U.S. Ranks Last Among High-Income Nations on Preventable Deaths

Up to 84,000 Lives Annually Could Be Saved if the U.S. Lowered Its Preventable Death Rate to That of the Top Three Performing Nations

From the Commonwealth Fund

The United States placed last among 16 high-income, industrialized nations when it comes to deaths that could potentially have been prevented by timely access to effective health care, according to a Commonwealth Fund–supported study that appeared online in the journal Health Policy this week and will be available in print on October 25th as part of the November issue. According to the study, other nations lowered their preventable death rates an average of 31 percent between 1997–98 and 2006–07, while the U.S. rate declined by only 20 percent, from 120 to 96 per 100,000. At the end of the decade, the preventable mortality rate in the U.S. was almost twice that in France, which had the lowest rate—55 per 100,000.

Preventable Death In “Variations in Amenable Mortality—Trends in 16 High Income Nations,” Ellen Nolte of RAND Europe and Martin McKee of the London School of Hygiene and Tropical Medicine analyzed deaths that occurred before age 75 from causes like treatable cancer, diabetes, childhood infections/respiratory diseases, and complications from surgeries. They found that an average 41 percent drop in death rates from ischemic heart disease was the primary driver of declining preventable deaths, and they estimate that if the U.S. could improve its preventable death rate to match that of the three best-performing countries—France, Australia, and Italy—84,000 fewer people would have died each year by the end of the period studied.

“This study points to substantial opportunity to prevent premature death in the United States. We spend far more than any of the comparison countries—up to twice as much—yet are improving less rapidly,” said Commonwealth Fund Senior Vice President Cathy Schoen. “The good news is we know lower death rates are achievable if we enhance access and ensure high-quality care regardless of where you live. Looking forward, reforms under the Affordable Care Act have the potential to reduce the number of preventable deaths in the U.S. We have the potential to join the leaders among high-income countries.”

Nolte and McKee noted that while preventable death rates declined in all 16 countries, the rate of decline varied significantly. Ireland, which ranked last with the highest preventable death rate in 1997–98, improved 42 percent by 2006–07. As a result, Ireland narrowed the gap with France, the country with the lowest “amenable mortality,” with 55 preventable deaths per 100,000 people. France was followed closely by Australia (57 per 100,000), and Italy (60 per 100,000). The U.S. ranked last, with 96 preventable deaths per 100,000 in 2006–07, down from 120 in 1997–98. The United Kingdom, which like Ireland began the decade with preventable death rates higher than the United States, now has rates that are considerably lower (83 per 100,000), reflecting more rapid improvement.

According to the study’s authors, the United States’ poor performance and relatively slow improvement compared with other nations may be attributable to “the lack of universal coverage and high costs of care.”

“Cross-national comparisons consistently find that people in the U.S. have a harder time getting and paying for the health care they need than people in other countries,” said Commonwealth Fund President Karen Davis. “The good news is that Affordable Care Act reforms are targeted at specifically the areas that are responsible for this divide—costs and access to health care.”


  1. Pam Krimsky on December 1, 2011 at 12:34 pm

    The US doesn’t enact legislation to prevent ‘accidental’ deaths or injuries because medical and health insurance and big business benefits from gov’t. non involvement. In developed, cultured nations, government actively and positively works to keep their populations well.

  2. Hugh Jass on December 1, 2011 at 12:43 pm

    let’s look on the bright side, people: at least some rich asshole went from being ridiculously rich to obscenely rich. NOTHING gets done in this country unless some rich, right-wing ghoul can collect his graft. thirty years of neocon economic bullshit, lies and propaganda has left us with a rank and squalid kleptocracy. THANKS assholes.

  3. Dr. Art Sutherland on December 1, 2011 at 1:47 pm

    The PPACA law will not control costs because it just cobbled on more complexity to our fragmented and chaotic health care market- access and affordability will remain problems. We need a national single payer program like an improved Medicare for All to bring about meaningful and moral health care reform.

    • KenS on December 1, 2011 at 5:02 pm

      Dr. Art has it right, except the name PPACA misrepresents it: doesn’t protect and isn’t affordable. It’s really Romneycare II, with mandates that force people to buy overpriced, under-performing (junk) insurance policies.

  4. Margaret Smith on December 1, 2011 at 3:14 pm

    We elected people with an uncharitable style so we did it to ourselves. People need to do what they can now; stop smoking, exercise, eat properly. Sadly, it is unrealistic to wait for assistance.

  5. Bill Todd on December 1, 2011 at 3:28 pm

    While I’m whole-heartedly in favor of Medicare for all (or an at least equivalent single-payer approach), I’m not sure that it would make a great difference in the results of this study. If IHD is indeed the dominant factor, then lifestyle changes much more than treatment availability may be the driving force in the differences reported.

    Over-selling (by possible exaggeration in this case) an otherwise desirable product can create a back-lash (especially driven by those with vested interests in suppressing it). Given the nature of the opposition, making sure that assertions such as this one (like Ceasar’s wife) are ‘above suspicion’ is important.

    • Margaret Smith on December 1, 2011 at 3:47 pm

      Absolutely re life style and correlation with IHD. There is so much concern about weapons of mass destruction – what are cigarettes if not that?

      • Bill Todd on December 1, 2011 at 4:10 pm

        As you noted in your earlier post, diet and exercise are important as well – and given the declining use of cigarettes in this country may account for even more preventable deaths (off the top of my head, anyway: I have no idea what the actual statistics may show).

        (I can’t believe that I misspelled ‘Caesar’ above: that’s what comes of depending excessively upon spell-checkers rather than proof-reading.)

  6. Lee Booth on December 1, 2011 at 5:04 pm

    Shame on us!

  7. Vashti Winterburg on December 1, 2011 at 5:18 pm

    To all of you “life-style change enthusiasts”: earlier this year the CIA released a study saying that the great majority of the U.S.’s third world health outcome numbers were due to lack of access. Not obesity, not smoking, etc. – ACCESS. When you have 50 million Americans without health insurance, another 50 million with essentially bogus insurance and a big pile of citizens with insurance that’s so expensive that all but the rich are afraid to use it ($1300/mo family policies with a $7500 deductible is pretty common) THAT is an access problem.
    When your country is spending over 17% of its GDP on “health care” and #2 Switzerland is spending 12% but they cover everyone and the U.S. doesn’t, life style is not the issue. Our non-system is expensive, ineffective, inefficient and immoral.

    • Bill Todd on December 1, 2011 at 8:19 pm

      I’m afraid that you failed to address the focus of this particular discussion – which it not generic “health outcome numbers” but very specifically “preventable deaths” and what might account for the specific comparisons being cited here. Kudos for your enthusiasm, but fewer for your attention to detail.

  8. Marci on December 2, 2011 at 3:39 am

    If people could get affordable dental care, including simple preventive care, over their lifetimes, many other health problems would diminish. Medicare does not provide dental care. Medicaid provides only minimal care and for adults it is generally limited to extracting teeth when they have become too painfully decayed to bear.

    This is an example of healthcare that would cost so much less to provide and prevent much more dire and expensive problems down the line. It’s just insane, the approach this country takes. But underlying the whole deal is the attitude that income is somehow based on or reflective of one’s righteousness. If you are rich, you deserve to be rich. If you aren’t rich, well you deserve that, too, and all the life experiences that follow from it.

  9. Margaret Smith on December 2, 2011 at 5:49 am

    Of course access is essential for the overall picture. It is the right thing to do. One interesting thing is how it interplays with petro dependency. Saudis have nationalized health care supported by the oil revenue. So, in the US, we are paying for universal health care – just not ours. I am a US citizen health care worker in Saudi Arabia since the US economy went down the drain in the 1990″s.

  10. Noelle on December 13, 2011 at 1:16 pm

    Preventable deaths are directly related to access to healthcare. When an uninsured/underinsured person is ill they will not seek healthcare unless their condition becomes unmanagable and life threatening. My son in law was given a prescription of Pen VK for strep throat. He had never been sick before. Never taken antibiotics. He is not insured. In the middle of the night my daughter wakes me saying he can’t breath. We got him into the car as I was giving him 50 mg of Benadryl and headed to the ER. At the ER he didn’t want to go in. He didn’ t have any money to pay what he knew would be a lot of money to be seen. (His mother, visiting on a visa, just incurred a huge bill he and his siblings had paid cash for) Because he was with us he of course was seen in the ER. $1,500+ for the two hour visit that saved his life.
    I paid the bill. He’s still uninsured and under employed. But he’s alive and not one of the preventable deaths!