Calling deaths ‘preventable’ can obscure barriers to health care access and shift blame to individuals – The Conversation

Report on Systemic Barriers to Health and the Misnomer of “Preventable Deaths”

Introduction: Re-evaluating Mortality in the Context of Sustainable Development Goals

In the United States, the classification of tens of thousands of annual deaths as “preventable” masks profound systemic failures that directly impede progress toward United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities). While the term is used in epidemiology to denote a death that could have been averted through timely medical intervention, its broader application obscures the structural, policy-driven, and institutional barriers that create health disparities. This report analyzes the concept of preventable death, highlighting how it misattributes responsibility to individuals while overlooking the systemic inequities that are the true drivers of premature mortality.

SDG 3: Good Health and Well-being vs. Systemic Inequities

The core objective of SDG 3 is to ensure healthy lives and promote well-being for all at all ages. However, the phenomenon of preventable deaths in the U.S. demonstrates a significant gap between this goal and reality, a gap created by policy choices and underinvestment in health infrastructure.

The Disparity Between Technical Definition and Public Perception

In a clinical context, a preventable death is one resulting from a manageable condition, such as untreated hypertension or diabetes. This definition is a useful metric for public health agencies. However, when used in public discourse, it implies that prevention is a matter of individual choice or access, failing to address the underlying reasons why care was not available or affordable. This narrative directly conflicts with SDG Target 3.8, which calls for achieving universal health coverage, including financial risk protection and access to quality essential health-care services.

Structural Failures Undermining Health Outcomes

The high incidence of preventable deaths is not a series of random, isolated events but a pattern reflecting deep-seated structural problems. These failures represent a direct challenge to achieving SDG 3.

1. Policy-Driven Gaps in Health Coverage: The decision by numerous states, primarily in the South, not to expand Medicaid has left millions of low-income adults without health insurance. Research confirms a direct correlation between Medicaid expansion and lower rates of premature death, indicating that these deaths are not merely preventable but are the foreseeable outcomes of policy decisions.
2. Under-resourced Health Services: Critical components of the health system, such as dental care, are chronically underfunded. Lack of dental coverage under Medicare and variable coverage under Medicaid create “dental deserts,” particularly in rural areas. This can lead to severe, life-threatening infections, representing a failure to provide comprehensive and essential health services.
3. Erosion of Rural Health Infrastructure: The closure of over 141 rural hospitals since 2010, coupled with difficulties in retaining healthcare workers, severely limits access to emergency and routine care. This underinvestment exacerbates health disparities, making it impossible for communities to achieve the well-being promoted by SDG 3.

SDG 10: Reduced Inequalities in Health Access and Outcomes

The patterns of preventable deaths starkly illustrate the failure to meet SDG 10, which aims to reduce inequality within and among countries. Health outcomes in the U.S. are heavily stratified along geographic, racial, and economic lines.

Geographic and Demographic Disparities

• Rates of potentially preventable deaths are significantly higher in the Southern U.S. compared to other regions.
• Black, Native, and Hispanic populations experience higher rates of preventable death than white populations.
• These disparities align directly with inequalities in poverty rates, insurance coverage, and the availability of local health infrastructure.

These patterns are not coincidental; they are the result of systemic inequities that policy has failed to address. The language of “preventable death” obscures this reality, miscasting outcomes shaped by structural inequality as individual failures, thereby undermining efforts to achieve the equality targets of SDG 10.

Conclusion: Reframing the Narrative to Align with SDG Principles

To make meaningful progress toward SDG 3 and SDG 10, a paradigm shift in language and policy is required. The term “preventable death” must be contextualized to expose, rather than conceal, the systemic failures and policy decisions that lead to premature mortality.

Recommendations for a New Approach

1. Adopt Precise Language: Public health discourse should move away from ambiguous terms that imply individual blame. Instead, it should explicitly name structural determinants, such as lack of insurance, underinvestment in infrastructure, and policy failures, as the root causes of these deaths.
2. Promote Institutional Accountability: In line with SDG 16 (Peace, Justice and Strong Institutions), policy analysis must focus on the accountability of health systems and governmental bodies. The focus should be on creating effective, accountable, and transparent institutions that ensure equitable access to care.
3. Integrate Health Policy with Equity Goals: All health-related policies, from insurance coverage to hospital funding, must be evaluated based on their impact on health equity and their alignment with the principles of the Sustainable Development Goals.

Ultimately, a death is only preventable in practice if the systems are in place to allow for prevention. True progress requires addressing the structural inequities that determine whether an individual can access the care needed to live a healthy life.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article on “preventable deaths” in the U.S. directly addresses and connects to several Sustainable Development Goals (SDGs) by highlighting systemic failures in the healthcare system that lead to premature mortality and health inequities.

• SDG 3: Good Health and Well-being: This is the primary SDG addressed. The entire article revolves around health outcomes, specifically deaths that could be avoided with timely and effective healthcare. It discusses mortality from non-communicable diseases like heart disease, diabetes, and cancer, and the importance of access to quality essential health services.
• SDG 10: Reduced Inequalities: The article strongly emphasizes the unequal distribution of health outcomes. It explicitly states that “rates of potentially preventable death are significantly higher in the South” and “higher among Black, Native and Hispanic populations compared with white populations.” This directly points to inequalities in health access and outcomes based on geography and race, a core concern of SDG 10.
• SDG 1: No Poverty: The article links poor health outcomes to economic status. It discusses how policy choices regarding Medicaid expansion leave “many low-income adults without access to affordable health coverage.” It also notes that health disparities “track closely with differences in poverty rates,” connecting the lack of financial resources to the inability to access preventative care.
• SDG 16: Peace, Justice and Strong Institutions: The article critiques the effectiveness and equity of health institutions. It argues that preventable deaths are the “foreseeable result of long-standing policy decisions” and that the health system is an institution failing to provide equitable access. The discussion of hospital understaffing, rural hospital closures, and policy choices like not expanding Medicaid points to weaknesses in institutional governance and effectiveness.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues discussed, several specific SDG targets can be identified:

1. Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • Explanation: The article’s central theme is “preventable death,” which it defines as death that could have been avoided with timely care. It explicitly lists “heart disease, diabetes, respiratory illness and certain infections” as examples, which are major non-communicable diseases (NCDs). The discussion of a “missed cancer screening” leading to a fatal outcome is a direct reference to the prevention and treatment aspect of this target.
2. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
   • Explanation: The article details numerous barriers to universal health coverage. It highlights the lack of “stable health insurance,” “cost barriers to filling a prescription,” and the absence of dental benefits in Medicare. The mention of millions living in states that “have not expanded Medicaid” directly addresses the failure to provide health coverage for low-income populations. Furthermore, the closure of “more than 141 rural hospitals” and the existence of “dental deserts” points to a lack of access to quality essential healthcare services.
3. Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.
   • Explanation: The article demonstrates a lack of health inclusion for specific groups. It states that preventable death rates are higher for “Black, Native and Hispanic populations” and for people living in the South and rural areas. These disparities show that certain populations are excluded from the benefits of the healthcare system, which is a central concern of this target.
4. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and action in this regard.
   • Explanation: The article identifies specific policy decisions that create unequal outcomes. The choice by some states to “not expand Medicaid” is presented as a policy that directly leads to worse health outcomes for low-income adults. This is a clear example of a policy that fails to ensure equal opportunity in accessing life-saving healthcare.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

The article mentions or implies several indicators that align with the official SDG indicators used to measure progress.

• Indicator for Target 3.4 (Implied): The article refers to statistics on “tens of thousands of deaths” categorized as preventable from conditions like “heart disease, diabetes, respiratory illness.” This directly relates to Indicator 3.4.1: Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease. The article’s entire premise is based on the existence and analysis of this data.
• Indicators for Target 3.8 (Mentioned and Implied):
  • The discussion of people lacking “stable health insurance” or living in states without Medicaid expansion relates to measuring the coverage of essential health services (Indicator 3.8.1). The article provides a concrete negative indicator: “more than 141 rural hospitals have closed since 2010,” which is a direct measure of reduced service availability.
  • The mention of “cost barriers to filling a prescription” and the lack of “affordable health coverage” implies the financial burden of healthcare, which is measured by Indicator 3.8.2: Proportion of population with large household expenditures on health as a share of total household expenditure or income.
• Indicators for Target 10.2/10.3 (Mentioned): The article provides disaggregated data that serves as a direct measure of inequality. It states that “rates of potentially preventable death are significantly higher in the South” and “higher among Black, Native and Hispanic populations compared with white populations.” This comparative data is precisely the type used to measure inequalities of outcome. It also points to disparities in “insurance coverage” and “poverty rates” between these groups, which are key indicators of economic inclusion and opportunity.

SDGs, Targets, and Indicators Summary Table

Source: theconversation.com