Dr Julie Ling, Chief Executive of the European Association for Palliative Care
The publication of the revised Quality of Death Index – Ranking palliative care across the world – reports on and compares palliative care in eighty countries worldwide. Commissioned by the Lien Foundation, a Singaporean philanthropic organisation, the Quality of Death Index is based on qualitative and quantitative indicators and interviews conducted with more than 120 palliative care experts from around the world. The rankings are based on a number of the structures that support palliative care in each country rather than patient-related outcomes and therefore it is not clear whether the structures that the rankings are based on are making a difference to patients and their families who are availing themselves of palliative care services.
The rankings at the top of the table have not changed since the last index was published in 2010  with the same countries appearing in the top five places. The UK maintains its top ranking followed by Australia, New Zealand, Ireland and Belgium. Although these countries continue to lead the way, the report points out that no one country has it completely right and continuous improvements are needed to ensure that palliative care has the ability to meet the new challenges ahead. Future care demands need to be considered and the report suggests that areas such as ageing populations and the increasing incidence of non-communicable diseases will inevitably impose an increasing burden on palliative care services. The report suggests that countries such as China (ranked 67th) and India (ranked 71st) face huge challenges due to, among other things, the sheer size of their populations.
Overall, the report suggests that funding is a key element in providing responsive palliative care services and it would be naive to suggest otherwise. However, what is clear is that great strides are being made in resource-poor countries where funding is not readily available. Good examples are Panama (ranked 28th) where palliative care has been integrated into primary care and Mongolia (ranked 31st) where education is at the heart of developments. In the report, the development of palliative care in resource-poor countries such as Mongolia has been attributed to the pioneering efforts of enthusiastic and motivated individuals.
The publication of this report is not only interesting to those of us working or with an interest in palliative care, intrigued by where our country ranks, but importantly has also generated huge interest from outside of our specialty. I look forward to the next report in 2020.
1. The Quality of Death Index 2015 – Ranking palliative care across the world. A report by The Economist Intelligence Unit, October 2015.