, 4 indicators)
• Human resources (20% weighting, 5 indicators)
• Affordability of care (20% weighting, 3 indicators)
• Quality of care (30% weighting, 6 indicators)
• Community engagement (10% weighting, 2 indicators)

This year, the EIU also prepared a supplementary assessment of the need for palliative care provision, to enable assessment of the “demand” for such care alongside the quality of “supply” revealed in the main Index. This is based on three categories:

• The burden of diseases for which palliative care is necessary (60% weighting)
• The old-age dependency ratio (20%)
• The speed of ageing of the population from 2015-2030 (20%)

To build the Index and conduct the demand analysis the EIU used official data and existing research for each country, and also interviewed palliative care experts from around the world. A full methodology and data sources are available in an appendix to the accompanying white paper.

About The Economist Intelligence Unit

The Economist Intelligence Unit is the world leader in global business intelligence. It is the business-to-business arm of The Economist Group, which publishes The Economist newspaper. The Economist Intelligence Unit helps executives make better decisions by providing timely, reliable and impartial analysis on worldwide market trends and business strategies. More information can be found at www.eiu.com or www.twitter.com/theeiu.

About the Lien Foundation

The Lien Foundation (www.lienfoundation.org) is a Singapore philanthropic house noted for its model of radical philanthropy. It invests in innovative solutions, convenes strategic partnerships and catalyses action on social and environmental challenges. The Foundation seeks to foster exemplary early childhood education, excellence in eldercare and effective environmental sustainability in water and sanitation. In the sphere of eldercare, the Foundation focuses on end-of-life care through initiatives such as the commissioning of the first-ever global Quality of Death index in 2010, and the Design for Death competition on deathcare innovations. It also enhances palliative care leadership and capacity in developing countries through the Lien Collaborative For Palliative Care in partnership with the Asia Pacific Hospice and Palliative Care Network.

Responding to the 2015 Quality of Death index, the Foundation and various global and regional palliative care organizations are calling for governments to act on the resolution on palliative care adopted by the WHO’s World Health Assembly in 2014 http://bit.ly/QoD2015IntlRelease

For more information, visit www.qualityofdeath.org