The UK and Australia top a list of 40 nations in terms of providing a good quality of death for its population, says a study published today, which notes that the UK has “led the way globally in terms of its hospice care network and statutory involvement in end-of-life care.”

In many nations, standards of end-of-life care suffer from inadequate policy, high costs, cultural barriers and poor access to painkillers, according to the study, from the Economist Intelligence Unit. The new Quality of Death Index devised by the Unit and commissioned by the Lien Foundation ranks the UK first among the 40 nations for indicators such as public awareness, training availability, access to painkillers and doctor-patient transparency.

Overall, the Index gives both the UK and Australia a score of 7.9 out of 10. Next are New Zealand (7.7), Ireland (6.8) and Belgium (6.8). Many wealthy nations lag a long way behind, including Denmark (in 22nd place), Italy (24th) and South Korea (32nd) – in these nations the quality and availability of care is often poor and policy co-ordination is lacking, says the report.

India comes bottom of the table, with 1.9 points out of 10, and the four above it are Uganda (2.1), Brazil (2.2), China (2.3) and Mexico (2.7). Despite notable exceptions of excellence - such as the Indian state of Kerala, and services delivered through Hospice Africa Uganda - progress on providing end-of-life care the developing and BRIC nations is slow and, in the case of China and India, further problems are their vast populations for whom end-of-life coverage extends to only a fraction of those in need, it adds.

Drug availability is the most important practical issue, the researchers found. Pain control is the point from which all palliative care stems, and the availability of opioids (morphine and its equivalents) is fundamental to quality of end-of-life care.

However, accessing opioids remains a struggle in many countries, with an estimate five billion people who are living in pain but unable to access opioids, notes Cynthia Goh, co-chair of the Worldwide Palliative Care Alliance (WPCA) and a contributor to the report. “The main obstacles we have to overcome are governments’ excessive concerns around illicit drug use, as well as a lack of training for doctors and nurses on how to administer these drugs,” she says.

Another important issue is the fact that state funding of end-of-life care is limited and often prioritises conventional treatment. Even in countries where palliative care treatment is available through national healthcare systems or insurance, in many cases end-of-life care bodies rely on charitable donations and philanthropic activity to support them. And in the US, palliative care is available through public medical insurance but patients must relinquish curative treatments to be eligible for reimbursements, unlike the UK, the study notes.

The WPCA says that less than 8% of the over 100 million patients and caregivers worldwide who need palliative care annually actually receive it, but the EIU reports that more palliative care may mean less health spending. By increasing the proportion of community and homecare, palliative care can reduce costs associated with hospital stays and emergency admissions, it says, and forecasts that, particularly in the US with its recently-passed major healthcare reform bill, this is likely to become a focus of debate. One study in Spain found that in 2006 a shift away from the use of conventional hospital treatment towards palliative care, an increase in homecare and lower use of emergency rooms generated savings of 61% compared with expenditure recorded in a 1992 study.

However, the Unit also cautions that the costs associated with non-cancer palliative care are higher than for cancer-related care and that, as the population ages, more end-of-life care will be needed overall.

The findings were described as “heartening” by David Praill, WPCA co-chair and chief executive of Help the Hospices, who noted that the UK pioneered hospice care and that for many British people the hospice and palliative care they receive is excellent. However, he added, the system is far from perfect. While palliative care is a human right, there remains a huge disparity in the level of National Health Service (NHS) funding for end-of-life care, which can vary from £13 per head of population to less than £2.