Calling deaths ‘preventable’ can obscure barriers to health care access and shift blame to individuals
- Written by Zachary W. Schulz, Senior Lecturer of History, Auburn University
Each year in the U.S., tens of thousands of deaths are categorized as “preventable[1]” — meaning, in theory, they did not need to happen. A missed cancer screening, a fatal asthma attack or a death from untreated infection might all be counted as preventable[2].
The term is commonly used in public health reports, policy documents and local news coverage, and it generally implies that something went wrong and could have been prevented.
But it’s also deceptively simplistic. Researchers have noted that definitions of preventable death are often imprecise and shaped by subjective judgment[3]. In clinical settings like intensive care units, reviews of mortality[4] frequently focus on individual decisions or errors, while broader systemic issues — like hospital understaffing or regional disparities in access — may go unexamined.
I’m a historian of public health[5] who studies how U.S. health systems have developed over time, especially in rural and underserved areas. I study how structural decisions — about Medicaid, dental care and regional health investment — shape health access and outcomes today.
The language of preventability is widely used and often well-intentioned. But it can make certain deaths appear to be caused by regrettable choices or the failures of an overburdened health system. This, in turn, can lead to policy choices based on mistaken assumptions about where responsibility lies and how solutions should be designed.
What does ‘preventable death’ really mean?
In epidemiology, a preventable death[6] typically refers to a death that could have been avoided with timely and effective medical care, public health intervention or behavioral change. The Centers for Disease Control and Prevention uses the term to describe deaths from conditions like heart disease, diabetes, respiratory illness and certain infections[7] — illnesses that can often be managed or averted with adequate care.
This definition is useful: It helps health departments set priorities, allocate funding and measure progress[8].
But when the term circulates outside that context — in news articles, political speeches or everyday conversation — it often loses its technical grounding. In those settings, “preventable” can imply that prevention is merely a matter of personal knowledge or access, obscuring the deeper structural forces at play.
For example, a person who dies from untreated high blood pressure might be counted in preventable death statistics, since their death could likely have been avoided with routine medical care, effective treatment and support for managing blood pressure.
Health outcomes shaped by policy
But the label overlooks some deeper causes. For example, it doesn’t reflect whether a patient had stable health insurance[10], lived near a provider or faced cost barriers to filling a prescription. And it doesn’t show whether they were one of the millions of Americans living in states that have not expanded Medicaid[11], which provides government-supported health insurance for low-income Americans[12] under the Affordable Care Act. These variables can be the determining factor for whether someone is able to receive the care they need that could have made the death preventable.
Since 2010, states have had the option to expand Medicaid, and many states did. But a number of states — primarily in the South — have chosen not to[13]. This policy choice has left many low-income adults without access to affordable health coverage, especially in Southern and rural regions.
Research shows that these decisions have real consequences. Numerous studies have linked Medicaid expansion[14] with lower rates of premature death[15], better cancer outcomes and improved management of chronic diseases.
Similarly, dental care is one of the most consistently under-resourced[16] parts of the health system. Medicare does not include dental benefits[17], and Medicaid dental coverage varies widely by state. Dental disease can lead to serious medical complications, including infections that can become life-threatening[18] — yet dental deserts, especially in rural America[19], leave many without timely access to care.
Rural hospitals and clinics also face persistent underinvestment[20]. According to the Chartis Center for Rural Health, more than 141 rural hospitals have closed[21] since 2010, with hundreds more at risk. Many rural areas struggle to attract and retain health care workers[22], leaving residents with long travel times and limited emergency coverage.
A pattern, not a fluke
National health statistics reflect these structural gaps[23]. According to the CDC, rates of potentially preventable death are significantly higher in the South[24] than in other regions of the U.S. They are also higher among Black, Native and Hispanic populations[25] compared with white populations — disparities that track closely with differences in poverty rates[26], insurance coverage[27] and local health infrastructure[28].
In other words, when one looks more closely at who is dying from so-called preventable causes — and where — consistent patterns emerge. These are not random tragedies, but outcomes that follow familiar policy lines. They are, in many cases, the foreseeable result of long-standing policy decisions[29] and predictable outcomes shaped by structural inequities.
Yet the language of “preventable death” rarely points directly[30] to those decisions. Instead, it implies that the right care simply wasn’t accessed — but not why it wasn’t available or affordable in the first place.
How language shapes perception
In public health, the terms used matter[31] — they shape how both the public and the health system perceives risk, attribute responsibility and support reform.
Without context, calling a death preventable can imply individual failure — that someone didn’t eat right, didn’t take their medication, didn’t go to the doctor in time. The word erases the conditions[32] that make such behaviors difficult or impossible, miscasting structural faults as personal shortcomings. Someone without transportation to a clinic, or without health insurance to cover basic treatment, may not be positioned to “prevent” anything. In that sense, the death is only preventable in theory — not in practice.
As public health experts increasingly embrace the importance of structural barriers to health, some are proposing[33] alternatives to[34] the phrase or are calling for clearer explanations[35] when it is used.
As the health system grapples with widening inequities and eroding trust, speaking clearly about how individual choices interact with the systems in which people make them will help guide stronger policies, more equitable health systems and genuine access to health care. For patients and families, that clarity can mean something as basic as knowing a local clinic will be open when they need it, or that cost won’t keep them from filling a prescription.
References
- ^ preventable (doi.org)
- ^ might all be counted as preventable (doi.org)
- ^ imprecise and shaped by subjective judgment (doi.org)
- ^ reviews of mortality (doi.org)
- ^ historian of public health (cla.auburn.edu)
- ^ preventable death (doi.org)
- ^ heart disease, diabetes, respiratory illness and certain infections (www.cdc.gov)
- ^ set priorities, allocate funding and measure progress (www.ncbi.nlm.nih.gov)
- ^ alvaro gonzalez/Moment via Getty Images (www.gettyimages.com)
- ^ whether a patient had stable health insurance (doi.org)
- ^ states that have not expanded Medicaid (www.kff.org)
- ^ government-supported health insurance for low-income Americans (www.hhs.gov)
- ^ have chosen not to (doi.org)
- ^ linked Medicaid expansion (www.healthaffairs.org)
- ^ lower rates of premature death (www.ama-assn.org)
- ^ most consistently under-resourced (www.ncbi.nlm.nih.gov)
- ^ does not include dental benefits (www.carequest.org)
- ^ infections that can become life-threatening (doi.org)
- ^ especially in rural America (www.ruralhealthinfo.org)
- ^ face persistent underinvestment (kffhealthnews.org)
- ^ more than 141 rural hospitals have closed (www.chartis.com)
- ^ struggle to attract and retain health care workers (www.ruralhealthinfo.org)
- ^ reflect these structural gaps (doi.org)
- ^ significantly higher in the South (www.cdc.gov)
- ^ Black, Native and Hispanic populations (www.commonwealthfund.org)
- ^ differences in poverty rates (www.cdc.gov)
- ^ insurance coverage (www.cdc.gov)
- ^ local health infrastructure (www.ers.usda.gov)
- ^ foreseeable result of long-standing policy decisions (www.ncbi.nlm.nih.gov)
- ^ rarely points directly (doi.org)
- ^ the terms used matter (doi.org)
- ^ word erases the conditions (doi.org)
- ^ are proposing (doi.org)
- ^ alternatives to (doi.org)
- ^ calling for clearer explanations (health.ri.gov)
Authors: Zachary W. Schulz, Senior Lecturer of History, Auburn University
