Avoidable mortality (preventable and treatable)
Indicators of avoidable mortality offer a general “starting point” to assess the effectiveness of public health and health care systems in reducing deaths from various diseases and injuries. However, further analysis is required to assess more precisely different causes of potentially avoidable deaths and the interventions to reduce them.
In 2019, across OECD countries, over 3 million premature deaths amongst people aged under 75 years could have been avoided through better prevention and health care interventions. This amounts to over one-quarter of all deaths. Of these deaths, about 1.9 million were considered preventable through effective primary prevention and other public health measures, and over 1 million were considered treatable through more effective and timely health care interventions.
Some cancers that are preventable through public health measures were the main causes of preventable mortality in 2019 (31% of all preventable deaths) – particularly lung cancer (Figure 3.9). Other major causes were injuries, such as road accidents and suicide (21%); heart attack, stroke and other circulatory diseases (19%); alcohol and drug-related deaths (14%); and some respiratory diseases such as influenza and COPD (8%).
The main treatable cause of mortality in 2019 was circulatory diseases (mainly heart attack and stroke), which accounted for 36% of premature deaths amenable to treatment. Effective, timely treatment for cancer, such as colorectal and breast cancers, could have averted a further 27% of all deaths from treatable causes. Respiratory diseases such as pneumonia and asthma (9%) and diabetes and other diseases of the endocrine system (8%) are other major causes of premature death that are amenable to treatment.
The average age-standardised mortality rate from preventable causes was 126 deaths per 100 000 people across OECD countries. It ranged from 90 or fewer per 100 000 in Luxembourg, Israel, Iceland, Switzerland, Japan, Italy and Spain to over 200 in Latvia, Hungary, Lithuania and Mexico (Figure 3.10). Higher rates of premature death in these countries were mainly due to much higher mortality from ischaemic heart disease, accidents and alcohol-related deaths, as well as lung cancer in Hungary.
Mortality rates from treatable causes across OECD countries were much lower, at an average of 73 per 100 000 population. They ranged from fewer than 50 deaths per 100 000 people in Switzerland, Korea, Iceland, Australia, Norway, Japan, France, Sweden and the Netherlands, to over 130 in Mexico, Latvia, Lithuania and Hungary. Ischaemic heart diseases, strokes and some types of treatable cancers (including colorectal and breast cancers) were the main drivers in Latvia, Lithuania and Hungary – countries with some of the highest treatable mortality rates.
Preventable mortality rates were 2.5 times higher among men than among women across OECD countries (185 per 100 000 population for men compared with 73 for women). Similarly, mortality rates from treatable causes were about 36% higher among men than women, with a rate of 86 per 100 000 population for men compared with 63 for women. These gender gaps are explained by higher mortality rates among men, which are in part linked to different exposure to risk factors such as tobacco smoking (see indicator “Main causes of mortality” and Chapter 4 for an in-depth analysis of risk factors for health).
Note that this section analyses the main causes of mortality in 2019. In 2020 and beyond, the COVID-19 pandemic will have a large impact on avoidable mortality. As well as COVID-19 deaths that might have been avoided with more timely policy interventions, this also includes indirect effects caused by the disruptions to preventive and curative health care.
Based on the 2019 OECD/Eurostat definitions, preventable mortality is defined as causes of death amongst people aged under 75 years that can be mainly avoided through effective public health and primary prevention interventions (i.e. before the onset of disease/injury, to reduce incidence). Treatable (or amenable) mortality is defined as causes of death that can be mainly avoided through timely and effective health care interventions, including secondary prevention and treatment (i.e. after the onset of disease, to reduce case fatality).
The two current lists of preventable and treatable mortality were adopted by the OECD and Eurostat in 2019. The attribution of each cause of death to the preventable or treatable mortality category was based on the criterion of whether it is predominantly prevention or health care interventions that can reduce it. Causes of death that can be both largely prevented and also treated once they have occurred were attributed to the preventable category on the rationale that if these diseases are prevented, there would be no need for treatment. In cases when there was no strong evidence of predominance of preventability or treatability (as with ischaemic heart disease, stroke and diabetes), the causes were allocated on a 50:50 basis to the two categories to avoid double-counting of the same cause of death in both lists. The age threshold of premature mortality is set at 74 years for all causes (OECD/Eurostat, 2019[10]).
Data come from the WHO Mortality Database, and the mortality rates are age-standardised to the OECD 2010 Standard Population (available at http://oe.cd/mortality).
Note: The 2021 OECD/Eurostat list of preventable and treatable causes of death classifies specific diseases and injuries as preventable and/or treatable. For example, lung cancer is classified as preventable, whereas breast and colorectal cancers are classified as treatable.
Source: OECD calculations, based on the WHO Mortality Database.
Source: OECD Health Statistics 2021.