I have quoted a dozen authoritative, medical, etc., definitions of “amenable mortality.” They all say that amenable mortality rates represent deaths that are potentially preventable with timely and effective time care.

If you choose to put forth your own definitions, feel free, but that's not how a sensible discussion/debate goes.

it has been a pleasure

No they don't. That is not how they calculate it. They don't say “that guy who is 500lbs doesn't count as a heart attack because he is so fat” or was using drugs or didn't exercise. Come on. Now what they do is attached a number to it and say 50% of heart attacks are due to lifestyle so only 50% will count towards the total but the number is arbitrary and could be anything.

You, and others, are trying to make these studies do something they are not designed to do.

Not really, my points stand anyway.

Wrong: Ameniable mortality inclludes just deaths that are potentially preventable with timely and effective health care.

The fact that ameniable mortality does not peripheral stuff such as auto accidents, violent deaths,etc., but just deaths that are potentially preventable with timely and effective health care, is at the core of the discussion here.

“Sorry DE doesn't do it for me. You don't link the study so we can't tell what amenable mortality encompasses but I believe in includes auto accidents and violent deaths which are not directly medical related in origin.”

Below are two links to the study I quoted, followed by a series of authoritative (medical world/sources) definitions of “amenable mortality” which clearly do not include auto accidents, violent deaths,etc., just deaths that are potentially preventable with timely and effective health care.

http://www.pnhp.org/news/2008/january/united_st…

We compared trends in deaths considered amenable to health care before age seventy-five between 1997-98 and 2002-03 in the United States and in eighteen other industrialized countries.

and
http://www.commonwealthfund.org/Content/Publica…

In “Measuring the Health of Nations: Updating an Earlier Analysis” (Health Affairs, Jan./Feb. 2008), Ellen Nolte, Ph.D., and C. Martin McKee, M.D., D.Sc., both of the London School of Hygiene and Tropical Medicine, compared international rates of “amenable mortality”—that is, deaths from certain causes before age 75 that are potentially preventable with timely and effective health care.

http://ije.oxfordjournals.org/cgi/content/abstr…

Background Amenable mortality is used to assess the effects of health care services on gains in mortality outcomes.

http://74.125.47.132/search?q=cache:0UYXIKkhc2Q…

Amenable mortality is mortality that can theoretically be averted by good health care. The concept of amenable mortality first appeared in the 1970s and a substantial amount of work in this area was undertaken in the 1980s (Ruststein et al 1976, Charlton et al 1983, Mackenbach et al 1988, Holland 1988). More recently a comprehensive review was published which evaluated the conditions considered amenable to medical intervention (Nolte & McKee 2003, 2004).

http://www.demogr.mpg.de/cgi-bin/publications/p…

We used the concept of deaths from certain causes that should not occur in the presence of timely and effective health care (amenable mortality) and calculated the contribution of changes in mortality from these conditions to changes in life expectancy between birth and age 75 [e (0-75)] for the periods 1980/81 to 1988 and 1992 to 1997.

http://blogs.consumerreports.org/health/2009/08…

Enter the concept of “amenable mortality.” Invented years ago in the United States and used worldwide by researchers ever since, it’s basically a body count of people who die for want of “timely and effective health care.” A higher rate is bad, because it means the country’s health care system is falling down on its one and only job, which is to keep people healthy and do the best job possible of treating them if they get sick.

http://www.maorihealth.govt.nz/moh.nsf/indexma/…

Amenable mortality is a subset of avoidable mortality and is restricted to deaths from conditions that are amenable to health care (Ministry of Health 1999).

<quote>The quest for accountability has generated an industry engaged in ranking performance in many different sectors. This approach developed from control systems in industrial management, where it has long been used with processes where the inputs and products are simple and unambiguous, and there are few if any extraneous factors. It is intuitively appealing, especially to politicians who are anxious to know how public funds are being spent. It is seen as a means to reduce a mass of complex information into a format that almost anyone can understand. Yet its apparent simplicity can be misleading, and many commentators have noted numerous technical problems, ranging from lack of validity to creation of perverse incentives as those involved change their practice or recording methods to achieve higher rankings, despite leading to worse performance.
We have looked at one of many possible issues related to health system rankings that has so far been unexplored. The hypothesis was that a measure of health attainment more closely linked to the health-care system would produce a systematically different ranking. This hypothesis was confirmed, with the Nordic countries doing better than in the WHO model of the 2000 report.
However we do not argue that amenable mortality should substitute disability adjusted life expectancy even if performance was to be ranked. Firstly, it is impossible to rank all countries by amenable mortality given the widespread absence of data by diagnosis. It should be noted, though, that lack of even total mortality for many countries was not seen as an obstacle by the authors of the 2000 World Health Report, who used regression modelling to impute figures for disability adjusted life expectancy. A recent study that looked at the method used in the report to generate data on disability adjusted life expectancy showed that, where actual data became available, the regression result produced a quite different value.17
Secondly, amenable mortality has itself some limitations. The diagnostic categories and the age range used involve some choices that are inevitably arbitrary. A major limitation is that, for many conditions, death is the final event in a complex chain of processes that involve issues related to underlying social and economic factors, lifestyles, and preventive and curative health care. Partitioning deaths among the categories is an inexact science. The example of ischaemic heart disease is instructive. Accumulating evidence suggests that advances in health care have contributed to the fall in mortality from ischaemic heart disease in many countries, yet it is equally clear that large international differences in mortality are caused primarily by factors outside the healthcare sector.16,18-21 Thus our second analysis included only 50% of mortality from ischaemic heart disease. Obviously many different proportions could be used, from 40% up to 70%, and the choice may vary by country.16,22 However, it is important to note that the inclusion of ischaemic heart disease in our measure of healthcare outcomes again changes the rankings of countries compared with those of the 2000 World Health Report. This highlights the problems associated with rankings that are based on summary measures, as they can be sensitive to underlying definitions and concepts.
</quote>
from http://www.pubmedcentral.nih.gov/articlerender….

Now I'm not saying that there is no difference or that you can't learn from these studies just that any attempt to portray them as “proof” of something as complex as what system works “better” is absurd. It also leaves out all other conciderations possible. We might improve amenable mortality rates more by boosting spending on urban medical centers or minority outreach programs than we ever could by Govt insurance. There is no way for these studies to tell us that untill after we have tried something and even then it's only in reference to what has already been in practice.

Let me just “borrow” a very pertinent quote from an article that Don Quijote quoted in a different thread.

I believe it uniquely applies to what has been discussed in this thread: comparions of mortality rates, etc.

“In a Commonwealth Fund-supported study comparing preventable deaths in 19 industrialized countries, researchers found that the United States placed last. While the other nations improved dramatically between the two study periods—1997–98 and 2002–03—the U.S. improved only slightly on the measure.

In “Measuring the Health of Nations: Updating an Earlier Analysis” (Health Affairs, Jan./Feb. 2008), Ellen Nolte, Ph.D., and C. Martin McKee, M.D., D.Sc., both of the London School of Hygiene and Tropical Medicine, compared international rates of “amenable mortality”—that is, deaths from certain causes before age 75 that are potentially preventable with timely and effective health care. In addition to the U.S., the study included 14 Western European countries, Canada, Australia, New Zealand, and Japan. According to the authors, if the U.S. had been able reduce amenable mortality to the average rate achieved by the three top-performing countries, there would have been 101,000 fewer deaths annually by the end of the study period.

The concept of amenable mortality was developed in the 1970s to assess the quality and performance of health systems and to track changes over time. For this study, the researchers used data from the World Health Organization on deaths from conditions considered amenable to health care, such as treatable cancers, diabetes, and cardiovascular disease.

U.S. Ranks Last
Between 1997–98 and 2002–03, amenable mortality fell by an average of 16 percent in all countries except the U.S., where the decline was only 4 percent. In 1997–98, the U.S. ranked 15th out of the 19 countries on this measure—ahead of only Finland, Portugal, the United Kingdom, and Ireland—with a rate of 114.7 deaths per 100,000 people. By 2002–03, the U.S. fell to last place, with 109.7 per 100,000. In the leading countries, mortality rates per 100,000 people were 64.8 in France, 71.2 in Japan, and 71.3 in Australia.

The largest reductions in amenable mortality were seen in countries with the highest initial levels, including Portugal, Finland, Ireland, and the U.K, but also in some higher-performing countries, like Australia and Italy. In contrast, the U.S. started from a relatively high level of amenable mortality but experienced smaller reductions.

Many Lives in U.S. Could Be Saved
The researchers estimated the number of lives that could have been saved in 2002 if the U.S. had achieved either the average of all countries analyzed (except the U.S.) or the average of the three top-performing countries. Using this formula, the authors estimated that approximately 75,000 to 101,00 preventable deaths could be averted in the U.S. “[E]ven the more conservative estimate of 75,000 deaths is almost twice the Institute of Medicine's (lower) estimate of the number of deaths attributable to medical errors in the United States each year,” the authors say.

Future Implications

The rate of amenable mortality is a valuable indicator of health care performance, say the authors—one that can point to potential weaknesses in a nation's health system that require attention. “[T]he findings presented here are consistent with other cross-national analyses, demonstrating the relative underperformance of the U.S. health care system in several key indicators compared with other industrialized countries,” they say.”

thanks for “coming to my rescue” I have been raking my brain as to who brought it up. I wasn't sure as to whether there was a reference to the race of the crack baby mothers, that's why I put “African American” in parentheses.

That could have been me although I did not bring race into it. All states I have lived in provide for prenatal care, but the problem often is getting the mothers-to-be to come in. The clinics are there, the money is there, the providers are there, what isn't there often is the patient.

Also as you mention it is sometimes difficult to get women who are abusing drugs, alcohol or tobacco to quit while they are pregnant. These are not issues related to a bad health system, cost problems and lack of availability. These are socio-economic problems.

When people point to infant mortality I don't see it as mostly a health systems problem, I see it as a larger societal problem. I know that's not the popular way to look at it. I would encourage you to talk to an obstetrician and see what they have to say on this.

But even if people were making the claim you mention, or if were true- that still shows how this stat would not be an example of our healthcare system not performing up to the standards of other countries' systems. No matter how good a healthcare system is, if the citizens are engaging in unhealthy practices, the doctors and hospitals can't change that and the stats on outcome will be skewed by the behaviors, not the performance of the healthcare system.