The index, commissioned by Singapore nonprofit the Lien Foundation, was compiled by the Economist Intelligence Unit’s healthcare arm, and rated the U.K. as providing the best end-of-life care and Iraq as the worst.

India came in 67th out of 80 countries in the good death race, ahead of China, the Philippines and Bangladesh.

The authors put the improvement on India’s previous position in 2010–when it came last out of 40 nations–down to a stronger government commitment to palliative care and legislative changes which have made it easier for doctors to prescribe morphine.

The expanded field also played a part in helping India move out of last place but also made it move lower overall as other countries slotted in ahead of it.

But, the report warned that both India and China “perform poorly overall,” which in the context of the size of their populations–the two nations hold every third person on the planet–“is worrying.”

“India, for example, has a shortage of specialized care professionals and accreditation for palliative care is not yet the norm,” the report said.

Even among other low-income countries, India lagged behind Uganda, Egypt, Zimbabwe and Kenya on the quality of death a person can expect.

The ranking is compiled using indicators that measure the quality of palliative and healthcare environment, the training of doctors and nurses, the affordability of care and its quality and the level of community engagement with those at the end of life.

“In many countries, the proportion of older people in the population is growing and noncommunicable

diseases such as heart disease and cancer are on the rise,” the report’s authors said. “The need for palliative care is also therefore set to rise significantly.”

The U.S. came in ninth place overall behind Germany, Taiwan and Australia among others.  In 2010,  the U.S. shared ninth place with Canada.

The U.S. came joint 18th place with Hong Kong, Chile and Switzerland for the affordability of care, something the authors of the report said might surprise “since U.S. healthcare is largely operated by the private sector and Americans pay a high price for it, both in insurance premiums and out-of-pocket costs.”

Yet for Americans things change dramatically after the age of 65, when they become eligible for the federally funded Medicare program, which provides health insurance to those that have worked and paid into the system, the report said.