Intended for healthcare professionals


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

BMJ 2003; 327 doi: (Published 13 November 2003) Cite this as: BMJ 2003;327:1129

This article has a correction. Please see:

  1. Ellen Nolte, lecturer in public health1,
  2. Martin McKee, professor of European public health1
  1. 1European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  1. Correspondence to: E Nolte
  • Accepted 5 September 2003


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.


  • Contributors EN led the study design and analysis of the data. MM supervised the study and contributed to the generation of the hypothesis and study design. Both authors wrote the paper and will act as guarantors for the paper.

  • Funding EN is the holder of a fellowship on international benchmarking awarded by the Nuffield Trust. The literature review on which this work was based was funded by an unrestricted educational grant by Merck Sharp & Dohme. MM's work on health systems' performance is funded through the health systems development knowledge programme of the UK Department for International Development. The guarantorsaccept full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.

  • Competing interests MM is director of a WHO collaborating centre and a member of several WHO committees. He was a member of the regional reference group for the 2000 World Health Report.

View Full Text