Commentary: Approaches, strengths, and limitations of avoidable mortality
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Publication of recent papers such as the one by Schoenbaum and colleagues entitled ‘Mortality Amenable to Health Care in the United States: The Roles of Demographics and Health Systems Performance’ has stimulated this commentary. We discuss strengths and limitations of amenable and avoidable mortality in health-care systems’ performance and their contribution to health inequalities. To illustrate, we present a case study of avoidable and amenable mortality in Spain over 27 years. We conclude that amenable mortality is not a good indicator of health-care systems’ performance, or for determining whether it could give rise to health inequalities. To understand health problems and to assess the impact of interventions affecting health requires good, basic, and routine monitoring of health indicators and of socioeconomic determinants of health.
Keywordsmortality avoidable mortality health-care system inequalities
This study was partly funded by CIBER Epidemiología and Salud Pública of Spain, by the Ministerio de Sanidad y Consumo, Observatorio de Salud de la Mujer, Dirección General de la Agencia de Calidad, and by the Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III of Spain. The program of ‘Intensificación de la actividad investigadora (Carme Borrell)’ was funded by the Instituto Carlos III and the Department of Health, Generalitat de Catalunya, Spain. We also thank Dave Macfarlane for editing and reviewing the manuscript.
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