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Letters |
Amenable Mortality: A Different View
The Holy Grail of policymakers in health and health systems researchers is to find some simple metric to measure health system performance, but the recent literature gives no hope that there will soon be a new Galahad. The paper by Ellen Nolte and C. Martin McKee (Jan/Feb 08) uses a tried methodology to assess how health care can be improved. It focuses on the United States, and, given the current political debate about health, it is a very timely input. It is well to note certain aspects that could be explored further.
There is a facile interchange between health and health care systems. But health care is only one of the parts of a health system that is a complex interlocking of various functions, as was spelled out in the World Health Report 2000.
The analysis of amenable mortality and the apparently poor showing of the United States does not go far enough. Amenable mortality includes causes that are amenable to primary preventions and those that are "treatable." It has been shown in a developing country that there can be differential rates of decline in these two, with major policy implications.1 There is a wide range of interventions for addressing preventable causes that are more cost-effective than those available for the "treatable."
The United States lags behind in amenable mortality, but it is not only amenable mortality that is important. The United States is the only one of the countries in which mortality from other causes in males exceeded amenable mortality, and the decline in other causes was greater than in seven countries. The U.S. decline in other causes for females was greater than in nine countries. It is unbalanced not to give attention to these other causes of mortality. It is as important to examine these, because it may well be that some of them are susceptible to cost-effective interventions. The argument might well be made that the other countries should emulate the United States in terms of mortality decline from other causes.
The possibility of applying this approach to and comparing countries, especially the developing ones, should also take account of differing epidemiological profiles and demographic factors as well as the difference of opinion as to the causes that should be on the list.
Director Emeritus, Pan American Health Organization, Washington, D.C.
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- M. Niti and T.P. Ng, "Temporal Trends and Ethnic Variations in Amenable Mortality in Singapore 1965–1994: The Impact of Health Care in Transition," International Journal of Epidemiology 30, no. 5 (2001): 966–973.
[Abstract/Free Full Text]
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