title: Delhi's health system exceptionalism: inadequate progress for a global capital city.
abstract: OBJECTIVE
  India has proclaimed commitment to the goal of Universal Health Coverage and Delhi, the National Capital Territory, has increased investment in public health and other health services over the past decade. The research investigates whether Delhi's increased investment in health over this period is associated with a reduction in premature deaths, after the age of 1 year, which could have been avoided with better access to effective health care interventions (amenable mortality).
  
  
  METHODS
  A population-based study of changes in amenable mortality (AM) in Delhi over the 2003-2013 period.
  
  
  METHODS
  To calculate AM, a list of International Classification of Disease (ICD) codes from the published literature was relied upon. In defining AM in India, an upper age limit of 69 years was adopted, rather than the more common limit of 74 years. Population estimates and vital statistics were downloaded from the Delhi Statistical Handbook. Deaths by cause and age, including medical certification, are from the Vital Statistics site of the Delhi Government. To age-adjust these data, the direct method was employed, using weights derived from the 2010 United Nations world standard population.
  
  
  RESULTS
  The research found that, between 2004 and 2013, the age-adjusted rate of AM rose from 0.87 to 1.09. The leading causes of death in both years were septicemia and tuberculosis. Maternal mortality is well above the global level for middle-income countries.
  
  
  CONCLUSIONS
  Recent investments in public health and health care and the capacity to leverage them to improve access to effective care have not been sufficient to overcome the crushing poverty and inequalities within Delhi. Large and growing numbers of residents die prematurely each year due to causes that are amenable to public health and health care interventions.
authors.affiliation: Department of Health Systems and Policy, School of Public Health, Rutgers University, 112 Paterson Street, Room 424, New Brunswick, NJ, USA; The Hastings Center, Garrison, NY, USA. Electronic address: mkg93@sph.rutgers.edu.
authors.forename: M K
authors.initials: MK
authors.lastname: Gusmano
authors.affiliation: Health Policy and Management, Wagner School of Public Service, New York University, USA.
authors.forename: V G
authors.initials: VG
authors.lastname: Rodwin
authors.affiliation: Columbia University, USA.
authors.forename: D
authors.initials: D
authors.lastname: Weisz
mesh_terms: D000328:Adult; D002423:Cause of Death; D046688:Child Mortality / Q000639:trends; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007194:India / Q000453:epidemiology; D007449:Investments; D008017:Life Expectancy; D008297:Male; D008428:Maternal Mortality; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*; D011203:Poverty; D011634:Public Health / Q000191:economics*; D012959:Socioeconomic Factors; D019472:Universal Health Insurance; D014505:Urban Population; D055815:Young Adult
keywords: Amenable mortality; Delhi; India; Premature mortality