Published on: January 29, 2022

In 2015, Lien collaboration and Economist Intelligence Unit had got together to publish the ‘Quality of Death Index‘. India ranked 67th among 80 countries in the world.

Recently, Eric A. Finkelstein and colleagues have published a cross-country comparison of expert assessments of the quality of death and dying. India is 59th among 81 countries studied. 

At one look, it would seem that India has climbed up in the ladder and has improved its position. We wish that were true.

Unfortunately, the two results are not comparable. The 2015 index was based on 24 different indicators of quality of palliative and end-of-life care in four domains. One of the domains was an environment conducive to improvement.

The 2021 report from Lien Foundation is based on an entirely different system of evaluation based on 13 indicators. The position of each country about the status on the 13 indicators was assessed by at least two experts in each country. The index is based on those experts’ perception. 

Comparing the rank in the two publications hence, would be like comparing oranges and apples. So what message do we take from the 2021 report? The simple answer for India is that our end of life care is still abysmally bad. 59th position among 81 is certainly nothing to boast about. 

Do we have an environment conducive to improvement? Well, yes. The fact that end of life care is included in undergraduate medical curriculum from 2019 and the fact that National Health Policy of 2017 includes palliative care are indeed promising developments for the future. But still, they would only be a small part of what needs to happen. 

Perhaps we should look at this report in the light of the Lancet Commission Report on the Value of Death to be published on 31st of January 2022. Let us look forward to seeing that report and to its Indian release event as part of the annual conference of the Indian Association of Palliative Care during a session at Jaipur on 11 February. 


Cross Country Comparison of Expert Assessments of the Quality of Death and Dying 2021

Quality of Death Index 2015

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