U.S. Last Among Industrialized Nations in Preventable Deaths

The United States places last among 19 countries in deaths that could have been prevented by access to timely and effective healthcare, a new study finds.

If the United States had performed as well as the top three countries out of the 19 industrialized countries in the study, there would be about 101,000 fewer U.S. deaths in the per year, the researchers estimate.

The top performers: France, Japan, and Australia.

Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine compare trends in deaths that could have been prevented by access to timely and effective healthcare. Specifically, they looked at deaths amenable to healthcare before age 75 between 1997–98 and 2002–03.

They found that while other countries saw these types of deaths decline by an average of 16 percent, the United States experienced only a 4 percent decline.

"It is notable that all countries have improved substantially except the U.S.," said Nolte, lead author of the study. 

In a statement today, Nolte and McKee said, "it is difficult to disregard the observation that the slow decline in U.S. 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."

The research was supported by The Commonwealth Fund and published in the January/February issue of the journal Health Affairs.

"It is startling to see the U.S. falling even farther behind on this crucial indicator of health system performance," said Commonwealth Fund Senior Vice President Cathy Schoen. "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 U.S. 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."

In 1997–98 the U.S. ranked 15th out of 19 countries on the "mortality amenable to health care" measure. However, by 2002–03 the U.S. fell to last place, with 109 deaths amenable to health care for every 100,000 people. In contrast, mortality rates per 100,000 people in the leading countries were: France (64), Japan (71), and Australia (71).

The other countries included in the study were Austria, Canada, Denmark, Finland, Germany, Greece, Ireland, Italy, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden and the United Kingdom.

The measure of deaths amenable to health care is a valuable indicator of healthcare system's performance because it is sensitive to improved care, the researchers stated. It considers a range of conditions from which it is reasonable to expect death to be averted even after the condition develops. This includes causes such as appendicitis and hypertension, where the medical nature of the intervention is apparent; it also includes illnesses that can be detected early with effective screenings such as cervical or colon cancer, and tuberculosis which, while acquisition is largely driven by socio-economic conditions, is not fatal when treated in a timely manner.

In a 2006 study, infant mortality in the United States was found to be among the worst of all industrialized nations. Another study found Americans had a higher rate of sickness than the British in all categories studied.

"Cross-national studies conducted by The Commonwealth Fund indicate that our failure to cover all Americans results in financial barriers that are much more likely to prevent many U.S. adults from getting the care they need, compared with adults in other countries," said Commonwealth Fund President Karen Davis. "While no one country provides a perfect model of care, there are many lessons to be learned from the strategies at work abroad."

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