Discussions with Al: Where's all the dying in America?

Sobered up from learning that the United States has the worst return on health investment in the developed world, Al called back a few days later asking meekly, "so where's all the dying?"

In other words, who was dying? And why were they dying in greater numbers than in other countries?

"It all starts with the kids. From the very moment of birth, the United States lags behind. Our infant mortality rate is one of the highest of any wealthy country."

"But we used to lead the way. What happened?"

"Actually, we were never the best, but relatively speaking, we were a lot better. In 1960, the United States had the 12th lowest infant mortality rate in the world. By 1990 it had dropped to 23rd place and in 2008 was ranked 34th."

"How's that possible? We have more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom."

"True, but we have a higher newborn mortality rate than any of those countries. Keeping infant mortality low is mostly about good antenatal care, safe delivery care, access to emergency obstetric care and less about how many expert specialists we have nearby."

"Seems like race plays a role in everything, this too?."

"Well, African-American infants have a lower chance of survival than babies born in Bulgaria and are twice as likely to die as white infants but this isn't just an issue of racial inequalities. In fact, the US's white population has an infant mortality rate nearly twice as high as that of Japan".

"So why are American infants dying so much?"

"Good question, I'll get back to you on that one."