Tied with Thailand on infant mortality
Post-Dispatch file photo
Americans like to think that we have the world’s best health care. Sometimes that’s true.
But in one of the most fundamental measures of health — infant mortality, the percentage of babies who die before their first birthday — we come up short. By a lot.
Roughly seven of every 1,000 babies born in the United States die before their first birthday. That puts America on a par with the rates in Serbia and Lithuania. In a ranking of countries’ infant mortality rates, with number one being the best, the United States is tied with Thailand in 29th place.
We rank slightly lower than Poland, Hungary, Croatia and South Korea. Our rate is more than twice as bad as the rates in Japan, Sweden, Cyprus and Italy, and three times worse than Iceland’s.
There is some good news: Recently released national numbers show that the infant mortality rate improved slightly here during 2006, the latest year for which complete statistics are available. That marked the first statistically significant change since rates stalled in 2000.
But the bad news strikes very close to home:
According to 10-year averages between 1996 and 2006, Missouri’s infant mortality rate was 7.6 deaths per 1,000 births. In St. Louis County, the rate was 8. But in the city of St. Louis, the infant mortality rate was a staggering 12.5. That’s about the same as the infant death rate in Syria — and twice as high as the rate in Canada and the United Kingdom.
The U.S. Centers for Disease Control and Prevention and most health experts regard infant mortality as among the most important indicators of a nation’s health. That’s because it is associated with and affected by a wide variety of factors: maternal health, access to health care, socioeconomic conditions and public health practices. The United States — and the St. Louis region in particular — fall short in many of these measures.
Because many factors influence the infant mortality rate, it can take a long time to see improvement. But widening disparities in access to health care and rapid increases in the number of people without health insurance make it even more difficult.
For example, about a third of U.S. infant deaths occur in premature babies. In St. Louis and St. Louis County, rates of premature birth are higher than the state average. Women who don’t get prenatal care are more likely to deliver prematurely.
Babies who are arrive too early and, thus, are very small receive heroic care at specialized hospitals at great cost. It’s not unusual for the care of such infants to cost hundreds of thousands of dollars. Yet many die before their first birthdays.
That care might not be needed if more money were spent to provide prenatal and preventive care to scores of mothers and infants. That makes premature births and infant mortality a problem for all of society, not just the mothers of these unfortunate infants.
In 1960, our country had the world’s 12th-lowest infant mortality rate. Since then, other nations have surpassed us at lowering their rates. And infant mortality isn’t the only international measure of health by which the United States does poorly.
Americans have a “healthy life expectancy” of 69 years. That’s a measure of the number of years a citizen can expect to live in full health. That’s about the same as residents of Slovenia and Portugal, two fewer years than the British, three fewer years than the French and six fewer years than the Japanese.
Americans have fewer doctors, CT scanners and MRI machines per capita than residents of many other Western nations. We see doctors less often and are less satisfied with the care we receive.
Yet we spend about twice as much on that care as the British, French or Japanese. At least $1,000 of our health care spending per person, on average, pays for paperwork — administrative expenses. Unlike Americans, every citizen in Britain, France, Japan and every other developed country has government-paid health care.
Health care reform clearly will be a major political issue over the next four years, although it’s too soon to say exactly what kinds of changes could occur. But it’s not too soon to ask if Americans want a fairer, more efficient health care system — or if they think that being tied with Thailand in infant mortality is good enough for the United States.
Actually the US infant mortality rate is 25%. 1 in 4 babies do not make it.
Where did you get 25%? The only numbers I have seen are between 6 and 7.
http://www.unicef.org/sowc/
https://www.cia.gov/library/publications/the-world-factbook/geos/us.html
http://www.who.int/whosis/en/index.html
Great Society not working out so well for you guys? Need some more WIC programs or social workers? Maybe a few more bureaucrats could get the moms out of school, off crack and nicotene, and sobered up before they deliver.
Your holy government is doing so well with drugs, poverty, and finance, let’s just throw some tax dollars at health care and turn it over to the feds. Your answer for everything.
Incidently, I didn’t see any figures for Cuba, North Korea, or the other Utopian cultures you want the U.S. to emulate. Darn mathematics and human nature!!!!
I’ve lost track of how many times the PD has trotted out this grossly misleading statistic to justify it’s support for government mandated health care. There are many causes for infant mortality that have nothing at all to do with the quality or availability of state-run medical programs. Crib death and accidents come to mind.
But the main factors affecting early infant survival are birth weight and prematurity. The way most countries tabulate and record this data is different than the way we do it in the US. In many countries, industrialized and developing, low birth weight infants are simply not counted against the “live birth” statistics.
The way statistics are calculated in Canada, Germany, and Austria, for example, a premature baby weighing less than 500g is not considered a living child. The US considers them a live birth. The mortality rate of these babies, which many countries define as “unsalvagable”, is extremely high. I think it’s in the 800+ per 1000 range for the first month of life alone. This obviously skews US infant mortality statistics.
Some of the countries which claim to have infant mortality rates lower than the US classify babies as “stillborn” if they survive less than 24 hours whether or not such babies breathe, move, or have a beating heart at birth. The fact is that 40% of all infant deaths occur in the first 24 hours of life. In the US, all infants who show signs of life at birth (take a breath, move voluntarily, have a heartbeat) are considered alive.
If a child in Hong Kong or Japan is born alive but dies within the first 24 hours of birth, he or she is reported as a “miscarriage” and does not affect the country’s reported infant mortality rates. Also, the length of pregnancy considered “normal” is 37-41 weeks. In most of the European Union countries, any baby born before 26 weeks gestation is not considered alive and therefore does not count against reported infant mortality rates. They are in the US.
In Switzerland and other parts of Europe, a baby that is less than 30 centimeters long at birth is not counted as a live birth, so they don’t count in Swiss infant mortality studies. They do in the US. Here we go out of our way to save these tiny babies. Since 2000, 42 of the world’s 52 surviving babies weighing less than 400g (0.9 lbs.) were born in the United States. I bet the parents of these children have a different take on socialized medicine than the opinion writers at the Post.
The next time the PD trots out statistics to bolster an argument, at least do us readers a favor and use meaningul ones.
Here are the relevant definitions from the World Health Organization Site, Go-Fish. They seem to contradict your claim.
“Infant mortality rate per 1000 live births
Rationale for use
Under-five mortality rate and infant mortality rate are leading indicators of the level of child health and overall development in countries. They are also MDG indicators.
Definition
Infant mortality rate is the probability of a child born in a specific year or period dying before reaching the age of one, if subject to age-specific mortality rates of that period.
Associated terms
Live birth refers to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life - e.g. beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles - whether or not the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered live born.”
What the WHO defines and what countries actually report are two entirely different things. Statistics that purportedly show the US has an infant mortality rate on par with certain third world and developing nations are mostly meaningless and many credible medical researchers reject them. The same goes with the statistics that supposedly show how high insurance administration costs negatively impact the quality and costs of care. What exactly are you comparing and how do you reach that conclusion?
I seriously doubt any American given the relevant information to make a decision with, would trade our results with anywhere else.
I too am disgusted that our media would misrepresent the numbers just to further an agenda.
One of the main reasons so many babies are dying is that doctors in the United States are saving more premature babies with advanced technology, technology that other countries don’t have. Some of these babies end up dying and of course, must be added to the statistics.
So, one could easily argue that it is our advancement in medicine that increases our infant mortality rate but you will never hear our MSM spouting anything good about healthcare in the U.S.
Mr Carlton,
Go_Fish is correct. Countries self report the statistics and there is no centralized review process of any real merit.
Aren’t you are the one calling himself a reporter. Can we continue to expect this type of serious investigative reporting with every other health care related topic? Sure seems that way.
Anybody who questions Go Fish’s claims - you can find his post, practically verbatim, on Wikipedia under “Infant Mortality”. Although he extrapolates a bit when he says “In most of the European Union countries, any baby born before 26 weeks gestation is not considered alive and therefore does not count against reported infant mortality rates”, the article simply mentions France and Belgium. The rest of what he/she has written can be found, word for word, at
http://www.coyoteblog.com/coyote_blog/2008/08/why-does-the-us.html
Go Fish - If you are going to question the use of the PD’s statistics, please don’t simply plagiarize other people.
By the way Mr. Carlton, you certainly wouldn’t find a picture like the one you have associated with this article in any of the countries listed ahead of the U.S. because their government funded health care systems would have defined the child as dead in the first place and never devoted any resources to the child’s care.
Preston,
First GoFish never said he was a reporter and second I don’t care who he plagiarizes as long as he keeps Mr Carlton from misinforming the rest of us.
Your data to the contrary is? — nothing.
At no point was I questioning his “data”, I was simply providing his sources of information since he “forgot” to do so.
There are eight countries who report their infant mortality rates and include even low-weight and premature births: Canada, Denmark, Finland, Iceland, Japan, Norway, Sweden, and the United States. Of these 8 the US ranks 8th. Iceland ranks 1st with 2.8/1000.
My source is a 2007 Congressional Research Service Report prepared to look at US health care spending compared to 30 other highly developed countries, found here (Pages 57-59):
http://assets.opencrs.com/rpts/RL34175_20070917.pdf
I will agree with GOFish and jvqb that without taking into account the reporting practice of each country participating in the WHO report the statistics are biased. Similar to reports that say the US lags behind other countries in science, math, etc. However, the US mortality rate would probably only move up a few spots in the WHO Report even if all countries followed the same reporting practice.
I should also point out that all 7 of the countries ahead of us have universal health care coverage.
Since the birth of my Granddaughter 6 years ago with all of her attendant difficulties, this has been an issue for me. So if you want some information try this:
“Infant mortality is one of the most important indicators of the health of a nation, as it is associated with a variety of factors such as maternal health, quality and access to medical care, socioeconomic conditions, and public health practices. The U.S. infant mortality rate generally declined throughout the 20th century. In 1900, the U.S. infant mortality rate was approximately 100 infant deaths per 1,000 live births, while in 2000, the rate was 6.89 infant deaths per 1,000 live births. However, the U.S. infant mortality rate did not decline significantly from 2000 to 2005, which has generated concern among researchers and policy makers.”
http://www.cdc.gov/nchs/data/databriefs/db09.htm
The fact is that at present, according to our own CDC, the US still has a 6.89 infant deaths per 1000, wee above.
From the same report:
“The 2000-2005 plateau in the U.S. infant mortality rate represents the first period of sustained lack of decline in the U.S. infant mortality rate since the 1950s.
The Healthy People 2010 target goal for the U.S. infant mortality rate is 4.5 infant deaths per 1,000 live births (4). The current U.S. rate is about 50% higher than the goal.
The impact of infant mortality is considerable: There are more than 28,000 deaths to children under 1 year of age each year in the United States.”
Also:
“Infant mortality rates were generally lowest (below 3.5 per 1,000) in selected Scandinavian (Sweden, Norway, and Finland) and East Asian (Japan, Hong Kong, and Singapore) countries. In 2004, 22 countries had infant mortality rates below 5.0 (5).
The United States’ international ranking fell from 12th in 1960 to 23d in 1990, and to 29th in 2004 (5).
International comparisons of infant mortality can be affected by differences in reporting of fetal and infant deaths. However, it appears unlikely that differences in reporting are the primary explanation for the United States’ relatively low international ranking.”
And:
“In 2005, there was a more than threefold difference in infant mortality rates by race and ethnicity, from a high of 13.63 for non-Hispanic black women to a low of 4.42 for Cuban women.”
And lastly:
“Preterm birth (births at less than 37 completed weeks of gestation) is a key risk factor for infant death. The percentage of preterm births has increased rapidly in the United States in recent years. From 2000 to 2005, the percentage of preterm births increased from 11.6% to 12.7%-a 9% increase.”
Why would my Granddaughter’s birth cause me to be interested in this? She was born 12 weeks pre-mature with Chromosome 18q damage. This particular chromosomal damage usually results in a 95% mortality rate in the first 6 months. She turned 6 this past October.
The basic facts are up above. Read them and understand that 28,000 infants die within their first year of life. Of that 28,000, 68.6% were pre-term infants — that is more than 2/3rds - or 19,208 infants. In other words, many of these infant deaths may have been preventable with better early pregnanacy care. That is the health issue.
By the way there is a racial component to this:
“The impact of preterm-related infant mortality was high for all racial and ethnic groups. However, some groups were disproportionately affected. For example, nearly half (46%) of infant deaths to non-Hispanic black women, and 41% of infant deaths to Puerto Rican women were preterm-related, compared with 32% for non-Hispanic white women.”
Source: NCHS Data Brief
Number 9, October 2008
Recent Trends in Infant Mortality in the United States
Marian F. MacDorman, Ph.D., and T.J. Mathews.M.S.
Ps:
That photo, while not my Granddaughter, looks very familiar to me. My Princess when she was born could have fit inside my hand with room to turn over. She will be tiny her whole life, but she has the biggest smile.
So guys do me a favor here. Stick to the facts, can the carping. These are real babies we are talking about, and for me they all look like my Princess.
RHarnack - Very good points. Race plays an enormous factor in infant mortality with the occurrence of black infant death nearly 3x that of whites. In the city of STL it’s even higher.
http://www.cdc.gov/nchs/data/nvsr/nvsr50/50_12t2a.pdf
I’m not sure why there was no data for hispanics in the above link.