No, the health system has not killed more people than the war: experts question the figures with which Petro defends his health reform

President Gustavo Petro has said that under several scenarios Colombia’s health system would have “killed more people” than the armed conflict. He had repeated this a few days earlier in front of hundreds of people in Cali when he proposed a National Constituent Assembly. The president said, “340,000 Colombians died when they could have lived if they had received care in a hospital or clinic, which is far more than was caused by armed violence in Colombia.” People clapped. Petro insisted. “In Colombia, the commercial health system we have created has taken more lives; it has taken the lives of 340,000 Colombians in the last 10 years, while stealing 15 million million pesos.” He has also written it in X.

The president has used that figure to support the urgency of getting Congress to approve his health system reform, which will return to public debate this week as the Senate’s Seventh Commission faces the looming decision to finally adjudicate it .

María Paula Fonseca, head of communications for the Presidency of the Republic, explains to EL PAÍS that this is “a figure from the National Health Institute (INS).” Fonseca says that during the period from 2010 to 2019, there were 2,160,686 deaths in Colombia, of which 16.8% or 364,113 are classified by the INS as “preventable deaths by the health system”. The president’s conclusion: “This means that 364,000 deaths should not have occurred if the health system had addressed or prevented them with the available equipment and medical knowledge.” According to this information, the system would be responsible for 24,000 additional deaths than those reported by Petro.

However, three academic experts on health systems and two former ministers in the sector agree that the figure reported by the INS is different, and does not mean what the Presidency suggests. In short, they say that the concept of “health system preventable deaths” does not mean that they are caused solely by failures in the health system.

Andres Vecino, professor and researcher in the Health Systems Program at Johns Hopkins University in the United States, explains that the concept “refers to people who die prematurely, before the age of 75, due to conditions that are exacerbated by technology and “The knowledge may already be there.” And he adds: “There comes everything, because ultimately almost everything can be fixed.” Vesino assures that all deaths from, for example, colon cancer or melanoma are included, since health strategies, medications and technologies exist to cure these types of cancers. The problem is that these treatments don’t work for everyone. “Deaths from gunshots, edged weapons, falls and injuries from traffic accidents are also included because these are potentially preventable.” Vecino summarized that very few things are absolutely untreatable today. “It is a very broad indicator of the health status in a country, but many of these factors do not correspond directly to the health system.”

Vecino, a doctor of medicine at Javeriana University, emphasizes that it is problematic that the president uses the report’s figures to promote fundamental changes in the system. “When Petro uses that indicator without nuance, he signals things that are not true. Basically, it is being said that the Colombian health system allowed 340,000 people to die and that is not the case. Vecino gives an example: “Leukemia involves death, because in some cases it can be treated. But not in many others, it depends on thousands of reasons and variables. “Any person who dies of leukemia will be counted as a preventable death by the health system, even if everything humanly possible was done to prevent it.”

The INS document from which the data comes is called When death can be avoided, show that of the total 7,993,591 deaths recorded in Colombia between 1979 and 2021, 19.7% (1,576,800) are considered preventable due to the health system. However, the same report refutes the idea that the health system has been harmful. “The rate of deaths that could have been prevented by health services decreased by 35.8%, from 136.9 per 100,000 inhabitants in 1979 to 87.9 per 100,000 inhabitants in 2021,” the report said. In other words, Colombia has been reducing its preventable deaths since concrete data became available 45 years ago. This decline occurred with the system that preceded the current system and was maintained with this system, which was essentially created by Law 100 of 1993. That year the rate was 134.1 deaths per 100,000 inhabitants.

Another finding of the report confirms that the system is improving as the share of all deaths that the health system could theoretically avoid has declined. “With regard to the proportion of deaths that could be prevented by the health system in total annual deaths, at the beginning of the period (1979) the value was 28.4%, while in 2019 it reached 16.4%.” That is to say, over those 40 years the health system has managed to reduce preventable deaths to such an extent that other sectors are responsible for many of the deaths. The report concludes, “For every preventable death caused by the health system, there are 1.6 additional deaths caused by other public policies.”

Jonatan García Ruiz, visiting researcher in the department of global health at Harvard School of Public Health, reminds that these data are statistical estimates of possible failures of the system, they are not absolute certainty, as the president claims. “There is no investigation in which scientists say that 340,000 Colombians were denied health care or were not treated and that is why they died.” He points out that, in contrast, the Colombian health system has notable achievements: “We have a system that works for our context with good outcomes despite inequality and low resources per capita. The resources invested in health in Colombia are 7 or 8 times less than in high-income countries, but our avoidable mortality rate is not 7 or 8 times higher, it is lower. Garcia stressed that the president did not mention the key finding of the INS report that preventable deaths related to the health system have declined. “Something is being done right, there are fewer and fewer deaths,” he says.

Alejandro Gaviria, a former health minister under Juan Manuel Santos, and Alejandro Gaviria, a former education minister under Petro, have also criticized the figure of 340,000 deaths. On his X account, he responded directly to his boss: “This tweet by President Petro is full of misleading interpretations. It is sad that even after a year and a half the debate over health reform is based on similar misconceptions. Preventable deaths are divided into preventable and treatable. For each category, relative values ​​(comparisons) matter, not absolute values. In comparison, Colombia is performing well. Contrary to what has been said, progress is undeniable,” reads the message from the former minister. Gaviria picked up some graphs from researcher Ramon Abel Castaño, a health systems consultant, that show how Colombia “is improving avoidable mortality rates and is much better than the US average.”

Castaño published a message regarding the statistics of preventable deaths: “I continue to emphasize the President’s mistake in saying that the health system has killed more people in Gaza than the war or violence . There is avoidable mortality in all countries, the important thing is to reduce it. And in this Colombia comes out very well compared to the region. For the expert, these data lead to the opposite conclusion to that of the President: “Colombia has significantly improved its avoidable mortality indicators and today is better than the average of the region.”

Augusto Galán, former health minister and director of the Así Vamos en Salud think tank, expressed his disagreement with the presidential figures in a conversation with EL País. The doctor says a recent study by the Pan American Health Organization (PAHO) shows that in Colombia “a significant reduction in the age-adjusted rate of potentially avoidable premature mortality for both men and women She has come.” This is a different and more accurate concept than preventable deaths. The data that Galan cites is that in 2000 there were 469 deaths per 100,000 inhabitants and two decades later, in 2020, the figure was 245. “This reflects a continued decline in potentially avoidable premature mortality,” says the former minister.

Galan points out that measurement of avoidable mortality is closely related to the Human Development Index, which includes factors beyond health systems. Economic growth, per capita GDP or education rate affects that rate. “Linking deaths exclusively to the health system and implying that reforms will stop them is careless at best,” says Galan. And he concluded: “That figure from the president is taken out of context and doesn’t reflect what’s really happening.”

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