Avoidable Mortality

Mortality in many instances is avoidable. Estimates Mühlichen et al. (2023) for Germany are as high as 19% of all deaths in the years 2017 to 2019. For men the figure is as high as 24%, for women “only” 13%. The scientific interest in the concept of avoidable death originates in the interest to indirectly gauge the efficiency of health systems. In order to do this the authors estimated cause-deleted life tables in a fine graded regional fashion. Avoidable deaths are defined as deaths that occur before the age of 75 and are either classified as medically preventable or preventable through a different life style. The study applies a quasi-experimental design in comparing German speaking regions within Europe. This allows to measure the influence of health care systems on a general level within Germany, Austria, Switzerland and South Tirol in Italy. The study corrects for different age structures in these regions. For Germany avoidable deaths are substantially higher in the North than in the South. Additionally Eastern parts of Germany have higher avoidable deaths. Even the best performing regions in Germany have higher rates of avoidable mortality than Switzerland.
The differential to other countries health systems is worth a concern, because the expenditure in the German health system per 1000 population are among the highest in Europe (OECD 2021). Despite the high expenditure per head, avoidable mortality remains particularly high for German men and in the North and East of Germany. Lack of prevention of unhealthy life styles is most likely the decisive factor to explain the disappointing results. There might be another “unaccounted” risk factor that originates in the lack of sufficient preventative health care and environmental risks during the young age of the regional populations. 33 years of unification and a cut-off age of 75 mean that in East Germany the oldest people lived through 40 years of high pollution coal as primary heating system.  Similar to Northern and Western Germany little concern and careless use of risky fertilizers might drive higher mortality decades after exposure. Life style patterns might additionally contribute, but are harder to assess in comparison. Research to clarify these differentials are just at the beginning. A valid conclusion remains: prevention is key, but it has many facets.


Drowning is a largely underestimated risk. 2.5 million people die of drowning in 10 years according to the WHO. low and middle income countries have the highest drowning rates. However, remedies like teaching how to swim and to assess drowning risks at an early age can make a huge difference. Flooding as natural disaster causes high numbers of casualties, but even in such extreme weather conditions survival strategies involve drowning prevention.

Even in the richest countries drowning is still a reality. Life guards cannot prevent the most irresponsible behavior like drinking alcohol, taking drugs and drowning risks. Overestimating one’s own swimming capabilities is yet another reason for drowning in wealthy countries. Try floating your body with as little movement as possible and you slowly enhance your capabilities to survive in dangerous water conditions. This increases your self-confidence to master tricky situations. Panic in water is surely not helpful. Learning how to help others in danger is for well-trained rescuers or professionals.