"Not only has the UK had the largest fall in death rates from myocardial infarction between 1980 and 2006 of any European country, if trends over the past 30 years continue, it will have a lower death rate than France as soon as 2012". John Appleby, chief economist for the King's Fund, British Medical Journal



With the debate over NHS reform raging in the Commons, something of a statistical battle has broken out between two rival groups: The first, citing the figures above, insist the improvements highlighted challenge the need to reform. Their opponents, argue that the UK nevertheless suffered twice the mortality rate for heart attacks seen in France, suggesting room for improvement, and hence the reforms.



Not only this, but Health Secretary Andrew Lansley argued yesterday that "we need not only to match European spending, as we do now, but to ensure that we achieve European-level results."



However, rather than looking at European levels of spending, Mr Appleby makes the point that the French pay 28 per cent more for their healthcare.



So, stepping back from the fiery debate, what do these contrasting sets of figures actually tell us?



Heart Attack deaths



The statement that 'someone in the UK is twice as likely to die from a heart attack as someone in France' is a claim that has been frequently highlighted by the coalition. This information was presented in the Department of Health's ministerial briefing on the Health and Social Care Bill, where it was offered as a justification for the NHS reforms that the coalition is trying to introduce.

According to data provided by the OECD upon request, the standardised death rate for myocardial infarction in the UK was about 41 cases per 100,000 people in 2006 whilst the rate for France was about 20/100,000 .



With the UK's death rate roughly double that of France, the data supports the claim that the coalition has put forward.



However the point made by Mr Appleby is that single year comparisons show “only part of the story”. The other part, he argues, is the rate of decline in these rates where the UK fares much better, as can be seen on the graph* below.

Where it is possible to compare the rate of mortality in the UK with other countries in Europe between 1980 and 2006, we actually find that Ireland saw a larger drop in the death rate for myocardial infarction (or heart attack) during this time.



Starting with a rate of 212.7 cases per 100,000 in 1980, the rate fell by 154.6 to 58.1 deaths in Ireland in 2006. In this time period, the UK managed a reduction of 135, from 175.5 in 1980 to 40.5 in 2006.



However, the UK did see the largest percentage decrease in this period, with a percentage change of 77 per cent. It is to be assumed that Mr Appleby's claim refers to this measure.



The datasets show a general decline in death rates for acute myocardial infarction in most countries. However it is not possible to conclude from this that the decrease in mortality is the result of specific health policies or spending within individual countries, as changes in lifestyles and risk factors will also have influenced the statistics.

A study that analysed the decline in coronary heart disease (CHD, a cause of heart attack) in England and Wales between 1981 and 2000 concluded that more than half (58 per cent) of the CHD decline in mortality was attributable to reductions in major risk factors, such as smoking.



Spending comparisons

In terms of health spending in the UK relative to the rest of Europe, the UK managed to achieve the previous government's target of matching EU spending on health in 2004. At 8.7 per cent of GDP in 2008, it is now, a recent report notes, slightly above the enlarged European Union member countries average.



However, spending still lags behind France whether you take a measure of GDP or per capita spending. The OECD figures, published in December 2010, show that France's health spending in 2008 was 11.2 per cent of GDP.



Conclusion



The debate over the reforms will not be won or lost on heart attack mortality rates. But in the battle that has broken out over what the figures tell us there is no clear winner.



Coming back to the claim made by Mr Appleby, the figures back him up. Although this does not mean ministers are wrong to cite the figures they do.



Instead the numbers fail to take account of the changing picture, and of the ability of factors other than healthcare policy to affect the change.



*For the sake of clarity the graph only displays selected European countries.