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References 1 Chatzicocoli-Syrakou S, ‘The Asklepieion’s Healing Environment - Learning from the Past’, World Hospitals and Health Services Vol. 33, No. 2, 1997, pp. 22-27. 2 Aravantinos AP, Asklepios and Asklepieia, 1st ed: 1906, 2nd ed: Leon ed. 1975(GR). See also: Edelstein E & L, Asklepius. A collection and interpretation of the testimonies, Baltimore, 1945. 3 Apollodoros, Mythologia, III, 118-120. See also: Hesiodos [Hesiod]*, Apospasmata, Hoiai, 18 (51) ** 4 Chatzicocoli - Syrakou S, Syrakoy AC, The Birth of the Healing Hospital in Ancient Greece, 2004 International Conference and Exhibition on Health Facility PDC, ASHE, American Hospital Association, Tampa, Florida, USA, March 15-17, 2004. Pub. PDC 2004 Resource Manual, pp. 303-306. 5 Homeros [Homer]*, Ilias, B 731, D 194, L 518, etc. ** 6 Chatzicocoli-Syrakou S, Syrakoy C, Asklepieian Ideas Supporting Contemporary ‘Holistic’ Healthcare Design, Chapter for Architecture, IHF Pan Regional Conference. Bahrain, 6-8 November 2000 7 Marketos S, Illustrated History of Medicine, Zeta Med Ed., 2000 (GR). 8 Chatzicocoli-Syrakou S, Syrakou C, Syrakos T, The Hellenic Mythology. A Source of Origin Research for the Philosophical and Ideological Foundations in Health Care, Human Centred Design for Health Care Buildings, International Conference and Workshop. 28-30 August 1997. Trondheim, Norway. Proceedings, Sintef, pp 107- 111. 9 Miller TS, The Birth of the Hospital in the Byzantine Empire, The Johns Hopkins University Press, Greek ed: Trans. Kelermenos N, Hiera Metropolis of Thebes and Levadia, 1998. 10 Georgakopoulos K, ‘Ancient Greek Physicians’, Iaso, 1998, pp 481-484 (GR). 11 Rutkow IM, Surgery. An Illustrated History, Mosby, 1993, pp 45-52. 12 Anapliotou-Vasaiou E, International standards in Health and National Systems, Athens, p. 86 (GR). 13 National Statistical Service of Greece (NSSGr), Social Welfare and Health Statistics, Athens, 2001, p.7. 14 Platon [Plato]*, Symposion [Symposium]*, 214b. ** 15 NSSGr, Social Welfare and Health Statistics, Athens, 2001. 16 NSSGr, Greece through numbers, 2002, p. 18. 17 NSSGr, Statistical Yearbook of Greece, Athens 2002, p. 45. 18 Chatzicocoli-Syrakou S, ‘Healthcare in Greece’, Siokis Medical Editions, (to be published). *The terms in brackets [ ] state the Latinised or English version of the presiding Greek term. **The ancient texts are available in several editions in Greece e.g.: Prof. G. Mistriotou, Athens 1880, 1895. Papyros, 1957, 1959. Zacharopoulos, 1939-1956. Kaktos, 1993, 1994.
POLICY: POPULATION HEALTH Population health in Europe: how much is attributable to health care? ELLEN NOLTE LECTURER IN PUBLIC HEALTH, LONDON SCHOOL OF HYGIENE & TROPICAL MEDICINE AND RESEARCH FELLOW, EUROPEAN OBSERVATORY MARTIN MCKEE PROFESSOR OF PUBLIC HEALTH, LONDON SCHOOL OF HYGIENE & TROPICAL MEDICINE AND RESEARCH DIRECTOR, EUROPEAN OBSERVATORY Abstract Does health care save lives? Commentators such as McKeown and Illich, 1,2 writing in the 1960s, argued that it contributed very little to population health, and might even be harmful. However, they were writing about a period when health care had relatively little to offer compared to today. More recent reviews of the contribution of health care to health have led to a consensus that McKeown was correct to the extent that ‘curative medical measures played little role in mortality decline prior to mid-20th century’. 3 But the rapidly changing scope and nature of health care means it cannot be assumed that this is still the case. Thus, several writers have described often quite substantial improvements in death rates from conditions for which effective interventions have been introduced. 4 Yet the debate continues, with some arguing that health care is making an increasingly important impact on overall levels of health while others contend that it is in the realm of broader policies, such as education, transport and housing that we should look to for future advances in health. Inevitably, this is to a considerable extent a false dichotomy. Both are important. But how much does health care contribute to population health? Voir page 40 le résumé en français. En la página 41 figura un resumen en español. One way of thinking about this question is to look at deaths that should not occur in the presence of effective and timely health care. 5 This has given rise to the development of a variety of terms including ‘avoidable mortality’ and ‘mortality amenable to medical/health care’. 4,6,7 However, much of this work was undertaken in the 1980s and early 1990s and it has received relatively little attention more recently. Indeed, as the World Health Report 2000 shows, 8 the concept has been overlooked in some influential recent studies. Furthermore, health care has advanced considerably in the intervening period. Another reason for revisiting this issue is that ‘avoidable’ deaths were often limited to those under, for example, the age of 65, a figure that seems inappropriately low in the light of life expectancies that are now about 80 years in many countries. So does ‘avoidable’ mortality still offer a means of assessing health system performance and is the list of causes of death previously deemed to be avoidable still valid? Revisiting the concept of ‘avoidable mortality’ In a recent study we have undertaken a systematic review tracing the evolution of the concept of ‘avoidable’ mortality from its inception in the 1970s, subjecting it to a detailed methodological critique and looking at how it has changed over time. 9 To help future researchers we have produced a comprehensive, annotated review of the work that has been undertaken worldwide so far. Our review has shown that ‘avoidable’ mortality was never intended to be more than an indicator of potential weaknesses in health care that can then be investigated in more depth. We describe examples of where this approach has been successful, drawing attention to problems that might otherwise have been missed. In contrast, many of the critics of ‘avoidable’ mortality, or more specifically, mortality amenable to health care (amenable mortality), have asked that it do something it was not intended to do, to be a definitive evaluation of the effectiveness of health care. Thus, it is not surprising that studies seeking to link amenable mortality with health care resources have failed to do so, especially when undertaken within countries, although it is notable that where gross differences exist, as between western and eastern Europe, the gap in amenable mortality is especially high. For these reasons, it seems justifiable to extend the extensive body of research that has already been undertaken to look at ‘avoidable’ mortality, updating the list of conditions 12 | World Hospitals and Health Services | Vol. 40 No. 3
Page 2 and 3: CONTENTS World Hospitals and Health
Page 4 and 5: IHF NEWSLETTER International hospit
Page 6 and 7: IHF NEWSLETTER Conference and event
Page 8 and 9: IHF NEWSLETTER AFRICA Dr Sambo nomi
Page 10 and 11: COUNTRY PROFILE: GREECE The develop
Page 14 and 15: POLICY: POPULATION HEALTH (a) betwe
Page 16 and 17: MANAGEMENT: GOVERNANCE Health care
Page 18 and 19: MANAGEMENT: GOVERNANCE Until recent
Page 20 and 21: SPECIAL FEATURE: INTERVIEW WITH RIC
Page 22 and 23: INFRASTRUCTURE: DESIGN Planning and
Page 24 and 25: INFRASTRUCTURE: DESIGN vicinity and
Page 26 and 27: INFRASTRUCTURE: DESIGN the staff an
Page 32 and 33: EHEALTH: SPAIN different models on
Page 34 and 35: EHEALTH: SPAIN corresponding with p
Page 36 and 37: CLINICAL CARE: DIABETES The global
Page 38 and 39: CLINICAL CARE: DIAGNOSTIC IMAGING i
Page 40 and 41: REFERENCE Programme vise clairement
Page 42 and 43: REFERENCE conectados y los hombres
Page 44 and 45: REFERENCE GETINGE INTERNATIONAL AB
Page 46 and 47: OPINION MATTERS Musings on the futu

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