It can’t get more ironical than this. Death, the great leveller that it is, doesn’t buck ranks when it comes to quality. And India, not surprisingly, ranks at the bottom, as much in quality of death as in life.
Since even the best customer-satisfaction surveys fall short of rating the quality of death, a Singapore charity commissioned the Economist Intelligence Unit to devise a new rating system. The results were announced last week where the UK, among a list of 40 countries, tops the list, and India ranks the lowest.
The quantitative indicators for this index account for life expectancy and healthcare spending as a share of gross domestic product; whereas the qualitative indicators include public awareness and the existence of a government strategy.
Ranking low is not new to India. Earlier UNDP quality of life indices, also called the human development index, have shown that India is slipping on this front—from ranks 126 in 2006 to 134 in 2009. People may shrug it off as yet another ranking or may choose to take it as a warning sign to devise strategies as the nation witnesses a large number of its people entering their 60s, 70s and beyond.
Arguably, this is a critical time when technology and health insurance are pitted against a medical culture that considers death to be a let-down. Studies show that aggressive healthcare at the end of life doesn’t mean good quality of death. There is also evidence that given a choice, a large number of people would like to die at home, but most die in hospital.
If willing, India has enough models to choose from—Kerala’s community care, which the new study makes a mention of; Uganda’s palliative care approach; or even the hospice movement of the UK which cares for people near death, even though death comes to less than 5% of its populace.
The starting point, for the public and private sectors alike, could well be something as simple as ensuring availability of painkillers and their right administration. Data shows that some five billion people lack access to painkillers such as morphine and its equivalents.
Should Indian healthcare change its attitude to death? Tell us at firstname.lastname@example.org