Where people die

Death certificates for 1977 filed with the New York State Department of Health were studied to determine where people died. Data were examined by the location and cause of death and by the age, sex, race, and marital status of the decedent. Comparisons were made with a similar study in which U.S. data were used for 1958 events. Approximately 60 percent of all the 1977 deaths in upstate New York occurred in hospitals; only 27 percent occurred outside an institution. The location of death varied by all the factors studied. Within all age categories, males had a higher percentage of hospital deaths. In those age categories in which nursing home deaths comprised a significant proportion of total deaths, females had a higher percentage of such deaths than males. Differences in the location of death according to its cause reflect the nature of the cause of death, for example, whether it was of sudden onset or the result of chronic disease. Most people do not consider in advance where they might die. The idea that age, sex, and marital status, as well as the more obvious cause, all play a part in the location may seem surprising. Yet all these factors were found to be associated withe location of deaths in upstate New York, and there is no reason to believe that this association does not hold true for the entire nation. More research, however, needs to be done based on more years and other geographic artal stutus may be instructive as to the present state of health resources.     

Purchasing for people

Newcastle Health Authority is taking a consumer-led approach to its purchasing activity. Here Ingrid Barker argues that user participation is vital to the success of the purchasing role and the achievement of relevant contracts for services. Newcastle's own progress in establishing consumer groups to inform purchasers is described and some indications are given of future directions.