Palliative care lacking in much of the world

HONG KONG, 15 july 2010-- Most people who are dying around the world have inadequate or no access to painkillers, hospice and palliative care, according to a report by the Economist Intelligence Unit on Wednesday.

The report blamed the cultural taboos surrounding death, government avoidance of the issue, poor public awareness and untrained healthcare workers for the problem, which affects even advanced countries like the United States and Japan.

While more than 100 million people worldwide would benefit from hospice and palliative care each year, less than 8 percent access it, according to the Worldwide Palliative Care Alliance.

"The focus is on curative care, where doctors focus on curing patients at all costs; the U.S. is an extreme example of that," said Tony Nash, EIU global director and key author of the report, which gave a "Quality of Death Index" covering 40 countries.

"There really isn't an acceptance of hospice and palliative care as a viable option, they are seen almost as surrendering once you enter those environments," Nash said in a telephone interview from Singapore.

Britain topped the index with the best quality-of-death care, followed by Australia, New Zealand, Ireland and Belgium. Near the bottom were China, Brazil and Uganda, with India ranked 40th.

The United States was ranked 9th, dragged down by the financial burden of healthcare near death, which reflects the high overall cost of healthcare, according to the report.

Singapore was ranked 18th, Hong Kong 20th and Japan 23rd.

The rankings took into account factors like availability of painkillers, hospices and public funding, transparency between doctor and patient, training of healthcare workers and whether palliative care is incorporated into national health policies.

The report cited India as having least access to painkillers because of strict laws against illicit drug use. Even doctors and nurses in some large cancer hospitals in India were not trained to administer morphine, the report said.

Five billion people live in countries with insufficient or no drugs controlling severe or moderate pain, according to the World Health Organization. The world's population is 6.8 billion.

The report said strong taboos surrounded death in Japan, China and India, adding that in some cases, relatives forbade healthcare workers from informing patients of their conditions.

It called for more discussion and public debate on providing end-of-life care, saying that would raise public awareness, encourage governments to incorporate palliative care into national health policies and open the way for healthcare workers to be trained in this area.

Only seven countries in the index -- Australia, Mexico, New Zealand, Poland, Switzerland, Turkey and Britain -- have national health policies that include palliative care. (