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EC working group on health services and 'avoidable deaths'


The objectives of the EC Concerted Action Project were:

i) to produce a set of maps illustrating the prevalence of 'avoidable deaths' from a number of selected conditions for specified age ranges;
ii) to make comparisons between and within the participating countries;
iii) to relate the resulting variation to differing levels or modes of delivery of health service inputs.
The Department of Public Heath Medicine, United Medical and Dental Schools of St Thomas's and Guy's Hospitals (UMDS), acts as the coordinating centre for the European Community (EC) Concerted Action Project on Heath Services and Avoidable Death. Measures of health service outcome have been developed for comparison over time and between and within the EC countries.

Avoidable mortality has been defined as death from specific diseases (within selected age groups) for which mortality should be wholly or substantially avoidable when medical care is sought and provided in good time. The 3 Atlases published to date provide the European Commission and the national administrations with a measure of the current status and variation over time of avoidable mortality.

The European Community Atlas of Avoidable Deaths, 1974-1978 showed for the first time maps of the EC countries shaded according to the death rate for each of 14 avoidable causes in specific age groups (a format which illustrates 5 to 10 fold variation between and within EC countries). The 2nd edition, Volume I, which covered the same conditions over the period 1980 to 1984 and included an analysis of variation over time, was published in 1992.

Mortality from almost all the causes studied has declined in Europe. However the comparison of ranks of the standardized mortality ratios (SMR) for health authority areas across the EC in 1980 to 1984 with their ranks in 1974 to 1978 indicated that areas with high SMRs in the first period were likely to have high SMRs in the second time period. Volume 2 of the 2nd edition, containing a further 8 conditions for which mortality is partly avoidable, was published in 1993.
The third edition of the atlas will be published in late 1996.
In the absence of any health services intervention mortality would be determined purely by social, environmental and genetic factors. Health services, through preventive and remedial activities, and governments, through legislative policy, modify the influence of some of these factors, with the objective of reducing mortality and morbidity. For some diseases medical knowledge is sufficiently advanced to prevent almost all deaths in more resilient age groups. For such deaths to be prevented, however, timely action is necessary and the observation of an appreciable number of deaths suggests that such action may not have been taken.

The sequence of events leading up to avoidable disease, death or disability of an individual can, however, be complex.

Diseases may be identified in which health education, immunisation practices, continuity of care, surgical standards and many other particular aspects of the health care system care important in avoiding unnecessary deaths. Geographical comparison of these 'avoidable deaths' can pinpoint areas with particular health care delivery problems. Comparison with areas where action has been effective in reducing such mortality may enable other areas to improve their performance.


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United Medical and Dental Schools of Guy's and St Thomas's Hospitals
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Lambeth Palace Road
SE1 7EH London
United Kingdom

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