According to the results of a study published in The Lancet, in 2016, 8.6 million deaths occurred globally that were amenable to healthcare. Approximately 5 million of those deaths were estimated to be the result of poor-quality care, and 3.6 million were the result of nonutilization of health care.

Universal health coverage has been proposed as a way of improving access to health care in low- and middle-income countries. However, it is not known whether implementing universal health coverage in these countries would result in reductions in mortality. Universal Health Coverage is a key piece in the Sustainable Development Goals, a set of development targets that were signed onto by 193 United Nations member states to improve health and development worldwide by 2030.

Margaret E. Kruk, MD, of the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, and colleagues used data from the 2016 Global Burden of Disease study to calculate mortality amenable to healthcare interventions for 61 sustainable development goal conditions and compare case fatality between low- and middle-income countries and 23 high-income countries that served as a reference point.

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South Asia has the greatest mortality because of the receipt of poor care — 1.9 million deaths — whereas sub-Saharan Africa has the highest percentage of deaths resulting from nonutilization of health care. Cardiovascular disease is the most frequent cause of these preventable deaths, accounting for approximately 30%, most as a result of poor quality care. The next most frequent causes are neonatal death, tuberculosis, road injuries, chronic respiratory disease, and cancer.

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The authors concluded that although universal health coverage could avert 8.6 million deaths per year, this is possible only if expansion of coverage is accompanied by substantial improvements in the quality of health care. 


Kruk ME, Gage AD, Joseph NT, Danaei G, Garcia-Saisó S, Solomon JA. Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries [published online September 5, 2018]. Lancet. doi:10.1016/S0140 6736(18)31668-4