The Politics of Achievable Mortality

Abstract

aThe article by Kindig and colleagues 1 in this issue of Public Health Reports is a noteworthy contribution in a line of research that seems highly relevant for policy but violates unwritten rules of politics, especially, but not exclusively, in the United States. Beginning with William Farr in Britain in the 1850s, 2 many investigators have used epidemiologic methods to estimate the extent to which rates of mortality could be reduced within countries and their political subdivisions. 3–5 Most of these studies have calculated mortality that could be avoided by appropriate health care. Some studies have also estimated mortality that could be avoided as a result of some combination of reducing high-risk behavior by individuals, ameliorating deleterious social and economic circumstances, and reducing or eliminating environmental stressors. The authors of studies of avoidable mortality, as well as their funders and devoted readers have, however, frequently been disappointed by the reluctance of most policy makers to accord high priority to reducing unwarranted mortality—particularly when reducing it requires coordination across government departments, economic sectors, and civil society. Kindig and colleagues attribute the weak influence of research on avoidable mortality to its methodological limitations. As relationships such as those described in this article gain better causal certainty, “they should be of substantial guidance to policy makers.” 1 Similarly, Walter Holland, lead author of three edi