A new report by a US health foundation has found that Americans get the worst deal in terms of preventable deaths among 19 industrialized nations.

The report is published in the January/February issue of the journal Health Affairs and is the work of researchers sponsored by the Commonwealth Fund, which is based in New York.

The authors found that while other countries dramatically reduced deaths preventable by effective health care between 1997-8 and 2002-3, the US did so only slightly. If the US had performed as well as the top ranking countries, 101,000 fewer deaths per year could have been prevented, wrote Ellen Nolte and Martin McKee, who are based at the London School of Hygiene and Tropical Medicine.

The best performers were France, Japan, and Australia.

To arrive at the figures, Nolte and McKee compared trends between 1997-8 and 2002-03 in deaths of people under 75 years of age whose cause of death was “considered amenable to health care”. They called this figure “amenable mortality” and included the US and 18 industrialized nations in their analysis.

The authors wrote that amenable mortality accounts, on average, for about 23 per cent of all deaths under the age of 75 in men and 32 per cent in women, and it declined by an average of around 16 per cent in all countries over the period they studied.

However, the United States was an “outlier”, they wrote, in other words it was far below the average, showing a decline in health care amenable deaths of only 4 per cent.

Nolte said in a press statement that:

“It is notable that all countries have improved substantially except the US.”

The authors linked the results to the current political scene in the US:

“It is difficult to disregard the observation that the slow decline in US amenable mortality has coincided with an increase in the uninsured population, an issue that is now receiving renewed attention in several states and among presidential candidates from both parties.”

Commonwealth Fund Senior Vice President, Cathy Schoen said she was startled to see the US falling so far behind:

“By focusing on deaths amenable to health care, Nolte and McKee strip out factors such as population and lifestyle differences that are often cited in response to international comparisons showing the US lagging in health outcomes.”

“The fact that other countries are reducing these preventable deaths more rapidly, yet spending far less, indicates that policy, goals, and efforts to improve health systems make a difference,” she explained.

In more detail, the results showed that:

  • In 1997-8 the US was in 15th place out of 19 countries on the amenable mortality scale.
  • By 2002-3 the US had fallen to last place, with 109 deaths amenable to health care for every 100,000 people.
  • This compared with France at 64, Japan at 71, and Australia at 71 per 100,000, the three top performers in 2002-3.

The other industrialized nations included in the report were:

Austria, Canada, Denmark, Finland, Germany, Greece, Ireland, Italy, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden and the United Kingdom.

Nolte and McKee said that amenable mortaity is a useful indicator of health care performance because it takes into account improved care, including public health initiatives.

The measure takes into account a range of conditions that one might reasonably judge to be responsive to effective health care and thereby avoiding early death. These include, for example, appendicitis and high blood pressure, where the type of care required is obvious. It also includes conditions that can be detected with effective screening programmes such as cervical and colon cancer and TB (which is not fatal if treated early).

Commonwealth Fund President Karen Davis said:

“While no one country provides a perfect model of care, there are many lessons to be learned from the strategies at work abroad.”

The Commonwealth Fund is a private foundation campaigning to give people better access, improved quality, and greater efficiency in healthcare. It is particularly concerned to do this for the most vulnerable, including people on low income, with no uninsurance, minority Americans, the young and the elderly.

“Measuring The Health Of Nations: Updating An Earlier Analysis.”
Ellen Nolte and C. Martin McKee.
Health Affairs, January/February 2008; 27(1): 58-71.
doi: 10.1377/hlthaff.27.1.58

Click here for Abstract.

Sources: journal abstract, Commonwealth Fund press release and website.

Written by: Catharine Paddock