Variations in amenable mortality--trends in 16 high-income nations.

BACKGROUND: There has been growing interest in the comparison of health system performance within and between countries, using a range of different indicators. This study examines trends in amenable mortality, as one measure of health system performance, in sixteen high-income countries. METHODS: Amenable mortality was defined as premature death from causes that should not occur in the presence of timely and effective health care. We analysed age-standardised rates of amenable mortality under age 75 in 16 countries for 1997/1998 and 2006/2007. RESULTS: Amenable mortality remains an important contributor to premature mortality in 16 high-income countries, accounting for 24% of deaths under age 75. Between 1997/1998 and 2006/2007, amenable mortality fell by between 20.5% in the US and 42.1% in Ireland (average decline: 31%). In 2007, amenable mortality in the US was almost twice that in France, which had the lowest levels. CONCLUSIONS: Amenable mortality continues to fall across high-income nations although the USA is lagging increasingly behind other high income countries. Despite its many limitations, amenable mortality remains a useful indicator to monitor progress of nations

Managing chronic illness in Europe: a comparative analysis

Many countries are experimenting with new models of care delivery involving enhanced integration and coordination of services to better meet the needs of those living with chronic illness. However, the available evidence on the relative value of different forms of integration remains uncertain. This paper will present the findings of a study undertaken in close collaboration with and co-funded by the European Observatory on Health Systems and Policies. It will provide an overview of strategies to chronic disease management that have been developed and/or implemented in five European countries (Denmark, England, France, Germany, Sweden) and Australia. It will also assess some of the contextual factors that enable or hinder implementation of strategies to address chronic illness

Assessing the economic costs of unhealthy diets and low physical activity: an evidence review and proposed framework

Unhealthy diets and low physical activity contribute to many chronic diseases and disability; they are responsible for some 2 in 5 deaths worldwide and for about 30% of the global disease burden. Yet surprisingly little is known about the economic costs that these risk factors cause, both for health care and society more widely. This study pulls together the evidence about the economic burden that can be linked to unhealthy diets and low physical activity and explores How definitions vary and why this matters The complexity of estimating the economic burden and How we can arrive at a better way to estimate the costs of an unhealthy diet and low physical activity, using diabetes as an example The review finds that unhealthy diets and low physical activity predict higher health care expenditure, but estimates vary greatly. Existing studies underestimate the true economic burden because most only look at the costs to the health system. Indirect costs caused by lost productivity may be about twice as high as direct health care costs, together accounting for about 0.5% of national income. The study also tests the feasibility of using a disease-based approach to estimate the costs of unhealthy diets and low physical activity in Europe, projecting the total economic burden associated with these two risk factors as manifested in new type 2 diabetes cases at €883 million in 2020 for France, Germany, Italy, Spain and the United Kingdom alone. The ‘true’ costs will be higher, as unhealthy diets and low physical activity are linked to many more diseases. The study’s findings are a step towards a better understanding of the economic burden that can be associated with two key risk factors for ill health and they will help policymakers in setting priorities and to more effectively promoting healthy diets and physical activity

Measuring the health of nations: analysis of mortality amenable to health care.

OBJECTIVE: To assess whether and how the rankings of the world's health systems based on disability adjusted life expectancy as done in the 2000 World Health Report change when using the narrower concept of mortality amenable to health care, an outcome more closely linked to health system performance. DESIGN: Analysis of mortality amenable to health care (including and excluding ischaemic heart disease). MAIN OUTCOME MEASURE: Age standardised mortality from causes amenable to health care SETTING: 19 countries belonging to the Organisation for Economic Cooperation and Development. RESULTS: Rankings based on mortality amenable to health care (excluding ischaemic heart disease) differed substantially from rankings of health attainment given in the 2000 World Health Report. No country retained the same position. Rankings for southern European countries and Japan, which had performed well in the report, fell sharply, whereas those of the Nordic countries improved. Some middle ranking countries (United Kingdom, Netherlands) also fell considerably; New Zealand improved its position. Rankings changed when ischaemic heart disease was included as amenable to health care. CONCLUSION: The 2000 World Health Report has been cited widely to support claims for the merits of otherwise different health systems. High levels of health attainment in well performing countries may be a consequence of good fortune in geography, and thus dietary habits, and success in the health effects of policies in other sectors. When assessed in terms of achievements that are more explicitly linked to health care, their performance may not be as good

Diabetes as a tracer condition in international benchmarking of health systems.

OBJECTIVE: To assess the performance of health systems using diabetes as a tracer condition. RESEARCH DESIGN AND METHODS: We generated a measure of "case-fatality" among young people with diabetes using the mortality-to-incidence ratio (M/I ratio) for 29 industrialized countries using published data on diabetes incidence and mortality. Standardized incidence rates for ages 0-14 years were extracted from the World Health Organization DiaMond study for the period 1990-1994; data on death from diabetes for ages 0-39 years were obtained from the World Health Organization mortality database and converted into age-standardized death rates for the period 1994-1998, using the European standard population. RESULTS: The M/I ratio varied >10-fold. These relative differences appear similar to those observed in cohort studies of mortality among young people with type 1 diabetes in five countries. A sensitivity analysis showed that using plausible assumptions about potential overestimation of diabetes as a cause of death and underestimation of incidence rates in the U.S. yields an M/I ratio that would still be twice as high as in the U.K. or Canada. CONCLUSIONS: The M/I ratio for diabetes provides a means of differentiating countries on quality of care for people with diabetes. It is solely an indicator of potential problems, a basis for stimulating more detailed assessments of whether such problems exist, and what can be done to address them

Exposure of children and adolescents to alcohol marketing on social media websites.

AIMS: In 2011, online marketing became the largest marketing channel in the UK, overtaking television for the first time. This study aimed to describe the exposure of children and young adults to alcohol marketing on social media websites in the UK. METHODS: We used commercially available data on the three most used social media websites among young people in the UK, from December 2010 to May 2011. We analysed by age (6-14 years; 15-24 years) and gender the reach (proportion of internet users who used the site in each month) and impressions (number of individual pages viewed on the site in each month) for Facebook, YouTube and Twitter. We further analysed case studies of five alcohol brands to assess the marketer-generated brand content available on Facebook, YouTube and Twitter in February and March 2012. RESULTS: Facebook was the social media site with the highest reach, with an average monthly reach of 89% of males and 91% of females aged 15-24. YouTube had a similar average monthly reach while Twitter had a considerably lower usage in the age groups studied. All five of the alcohol brands studied maintained a Facebook page, Twitter page and YouTube channel, with varying levels of user engagement. Facebook pages could not be accessed by an under-18 user, but in most cases YouTube content and Twitter content could be accessed by those of all ages. CONCLUSION: The rise in online marketing of alcohol and the high use of social media websites by young people suggests that this is an area requiring further monitoring and regulation