Be Proud America! as we watch our babies die

Summary: We’ll hear much about American exceptionalism from candidates for President during the next 17 months. Here’s a tangible example — the greater fraction of infants that die in America than in our peers. We know how to fix it; we have the money. We lack only the will. Be proud, America!  {1st of 2 posts today.}

Some insights into the factors affecting infant mortality, showing how badly we’re doing.

From the January NBER Bulletin on Aging and Health story about this study:

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 … 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.

…  In short, worse conditions at birth and a higher post-neonatal mortality rate are both important contributors to the U.S.’s higher IMR.

Finally, the authors explore how the U.S. IMR disadvantage varies by racial and education group. They find that the U.S.’s higher post-neonatal mortality rate is driven almost entirely by excess mortality among individuals of lower socioeconomic status. As the authors note, “infants born to white, college-educated, married women in the U.S. have mortality rates that are essentially indistinguishable from a similar advantaged demographic in Austria and Finland.”

The study. Read It and Be Proud, America!

This shows the cumulative probability of death by country and time of death for 2000-2005. To more directly measure health care, the sample is limited to single births at 22 weeks of gestation and 500 grams with for birth weight and gestational age. Be proud, America.

“Why is Infant Mortality Higher in the US than in Europe?“

By Alice Chen (Prof Medicine, UCSF), Emily Oster (Assoc Prof, Economics), and Heidi Williams (Prof Economics, MIT).
National Bureau of Economic Research, September 2014 (gated).

Abstract (red emphasis added)

The US has a substantial — and poorly understood — infant mortality disadvantage relative to peer countries. We combine comprehensive micro-data on births and infant deaths in the US from 2000 to 2005 with comparable data from Austria and Finland to investigate this disadvantage. Differential reporting of births near the threshold of viability can explain up to 40% of the US infant mortality disadvantage. Worse conditions at birth account for 75% of the remaining gap relative to Finland, but only 30% relative to Austria.

Most striking, the US has similar neonatal mortality but a substantial disadvantage in postneonatal mortality. This postneonatal mortality disadvantage is driven almost exclusively by excess inequality in the US: infants born to white, college-educated, married US mothers have similar mortality to advantaged women in Europe. Our results suggest that high mortality in less advantaged groups in the postneonatal period is an important contributor to the US infant mortality disadvantage.

Discussion and Conclusion

The goal in understanding the US infant mortality disadvantage relative to Europe is to better understand what policy levers might be effective in reducing infant mortality in the US. Our results on neonatal mortality strongly suggest that differential access to technology-intensive medical care provided shortly after birth is unlikely to explain the US IMR disadvantage. This conclusion is, perhaps, surprising in light of evidence that much of the decline in infant mortality in the 1950 to 1990 period was due to improvement in neonatal medical technologies. However, a variety of evidence suggests that access to technology-intensive post-birth medical care should affect mortality risks during the neonatal period, rather than during the postneonatal period: median time spent in the neonatal intensive care unit (NICU) is 13 days, and this care is thought to primarily affect neonatal mortality. Consistent with this assertion, Almond et al. (2010) analyze the mortality consequences of incremental increases in medical expenditures for at-risk infants (including NICU admission as well as other expenditures), and that the mortality benefits of additional medical care are concentrated in the first 28 days of life. Our results suggest that if anything the US has a mortality advantage during the neonatal period.

Instead, the facts documented here suggest that, in general, if the goal is to reduce infant mortality, then policy attention should focus on either preventing preterm births or on reducing postneonatal mortality. Al- though the former has received a tremendous amount of policy focus, the latter has — to the best of our knowledge — received very little attention. Our estimates suggest that decreasing postneonatal mortality in the US to the level in Austria would lower US death rates by around 1 death per 1000. Applying a standard value of a statistical life of US$7 million, this suggests on a standard cost-benefit test it would be worth spending up to $7000 per infant to achieve this gain. If policies were able to focus on individuals of lower socioeconomic status — given our estimates that advantaged groups do as well in the US as elsewhere — even higher levels of spending per mother targeted might be justified. …

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My thoughts about this

America is among the world’s richest nations. There is no excuse for it having such a high infant mortality rate when we ignore public health methods proven to reduce it. Conservatives obsess about aborting fetuses, but appear to have little concern about their health —  and less about their opportunities after birth.

We can do better.

For More Information

If you liked this post, like us on Facebook and follow us on Twitter. See all posts about inequality & social mobility, and all posts about health care, especially these…

• Hidden truths about American health care.
• The core truth about our health care system — It’s quite mad.
• What does the health care debate reveal about us, and our future?