HEALTH CARE/Joan Retsinas

Amenable Mortality:

Geography a Risk for Death

Post-funeral, the mourners intone the “if onlys”. If only the decedent had gotten a flu shot. If only she had lost 30 pounds. If only he had stopped smoking. Ex post facto regrets haunt bereavement. Unless the three fates truly scissor out our lives, these decedents might have lived a bit longer, “if only.”

Nobody intones: “if only s/he had lived in Minnesota, not Mississippi.” Or “if only s/he had lived in one of the European nations the Republicans are now castigating.” But they should: geography is a risk factor for death.

Researchers Ellen Nolte and C. Martin McKee, with funding from the Commonwealth Foundation, compared mortality rates in the United States, United Kingdom, Germany and France. (Health Affairs: http://content.healthaffairs.org/content/early/2012/08/20/hlthaff.2011.0851.full).

Americans, particularly Republicans, may think we have the best health care system on the planet. We certainly have the most expensive. We spend $7960 per capita, roughly double what the Western European countries spend.

But we are not the healthiest people on the planet.

Among the reasons is the fractured non-system of health that the Republicans are keen to keep.

The researchers focused on a few key conditions: hypertension, cerebrovacsular disease, diabetes, treatable cancers, surgical complications. They looked at “amenable mortality” rates, defined as “deaths that should not occur in the presence of timely and effective health care.” In short, if you see a physician regularly, and get treatment and oversight, you should not die from these conditions.

The overall statistics are disheartening.

First, the researchers found “amenable mortality” in all four countries: 21% of mortality under age 75 in men and 30% in women fell under the rubric of “amenable.”

Second, and crucially, the US has the highest “amendable mortality” rate of any of them – twice as high as France’s. For diabetes, the UK can boast amenable mortality rates 50% lower than ours. (Our comparative rates of obesity and overweight do not explain the difference.) In short, we have a lot of deaths that needn’t have happened.

Third, although “amenable mortality” rates have dropped in all the countries, the drop has been the lowest in the US. For instance, from 1999 to 2007, the amenable mortality rate for men in the UK dropped by 36.9%; in the US it dropped by 18.5%. A similar gap holds for women. Treatment for cerebrovascular disease and hypertension emerged as a crucial fault-line between the US and the European countries.

Finally, the US itself shows a range of rates of “amenable mortality.” The Minnesota rate was half that of Mississippi or the District of Columbia. Minnesota’s rate was similar to European rates.

For those under the statistical microscope, physicians had diagnosed a medical condition, like hypertension or diabetes. Their death certificates probably listed that as the “cause of death.” But these deaths needn’t have happened. In statistical jargon, they were “ amenable to timely and effective health care.”

The residents of the UK, France, and Germany are not markedly healthier, or markedly slimmer, than Americans. They don’t live markedly healthier lives. Yet they have regular access to physicians, medications, and treatment. Fewer of them die needlessly, from absent or poor care.

The statistical disparity is no surprise. The data end at 2007, when we had 44 million people without health insurance, a poorly funded safety net for the uninsured, and as many as 40 million “underinsured” people, with caps, clauses, and exclusions that rendered their insurance almost illusory. You would expect our “amenable mortality rates” to top rates in countries with universal coverage.

Fast forward to today. The Affordable Care Act, a.k.a. Obamacare, has extended insurance to more people, as well as made private insurers axe their egregious cost-saving maneuvers, like low caps, low payouts for services, and exclusions for pre-existing conditions. In a few years, when this Act is fully implemented, we should see “amenable mortality” drop. Politicians ramble on about “roads” for America. Obamacare is a good road to stay on.

At funerals, mourners will no longer need to lament geography.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, October 15, 2012