Preventable mortality: indicator or target? Applications in developing countries.

Preventable mortality, empirically defined, is analysed using the standardized mortality ratio for all ages (SMR), the SMR for deaths occurring before age 65, and the ratio of observed and expected years of potential life lost (RYPLL). Mortality data from Argentina and Mexico are used for illustration. To assess progress made, expected deaths are computed using data from the country's own past; to show challenges still ahead, expected deaths are computed using the rates of the United States of America. Comparisons with the past are made for mortality from all causes only; to assess what lies ahead, cause-specific mortality is also looked at. It is shown that for the data at hand the RYPLL is the indicator most sensitive to discrepancies between number of deaths observed and those expected, and that it provides information on inequalities beyond and in addition to that obtained from analysing crude and age-adjusted mortality rates and cause-specific proportional mortality. It is hoped that countries and areas will use these procedures for their own benefit to assess their current health situation against their own past and also against a suitable future reference, to assist them in priority setting and surveillance and evaluation of their health-services system.