Can the concept of avoidable deaths complement who health system performance
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Can the Concept of Avoidable Deaths Complement WHO Health System Performance?. Elena A. Varavikova, MD, PhD, MPH, Researcher, OSD/FSP. Outline of the Presentation. Concept of Avoidable Deaths - strengths and weaknesses

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Can the Concept of Avoidable Deaths Complement WHO Health System Performance?

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Can the concept of avoidable deaths complement who health system performance

Can the Concept of Avoidable DeathsComplement WHO Health System Performance?

Elena A. Varavikova, MD, PhD, MPH,

Researcher, OSD/FSP


Outline of the presentation

Outline of the Presentation

  • Concept of Avoidable Deaths - strengths and weaknesses

  • Concept of Avoidable Death and Conditions - what additional information does it provide?

  • Translating Assessment of Avoidable Deaths into Policy


How does medical care contribute to population health

How Does Medical Care Contribute to Population Health?

  • Safe maternity and infant care

  • Control infectious disease morbidity and mortality

  • Effective screening and treatment of CNID

  • Evidence based medicine

  • Disease prevention and health promotion

  • ……………...

  • Measure of success - declining MORTALITY


Why avoidable deaths

Why Avoidable Deaths?

  • Rising mortality in Russia, and still existing avoidable causes in developed countries

  • Rising inequality

  • Search for successful tool and environment for health policy prioritisation, measurement and implementation

  • Social importance of death and great potential for support from the society

  • Mortality was always basis for Epidemiology and evidence for health policy development


Examining contribution of health care to decline of mortality concept of avoidable death 1

Examining contribution of health care to decline of mortality, concept of avoidable death (1)

  • Rutsein et al. - 1976, Charlton 1983 - proposed list of conditions from which death should not occur if appropriate care was provided - “unnecessary untimely deaths”, or mortality amenable to medical interventions

  • Mackenbach and co-authors - estimated that in The Netherlands between 1959 - 1984 changes in death from amenable causes added a total 2.9 years to male and 3.9 to female Life Expectancy

  • Beaglehole 1986 - 42% of decline in death from CVD in New Zealand 1974-1981 could be attributed to MC

  • EC Atlas of avoidable death, Europe... Holland 1988,91


Examining contribution of health care to decline of mortality concept of avoidable death 2

Examining contribution of health care to decline of mortality, concept of avoidable death (2)

  • Hunnink et al. 1997 - estimated about 25% of the decline in CHD mortality in the USA 1980-90 was due to primary prevention, 72% due to secondary reduction in risk factors or improvements in treatment (comp.stimulation model)

  • Capewell et al. 1999 - 40% of the decline of coronary heart disease mortality in Scotland 1975-94 could be attributed to medical care, including variety of measures of primary and secondary prevention

  • WHO MONICA project data linking changes in coronary care and secondary prevention to declining adverse outcomes between mid-1980s - mid-1990


Concept of avoidable death avoidable illness condition

Avoidable deaths (mortality)

Mortality from certain causes of death, where death is avoidable according to current medical knowledge, practice and public health interventions in a defined age/sex group of the population

List of avoidable deaths based on expert opinion and consensus (manageable, age, sex)

Used as a measure of health system performance NYC, Spain, Germany (Ellen Nolte), Poland, Baltic countries, Russia

Concept of Avoidable Death (Avoidable Illness,Condition)


Early neonatal mortality rates

Early Neonatal Mortality Rates


Can the concept of avoidable deaths complement who health system performance

Example “Russian Case”PATTERNS OF avoidable mortality in RussiaAndreev-Nolte- Mckee -Shkolnikov-VaravikovaContributions of different groups of causes of death to the life expectancy gap between Russia and the UK: 1965-1999


Can the concept of avoidable deaths complement who health system performance

Contributions of different groups of causes of death to the life expectancy gap between Russia and the UK: 1965-1999


Life expectancy at birth in russia baltic countries and the uk in 1965 2000 both sexes

Life expectancy at birth in Russia, Baltic countries and the UK in 1965-2000 (both sexes)


Can the concept of avoidable deaths complement who health system performance

Trends in SDRs for avoidable causes of death since 1965: Russia, Baltic countries and the UK, both sexes, per 100000


Ischemic heart disease selected countries 1970 1998

Ischemic Heart Disease, Selected Countries, 1970-1998


Mortality from cerebrovascular disease selected countries 1970 1998

Mortality from Cerebrovascular Disease, Selected Countries, 1970-1998


Avoidable death survey rf

Avoidable Death Survey , RF

  • Moscow, Tver, St. Petersburg, Cheliabinsk

  • Russian List of Avoidable Death

  • Age groups

  • Promotion and prevention

  • Education


Improving health system performance using concept of avoidable conditions

Improving Health System Performance using Concept of Avoidable Conditions

  • Measure population health, health outcomes of the services, patient safety

  • Develop consensus on avoidable conditions and legislative support, (Dubna municipality)

  • Program development and implementation for the control of mortality and non-fatal avoidable health outcomes

  • Quality management (Netherlands, Finland)

  • Attention to health promotion and disease prevention

  • Injuries and trauma


Problems and questions

Problems and Questions

  • Eligibility of some ‘avoidable conditions’ as performance indicators for health services (Walworth-Bell &Allen, 1988 - cancer of cervix and hypertansion) {EBM}

  • Overstatement of if impact of health services (small portion of mortality) - {age 65, 75 or 80?, SHEP and Syst-Eur, female breast cancer}

  • Absence of a clear link at sub-national level with other measures of health care provision (Carr-Hill et al.) {modern studies CVD}

  • No account of differences in the underlying prevalence or severity of a disease {incidence-adjusted mortality rates, Netherlands}

  • Avoidable death and non-fatal health outcomes (and coverage) are qualitatively different

  • Quality of mortality data { List }

  • To effect change, policies need to be specific and based on disaggregated data + sub national level (RF, Japan, Hungary, USA)


Can the concept of avoidable deaths complement who health system performance

Strategic Analysis (population approach)

Regional comparison

Sub-national level

Monitoring of quality and effectiveness of Health System

Analysis of causes

Access, coverage

Quality control, Patient safety

Avoidable Mortality is a Tool for Prioritisation in Health Policy, Measure of success in the Reform process


Can the concept of avoidable deaths complement who health system performance

What Concept of Avoidable conditions

could add to Public Health practice?

  • Evidence on the effectiveness of health system reforms

  • A consistent framework for specifying goals and measuring outcomes

  • Clear base for societal and legislative support

  • Informed concern and demand for research and implementation

  • Evidence-based ‘Library’ for implementations to control avoidable conditions

  • Tool for implementation .


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