I don’t know what you would have done, but when I recently saw the adjective amenable used to describe mortality, I did a double take. The phrase appeared in a recent article in Health Affairs. Like any confused inhabitant of the 21st Century, I immediately went to www.dictionary.com for clarification.
Amenable. Ready or willing to answer, act, agree, or yield; open to influence, persuasion, or advice; agreeable; submissive; tractable.
So, amenable mortality must mean one of two things: either (a) deaths which people willingly engage in, or (b) deaths which are open to influence or are somehow tractable. Which do I select, (a), (b), all of the above, or none of the above? OK, I pick (b).
My confusion shifted to low-level irritation with people who come up with snarky cute phrases. Who thinks up terms like these any way? You know the phrases I’m talking about. Blue sky thinking. Stealth parenting. Gaining traction. I’m sorry, but I prefer good and simple words and phrases. Say what you mean and mean what you say.
After benefitting from a timely gulp of French roast, I decided to go ahead and read article on amenable mortality, and it was actually quite fascinating. The authors, Ellen Nolte and Martin McKee are knowledgeable health systems experts. They examined preventable deaths – which they refer to as amenable mortality – in the U.S. compared to three European countries from 1999 to 2007. The context for their study is that per capita health care spending in the U.S. is roughly twice that in Great Britain, France, and Germany. Do the additional expenditures yield better health outcomes?
Nolte and Martin found that although preventable deaths in all four countries dropped over the time period studied, the decline in the U.S. was notably slower than in the European countries. And amenable mortality in the U.S. was twice as high as in France by the time 2007 rolled by.
What conclusions did the authors reach? An obvious one is the U.S. is not benefitting by spending twice as much on health care. The authors observed that many preventable deaths are due to problems in access to health care. The three European countries all have universal access to health care. The U.S., of course, has tens of millions of people without insurance. Does this prove a cause-and-effect relationship? No, but as the authors point out, when looking at the subset of Americans treated according to usual best practices, there were no differences in amenable mortality between the U.S. and Western Europe.
Hopefully health insurance coverage in the U.S. will expand significantly in the next few years. If this happens, tens of millions of people will gain access to a primary care medical home. Preventive care and appropriate measures to address health problems early on will spread. As a result, the current embarrassing gap between us and the Europeans in amenable mortality should decrease, or maybe even disappear. I’d like nothing better than to see that happen. Besides better health status for the American people, there will be two additional benefits:
- We can focus our competition with Western Europe on more important issues, such as Olympic sports activities.
- We can lay to rest the use of the adjective amenable in describing the concept of mortality.
Richard Fleming, MD
Health Affairs, Sept 2012 31:2123-2129.