[afro-nets] Does Healthcare Save Lives? Avoidable Mortality Revisited

[Claudio Schuftan <claudio@hcmc.netnam.vn>]

Does Healthcare Save Lives? Avoidable Mortality Revisited
---------------------------------------------------------
From: Ruggiero, Mrs. Ana Lucia <ruglucia@PAHO.ORG>

Ellen Nolte is a Lecturer in Public Health in the European Cen-
tre on Health of Societies in Transition at the London School of
Hygiene and Tropical Medicine and Research Fellow at the Euro-
pean Observatory on Health Care Systems.

Martin McKee is Professor of European Public Health in the Euro-
pean Centre on Health of Societies in Transition at the London
School of Hygiene and Tropical Medicine and Research Director at
the European Observatory on Health Care Systems.
The Nuffield Trust, 2004


Available online as PDF file [139 pp. 5.0 MB!] at:
http://www.nuffieldtrust.org.uk/policy_themes/docs/avoidablemortality.pdf

Does health care save lives? Commentators such as McKeown and
Illich, writing in the 1960s, argued that it played very little
part, and might even be harmful. However they were writing about
a period when health care had relatively little to offer com-
pared to today. Since then, several writers have described often
quite substantial improvements in death rates from conditions
for which effective interventions have been introduced. But the
debate continues, with some arguing that health care is making
an increasingly important impact on overall levels of health
while others contend that it is in the realm of broader poli-
cies, such as education, transport and housing, that we should
look to for future advances in health. Inevitably this is to a
considerable extent a false dichotomy.

Both are important. But how much does health care contribute to
population health? One way in which this question has been ad-
dressed previously is to look at deaths that should not occur in
the presence of effective and timely health care, so-called
'avoidable' mortality. However much of this work was undertaken
in the 1980s and early 1990s, since when health care has ad-
vanced considerably. In addition, 'avoidable' deaths were often
limited to those before, for example, the age of 65, a figure
that seems inappropriately low in the light of life expectancies
that are now about 80 in many countries.

In this review the authors have traced the evolution of the con-
cept of 'avoidable' mortality from its inception in the 1970s.
The authors have undertaken a detailed methodological critique
of this concept, examining questions of attribution, issues re-
lating to comparisons over time and place, and relationships
with other indicators of health service provision.

This publication is in three parts.
Part I reviews the existing literature on 'avoidable' mortality
to create a framework for analysis that takes account of contem-
porary circumstances.

Part II applies this framework to routinely available mortality
data in European countries.

Part III provides a comprehensive, annotated review of empirical
studies of 'avoidable' mortality that have been undertaken
worldwide so far.