India has been ranked as one of the worst places in the world to die but Kerala was praised for bucking up the trend by providing good end-of-life care, according to an 80-country "quality of death" study.
The 'Economic Intelligence Unit' (EIU) report found the UK to be the best place in the world in which to die, with developing countries like India at the bottom of the index of 80 countries.
However, it praised Kerala's provision of palliative care for patients with serious illnesses.
"While India ranks at the bottom of the Index in overall score, and performs badly on many indicators, Kerala, if measured on the same points, would buck the trend. With only 3 per cent of India's population, the tiny state provides two-thirds of India's palliative care services," said the 'Quality of Death: Ranking end-of-life care across the world' report.
"Moreover, the state has a formal palliative care policy in place (it is the only Indian state with such a policy) and its government provides funding for community-based care programmes," it said.
Kerala's unique system revolves around the Neighbourhood Network in Palliative Care (NNPC) project, co-founded by Suresh Kumar with the aim of improving both accessibility and quality of end-of-life care.
"There are a lot of medical problems, but there are also a lot of social, spiritual and financial issues-so anybody who has time to spare can, if properly trained, take care of these people," he said.
Palliative care advocates not only in developing countries but also across the world are studying Kerala's potent combination of government support and civic involvement in end-of-life care, the report said.
The bottom ranks of the Quality of Death Index are dominated by developing and BRIC countries, such as India, China, Mexico, Brazil and Uganda, where progress on providing end-of-life care is slow.
Taiwan has the highest rank in Asia, at sixth position. India and China ranked 67th and 71st respectively.
The upper rungs of the index are dominated by wealthy European, Asia-Pacific and North American countries. Australia is second, New Zealand third and Ireland and Belgium complete the top five. The US is ninth in the index.
"A very strong marker in our index is the availability of specialised palliative care workers and this is where the UK scores particularly well. The other super strong marker is the way that the countries do have a plan for palliative care. That means they are on the dynamic of measuring progress and improving," said Annie Pannelay, EIU's healthcare specialist.
The Quality of Death Index, commissioned by the Lien Foundation, a Singaporean philanthropic organisation, is based on qualitative and quantitative indicators and took interviews of over 120 palliative care experts from around the world.
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