Summary: America has wealth and power never before seen in history. Yet the 1% reap the gains of our astonishing productivity while an underclass grows in our cities and rural areas. This post looks at one aspect of this, the price paid by American babies for our national mismanagement. There is no point in getting angry about this — unless you decide to act.
For we must consider that we shall be a city upon a hill. The eyes of all people are upon us, so that if we shall deal falsely with our God in this work we have undertaken, and so cause Him to withdraw His present help from us, we shall be made a story and a byword though the world.
— John Winthrop in A Model of Christian Charity (1630).
NBER Bulletin on Aging and Health, 2015 (1)
Graphics and red emphasis added.
The U.S. infant mortality rate (IMR) compares unfavorably to that of other developed countries, ranking 51st in the world in 2013. In the U.S., there are nearly 7 infant deaths during the first year of life per 1000 live births, roughly twice the rate in Scandinavian countries. The U.S. IMR is similar to that of Croatia, despite a three-fold difference in GDP per capita.
What explains the U.S.’s relatively high IMR? This is the subject of a new NBER working paper by researchers Alice Chen, Emily Oster, and Heidi Williams, “Why is Infant Mortality Higher in the U.S. Than in Europe?” (NBER, September 2014).
There are numerous theories as to why the IMR is higher in the U.S. than in other countries.
- There may be reporting differences for infants born near the threshold of viability, with the U.S. more likely to count them as live births while other countries are more likely to count them as miscarriages or stillbirths.
- Babies in the U.S. also may have lower birth weight or a lower gestational age at birth, predisposing them to worse outcomes.
- U.S. babies may experience a higher neonatal mortality rate (deaths within the first month of life) or higher post-neonatal mortality rate (deaths in months 1 – 12) than do babies of similar birth weight and gestational age in other countries.
To quantify the importance of these potential sources of the U.S. IMR disadvantage, the authors combine natality micro-data from the U.S. with similar data from Finland and Austria. These countries provide a useful comparison because Finland has one of the lowest IMRs in the world and Austria has an IMR similar to much of continental Europe.
To address the reporting difference issue, the authors limit their sample to infants born after 22 weeks of gestation with birth weight over 500 grams, since births are required to be reported above these thresholds. They also limit the analysis to singleton births, as access to reproductive technologies has increased the frequency of multiple births, which have higher mortality rates.
Making these restrictions reduces the U.S. IMR disadvantage by about 40%, but a substantial disadvantage remains. In this sample, the U.S. IMR is 4.65 per 1000, versus 2.94 in Austria and 2.64 in Finland. See the graph…