Stéphane Verguet1, Dean T Jamison. 1. Department of Global Health, University of Washington, Seattle, 98104, USA. verguet@uw.edu
Abstract
OBJECTIVE: To demonstrate the utility of rates of change in measuring country performance in health using the rate of decline of adult mortality for 22 countries in the OECD as an illustration. METHODS: We used adult mortality (the probability of dying between ages 15 and 60) for 1970-2010 by country as our outcome measure. We assessed and ranked country performance in rates of decline of adult mortality for four decades, and compared this to performance in levels of adult mortality. PRINCIPAL FINDINGS: We identified best and worst performers, and identified changes in performance. For example, for female adult mortality (FAM): in the 1970s, the top performer in the rate of decline was Japan and the worst performer was Denmark; in the 2000s, the top performer was Portugal and the worst performer was the United States. The Netherlands saw the largest improvement in the rate of decline of FAM, from 1991-00 to 2001-10. Finland showed the greatest decrease, from 1971-80 to 1981-90. We found little correlation between performance in rates of decline and performance in levels of FAM. CONCLUSIONS: Examining the rates of change of health indicators at the country level enables finding transition times in performance, and provides a more time-sensitive measure of country performance than does assessing performances in levels of health. The effects of changes in potential determinants of health can then be assessed in terms of their relation to transition times in performance.
OBJECTIVE: To demonstrate the utility of rates of change in measuring country performance in health using the rate of decline of adult mortality for 22 countries in the OECD as an illustration. METHODS: We used adult mortality (the probability of dying between ages 15 and 60) for 1970-2010 by country as our outcome measure. We assessed and ranked country performance in rates of decline of adult mortality for four decades, and compared this to performance in levels of adult mortality. PRINCIPAL FINDINGS: We identified best and worst performers, and identified changes in performance. For example, for female adult mortality (FAM): in the 1970s, the top performer in the rate of decline was Japan and the worst performer was Denmark; in the 2000s, the top performer was Portugal and the worst performer was the United States. The Netherlands saw the largest improvement in the rate of decline of FAM, from 1991-00 to 2001-10. Finland showed the greatest decrease, from 1971-80 to 1981-90. We found little correlation between performance in rates of decline and performance in levels of FAM. CONCLUSIONS: Examining the rates of change of health indicators at the country level enables finding transition times in performance, and provides a more time-sensitive measure of country performance than does assessing performances in levels of health. The effects of changes in potential determinants of health can then be assessed in terms of their relation to transition times in performance.