“Amenable mortality, or deaths from causes that should not occur in the presence of high-quality health care,15,16 has been used as a measure of the health-care dimension of health system performance for nearly 50 years.15–42 The most widely used list of causes of mortality amenable to health care was developed by Nolte and McKee, and has since been used to compare high-income countries’ performances at length.10,18,20–37 A recent study by Kruk and colleagues34 used case-fatality rates for causes included in the McKee and Nolte list and additional diseases to estimate the separate effects of utilisation versus quality for 137 countries. The only studies that are global in scope, however, are the Healthcare Access and Quality (HAQ) Index studies, developed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD).23,24 The HAQ Index is also the only approach that makes estimates of health-care access and quality comparable across locations using risk-standardised death rates (RSDRs) and mortality-to-incidence ratios (MIRs), as a way of excluding drivers not connected to the health system.”
Source: GBD 2019 Healthcare Access and Quality Collaborators (2022). Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. The Lancet. Global health, 10(12), e1715–e1743. https://doi.org/10.1016/S2214-109X(22)00429-6
“Globally, the overall HAQ Index increased by 19·6 points between 1990 and 2019, with improvements in HAQ Index scores in 185 of 204 countries and territories. Zimbabwe was the only country that did not improve (for others, the UIs overlapped). In 1990, Zimbabwe ranked 133rd globally, but in 2019 it dropped to 194th, a decline driven primarily by lack of progress across four diseases: inguinal, femoral, and abdominal hernia; idiopathic epilepsy; lower respiratory infections; and tuberculosis—but nearly all conditions failed to improve. Lesotho also had a substantial drop in rank order over the same period, falling from 151st to 185th globally. Although HAQ Index scores improved minimally for Central African Republic and Somalia, the two countries saw no change in global rank order over the time period. The gap between the lowest and highest HAQ Index scores in 2019 (77·9, 95% UI 15·2–93·1) was larger than the gap in 1990 (69·9, 9·7–79·6). High-SDI-quintile countries increased by 15·1 points, as compared with 25·9 points in middle-SDI and 11·8 points in low-SDI countries (figure 2). Across regions, increases were highest in east Asia (32·4 point increase), Andean Latin America (22·7 point increase), and high-income Asia Pacific (19·6 point increase). The smallest regional improvements over the time period occurred in Oceania (3·9 point increase), southern sub-Saharan Africa (6·3 point increase), and central Asia (8·2 point increase).”
Source: GBD 2019 Healthcare Access and Quality Collaborators (2022). Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. The Lancet. Global health, 10(12), e1715–e1743. https://doi.org/10.1016/S2214-109X(22)00429-6
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Page last updated January 20, 2026 by Doug McVay, Editor.