Sunday, May 17, 2009

Some thoughts on infant mortality in the US

There's a saying that you get what you pay for, but that's often just a b.s. platitude. Americans pay ridiculous amounts for health care, but there are many measures where people in the US fall short when compared with others who pay less as a percent of GDP.

Infant mortality is one of those measures. In 2005, the United States had an infant mortality rate of 6.9 per 1000 newborns, making it a second-tier nation.

Well, you might argue, there are a lot of poor people in the United States, so lumping them in with everyone else will drive up the infant mortality rate. Yes, believe it or not, that really is a defense of the US's atrocious infant mortality rate. I mean, come on, all the other countries also count all their poor as well, so why shouldn't the US? Moreover, it's just one more failure of the system that there is this "two Americas" approach to health care.

Anyway, the statistical refutation of that "defense" is that even if you remove "the poor" from the equation, infant mortality is still pretty bad. For sh¡ts and giggles, let's consider just Whites: non-Hispanic Whites in America had an infant mortality rate of 5.8 per 1000.

What's worse is the Black-White ratio, which in 2005 stood at 13.6 per 1000, a whopping 2.3 times higher than non-Hispanic Whites. Black infant mortality is comparable to island nations in the Caribbean or the Pacific — literally. We're talking Saint Kitts and Nevis, Grenada, Palau, Fiji, or Tonga.

And the Black-White gap appears to be getting worse: In 1950, the ratio was 1.6, it was 1.9 in 1960, 2.0 in 1980, and about 2.2 in 1989. What the hell is wrong here?

I'm often approached by friends, colleagues, or readers about health care issues in Korea. While going into a medical situation amidst the fog of not being able to freely use one's native tongue can be very daunting, the care side of the equation indicates things may not be so bad, even better than in the US. South Korea's infant mortality in 2009 is estimated at 4.26, nearly 40% lower than Americans in general in 2005, and 26% percent than Whites in general in 2005.

And that's the figure for all South Koreans, including the poor, the rural, the under-insured, etc. It's better, in fact, than a lot of Western European countries as well (Denmark, Austria, Belgium, Luxembourg, the Netherlands, the UK, Ireland, Italy, and the EU as a whole), not to mention Canada, Australia, and New Zealand. (South Korea has a ways to go to catch up with Japan, however, with a 2009 estimated rate of 2.79.)

Of course, another defense of the US's less-than-stellar numbers is that the US employs so much high-tech nowadays that a lot of questionable pregnancies make it to full term, which jack up the infant mortality rates after birth. While that explanation may account for some infant deaths each year, it does not explain the majority of the gap, and it certainly does not explain the Black-White ratio.

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