PUBLIC HEALTH AND MANAGEMENT AMT, vol. 21, no. 1, 2016, p. 1 DYNAMICS OF AVOIDABLE DEATHS IN ROMANIA BETWEEN 2006 AND 2013 ELENA TOPÎRCEAN 1 , CARMEN DANIELA DOMNARIU 2 1 PhD candidate “Lucian Blaga” University of Sibiu, 2 “Lucian Blaga” University of Sibiu Keywords: avoidable death, preventable and treatable causes, Romania, health status Abstract: Population’s health status assessment is quite difficult, especially due to its multi-determinism. One of the indicators of health status assessment is avoidable death caused by diseases that are “preventable” (primary prevention) and “treatable” (secondary prevention) as specific indicators of the efficiency/inefficiency of health systems. European studies on avoidable mortality show that Romania ranks first in the European Union, regarding both genders. In order to highlight the dynamics of avoidable deaths in Romania, we analysed in this study all deaths which fall within this concept, recorded during 2006-2013. To establish the criteria for inclusion in the study, the list of Leveque et al. was used. Both categories of avoidable deaths, amenable to health care, respectively to health policies have recorded a downward trend, but with a greater reduction in percentage for those determined by conditions responding to healthcare. The study of the dynamics of avoidable deaths allows making comparisons nationally and internationally with a view to identify areas with a high incidence of this phenomenon, as well as the disparities between those areas, the ultimate goal being to identify root causes and to remove/mitigate them. Optimizing the health system in Romania would positively contribute to improve these figures and to a better ranking among EU countries. 1 Corresponding author: Elena Topîrcean, Str. Cristianului, Nr. 4, Cod 557170, Orlat, Judeţul Sibiu, România, E-mail: elenflo21@yahoo.com, Phone: +40737 002054 Article received on 01.02.2016 and accepted for publication on 02.03.2016 ACTA MEDICA TRANSILVANICA March 2016;21(1):1-4 INTRODUCTION Health, along with other social, economic, cultural, educational etc. aspects defines the concept of “quality of life”. In 1946, the World Health Organization defined health as “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.(1) There is no protocol for quantifying the health status of an individual in particular, respectively of a population in general, because of the multitude of factors that can influence it and that are acting synergistically: biological factors, lifestyle of the individual, social networks and general environment conditions, socio-economic and cultural aspects. Achieving the standards in terms of health does not depend exclusively on health systems and their performance but also on the individual and the society itself.(2) Currently, health systems have an increasingly more positive influence on the level of overall mortality, which in fact, is influenced by many other factors. The limits of the beneficial influences of health systems are particularly manifested at the level of some types of cancer, which exclusively benefit from palliative treatment.(3) To overcome those limitations, there was introduced and perfected the concept of avoidable mortality that is attributable to healthcare services. This entity was originally introduced and defined in 1976 in the US by Rutstein, as a way of identifying and quantifying the failure of the health system.(4) According to the theory presented, at least theoretically, given early and effective healthcare, deaths could be avoided. Achieving this goal requires clear identification of the conditions in which healthcare can prolong survival and may avoid death. Avoidable deaths, as shown in the literature, are deaths before the age of 65, which can be influenced by curative and preventive methods (healthcare and preventive measures). The basic concept resulting from analysing avoidable mortality is that deaths from certain conditions for which effective public health interventions are available, should be rare or, ideally, should not occur.(5) Specifically, avoidable mortality combines standardized mortality rates for a range of diseases on which it is estimated that healthcare has a direct impact. The usefulness of this concept also derives from its use for comparisons at national and international level in order to identify areas with a high incidence of the phenomenon of avoidable mortality, as well as the inequities between those areas, the ultimate goal being to identify the root causes and to remove/mitigate them.(6,7) Depending on the type of disease leading to death, avoidable mortality is classified as follows: • treatable mortality caused by treatable diseases (disease amenable to secondary prevention) - causes of death from these illnesses could be prevented by therapeutic means or by means of secondary prevention (e.g. hypertension, colon cancer, gastric ulcer, leukemia, respiratory diseases, asthma, gallstones, maternal mortality etc.); • mortality caused by preventable diseases (diseases amenable to primary prevention) - refers to disorders that could be avoided through public health policies (prevention interventions, health promotion), thus avoiding the occurrence of disease (cirrhosis, road events, ischemic heart disease, lung cancer). From the literature and studies in this field, nationally and internationally, we note the following significant epidemiological data: • Multiple studies over the period 2001-2010 constantly