THE EFFECTIVENESS OF HEALTH SYSTEMS IN INFLUENCING AVOIDABLE MORTALITY IN NIGERIA
Objectives – To measure variations in the Holland and Charlton classifications of avoidable death causes and to estimate the effect of the Spanish national health system on avoidable mortality. Design – Mortality in the Valencian Community was assessed between 1975 and 1990. The classifications of Holland and Charlton, used to assess avoidable causes of death, were compared. Holland’s classification was then used to divide avoidable
mortality into two groups – medical care indicators (MCI), which show the effectiveness of health care, and national health policy indicators (NHPI), which show the status of primary prevention. Comparisons were made with rates, group rates, and population rates. Trends and indices were also studied. Setting – Valencia, Spain, 1975-90.
Results – During the study period, avoidable morality (only assessed by MCI) fell 63%, whereas the remainder of the mortality (non-MCI causes, that is all the nonavoidable causes together with the NHPI group) fell by 17%. Ifit is assumed that the mortality due to non-MCI causes indicates the overall effect of the environmental, social, nutritional, and genetic influences, then the difference between this and the MCI group would take us nearer the actual effect of the intervention of the health system. Conclusions – It is concluded that in this
community, the health system has been responsible for approximately 47% of the total reduction in mortality from avoidable causes in the period studied.
done since,49 the most important being the Project of Coordinated Action of the European Community, directed by Holland and published in 1988, which became the Atlas of Avoidable Death,0 with a second update in 1991.” This
study attempted to unify the list of avoidable mortality causes. In practical terms, all studies on avoidable
mortality use a selection of causes based on Rutstein’s original list and generally omit infrequent causes of mortality. Many also omit causes, such as lung cancer and hepatic cirrhosis (originally included in Rutstein’s list)
and motor accidents (not included), whose avoidance is outside the scope of the health care services and belongs instead to the primary prevention field. The separation into causes that are amenable to secondary prevention or
medical treatment (medical care indicators (MCI)) and those that are avoidable through primary prevention (national health policy indicators (NHPI)) comes from Holland’s work,’01’ and has been continued in some
national’213 and international studies. To study the evolution of avoidable mortality in the Valencian Community between 1975 and 1990 we compared the two most representative lists of death causes – those of Holland and
Charlton. We aimed to assess mortality trends for both the MCI and NHPI.