Avoidable Deaths Decrease In High-Income Nations And Increase In U.S.
Avoidable deaths are decreasing in high-income nations while they're increasing in the United States. It's a worrisome trend, which is partly responsible for the growing gap in life expectancy between the U.S. and its peers.
During the COVID-19 pandemic, U.S. life expectancy took a bigger hit than its peers, as the graph below shows. The figure also depicts how U.S. life expectancy was stagnant between approximately 2010 and 2020, unlike other wealthy, industrialized nations. And prior to 2012, beginning around 1985, the upward slope in life expectancy growth was flatter in the U.S.
There are many factors that have contributed to this trend, one of which is greater numbers of avoidable deaths in the U.S. compared to its peers. Avoidable mortality refers to deaths that ought not to occur in the presence of timely and effective healthcare, including prevention.
Clinicians often examine causes of death to determine whether they could have been avoided by some kind of public health measure. Avoidable deaths in most high-income countries around the world are going down. But in the U.S., avoidable deaths have been on the rise for more than a decade, according to a new study by researchers at the Brown University School of Public Health and Harvard University. They analyzed mortality trends across all 50 U.S. states as well as 40 comparably wealthy nations. The researchers compared mortality data and found that between 2009 to 2021, avoidable mortality in the U.S. worsened, while it improved elsewhere, with the exception of the 2020-2021 time period during COVID-19.
Lead study author Irene Papanicolas, a professor of health services, policy and practice at Brown University's School of Public Health, told Medical Express that the findings published last month in JAMA Internal Medicine suggest unresolved issues in the American healthcare system, in which gaps in public policy may be contributing to worsening health outcomes.
Take, for instance, rising road traffic fatalities since the early 2010s in the U.S. (while these have been diminishing elsewhere), continued very high levels of gun deaths and illicit drug overdoses, higher rates of suicide as well as maternal and infant mortality and illnesses preventable by early detection and treatment, such as cervical cancer and ischemic heart disease.
The researchers found that deaths from a variety of different causes are rising in every U.S. state, with considerable variation across states. The cited study found that between 2009 and 2021 avoidable deaths in the U.S. increased from around 20 to 44 per 100,000.
On the other hand, in most high-income countries around the world, these kinds of avoidable deaths have been decreasing during the same time frame. Other countries saw about 14 fewer avoidable deaths per 100,000. In European Union countries, the reduction was even greater, with an average of almost 24 fewer deaths per 100,000.
Clearly, it's not simply a matter of number of dollars spent on healthcare, given that the U.S. spends more per capita on healthcare than every other high-income country. Perhaps where or how that money is spent that is the key issue.
And as Papanicolas said, referring to policy debates that have occurred across multiple presidential administrations, 'there's been a lot of discussion about preventable deaths in the U.S. such as drug-related deaths or suicides, which do account for a big proportion of this trend. However, we found that deaths from nearly all major categories are increasing."
Under the new Trump administration, Secretary of Health and Human Services, Robert F. Kennedy Jr., has promoted the idea of making Americans healthy again, advocating for things like eating healthier and limiting exposure to potentially harmful food additives. However, his MAHA vision doesn't address gun violence, motor vehicle safety, maternal and infant mortality, mental health, certain harm reduction factors related to illegal drug consumption and a host of other items contributing to avoidable deaths. And HHS budget cuts may worsen the situation going forward. A conspicuous example of this is a proposed plan by the department to eliminate a relatively small, but effective $56 million annual grant program that distributes the opioid overdose antidote naloxone to first responders across the country.
And what could further exacerbate the problem is the fact that the Trump administration doesn't appear to be focused on measuring certain avoidable deaths. As an illustration, the Department of HHS laid off the entire 17-person team in charge of the National Survey on Drug Use and Health. And the Centers for Disease Control and Prevention have gotten rid of divisions that oversee databases on things like accidental deaths and injuries, including fatal shootings, poisonings and motor vehicle crashes. Moreover, there is now considerably less federal funding for tracking HIV and other sexually transmitted diseases, all of which are preventable. What's not measured can't be properly addressed with tangible policies.
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