A recent paper by Wesiz et al. (Eur J Pub Health 2008) attempts to compare mortality rates and avoidable mortality rates in the urban core of 3 world cities: London (Inner London); New York (Manhattan) and Paris. Mortality
The authors find that Paris has the lowest mortality rates and New York has the highest mortality rates with London in between.
Avoidable mortality is death from diseases such as tuberculosis, septicemia, hypertension, influenza, peptic ulcer, appendicitis, etc. Paris also has the lowest avoidable mortality rates while London has the highest and New York in between. The authors also find that the difference between Paris and New York is higher when measuring avoidable mortality than total mortality. Avoidable mortality rates are higher within poor areas of each city.
The authors interpret these findings as avoidable mortality is due to a lack of access to care, especially for the poor. Government provided health insurance is far less prevalent in the U.S. than in the other countries so this access to care in the U.S. may be lower than in other countries. However, it could also be the case the physician practices are better in Paris than in the New York or London. Further, Great Britain also has a national health insurance system yet avoidable mortality is higher in London than in New York. It is possible that the frequency with which the population visits a doctor is culturally different in the three cities in a way that is unrelated to insurance coverage. Thus, while Paris should be celebrated for having the lowest avoidable mortality rate, the cause of their success is unclear from this study and what steps New York or London could take to decrease avoidable mortality are also unclear.
- Daniel Weisz, Michael K. Gusmano, Victor G. Rodwin, Leland G. Neuberg (2008) “Population health and the health system: a comparative analysis of avoidable mortality in three nations and their world cities” European Journal of Public Health, Vol. 18, No. 2, 166–172