The European Journal of Public Health Advance Access originally published online on August 9, 2007
The European Journal of Public Health 2008 18(2):166-172; doi:10.1093/eurpub/ckm084
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Health Care and Health |
Population health and the health system: a comparative analysis of avoidable mortality in three nations and their world cities
Daniel Weisz1,*, Michael K. Gusmano1,2, Victor G. Rodwin1,3 and Leland G. Neuberg4
1 World Cities Project, International Longevity Center, USA
2 Assistant Professor of Health Policy and Management, the Mailman School of Public Health, Columbia University
3 Professor of Health Policy and Management, Robert F. Wagner School of Public Administration, New York University
4 Adjunct Professor of Statistics, Boston University
* Correspondence: Daniel Weisz, MD, Research Associate, World Cities Project, International Longevity Center, 60 East 86th Street, New York, NY 10028, USA, tel: 212-606-3382, fax: 212-288-9122, e-mail: DanielW{at}ilcusa.org
Received December 26, 2006 , accepted June 28, 2007
Background: Access to timely and effective medical services can reduce rates of premature mortality attributed to certain conditions. We investigate rates of total and avoidable mortality (AM) and the percentage of avoidable deaths in France, England and Wales and the United States, three wealthy nations with different health systems, and in the urban cores of their world cities, Paris, Inner London and Manhattan. We examine the association between AM and an income-related variable among neighbourhoods of the three cities. Methods: We obtained mortality data from vital statistics sources for each geographic area. For two time-periods, 1988–90 and 1998–2000, we assess the correlation between area of residence and age- and gender-adjusted total and AM rates. In our comparison of world cities, regression models are employed to analyse the association of a neighbourhood income-related variable with AM. Results: France has the lowest mortality rates. The US exhibits higher total, but similar AM rates compared to England and Wales. Rates of AM are lowest in Paris and highest in London. Avoidable mortality rates are higher in poor neighbourhoods of all three cities; only in Manhattan is there a correlation between the percentage of deaths that are avoidable and an income related variable. Conclusions: Beyond the well-known association of income and mortality, persistent disparities in AM exist, particularly in Manhattan and Inner London. These disparities are disturbing and should receive greater attention from policy makers.
Keywords: avoidable mortality, health system, income