November 18, 2008

The System is the Problem: Where the U.S. Ranks on Infant Mortality

“President-Elect Obama’s healthcare reform proposals have focused intensely on two key questions: How much would reform cost and how many people would be covered? He also must address the critical issue of why the United States has such poor health outcomes despite all the money we spend,” write Judy Norsigian, OBOS executive director, and Eugene Declercq, a professor of maternal and child health at Boston University School of Public Health, in this Boston Globe editorial.

A report from the Centers for Disease Control and Prevention documents a slight decline in the national infant mortality rate (the number of deaths to babies under 1 year of age) in 2006, but the rate has essentially remained flat since 2000, leaving the United States 29th among industrialized countries.

Advocates of health reform who focus exclusively on access presume that the United States provides effective but expensive healthcare, and that the only real problem is lack of access to this care. The reality is more complex when we examine those mortality figures. The low US ranking is misleading since many of the countries rated ahead (e.g., Singapore, Hong Kong, Norway) have fewer births than an average US state. So, what if we do a fair test – only comparing the United States with other wealthy countries that have at least 100,000 annual births?

There are 16 such countries. Among them, the United States ranks last in infant mortality, third to last in perinatal mortality (deaths in the first seven days and fetal deaths), and last in maternal mortality.

It gets even more interesting — in response to the argument that the problem is not our healthcare system itself, but rather a lack of access and social supports across the board, as well as inappropriate health behaviors, the authors turn the lens on births to white, non-Hispanic, U.S.-born mothers who begin prenatal care in the first trimester. Wondering how high we rank then? Continue reading here.


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