The following article is based on excerpts from the recently released book The Measure of a Nation: How to Regain America's Competitive Edge and Boost Our Global Standing
A key goal in Measure of a Nation is to compare the United States to other wealthy countries, with the idea being to identify which countries are performing the best in each area of interest: health, safety, democracy, education and equality. In each of those areas, the countries that are performing the best are examined to determine which best practices might be applied here in America. In order to do this analysis, we selected the subset of countries that are both wealthy (nominal GDP per capita over $20,000) and have a population greater than 10 million (upper third of national populations, no city-state countries) as a comparison group. This comparison group consists of 14 countries: Australia, Belgium, Canada, France, Germany, Greece, Italy, Japan, Portugal, The Netherlands, South Korea, Spain, the United Kingdom, and the United States.
Infant mortality rate is defined as the number of deaths of infants one year or younger per 1,000 live births. It is a critical measure because the death of a young child has a greater impact on a population's life expectancy than does a death from disease or injury in the middle or later stages of life. In the developing world, infant mortality tends to be a result of pneumonia, diarrhea, tetanus, and congenital malformation. In the developed world, it is typically associated with low birth-weight or extremely premature births.
We usually don't think about infant mortality in the United States. We associate it with the developing world or with the distant past. Globally, in just the brief period between 1960 and 2001, infant mortality declined from 126 infant deaths per 1,000 live births to 57 per 1,000 live births.
The United States has the highest rate of infant mortality of any of these comparison countries while Japan, the competitor with the longest life expectancy, has the lowest. In the United States, the most common causes of infant mortality are congenital malformations and disorders associated with low birth-weight and short gestation.
The fact that the United States has the highest infant mortality is not because of a lack of specialists or facilities for neonatal births; on the contrary, America has more neonatologists and neonatal intensive care beds per person than Australia, Canada, or the United Kingdom.
As with other health metrics, America's relative performance is declining. In 1960, the United States had the twelfth lowest infant mortality rate in the world. By 1990, we had dropped to twenty-third, and we sank to thirty-fourth in 2008. Our high infant mortality rate evidences the economic, ethnic, and racial disparities referred to earlier. For example, in 2005, African-American infants suffered a death rate of 13.63 per 1,000 births, more than twice the national average. The CDC's 2004 world rankings indicate that an African-American baby would have a better chance of survival if born in Russia or Bulgaria than in the United States. Low birth-weight incidence explains some of the racial inequality. Low-weight births, defined as newborns weighing less than 2,500 grams or approximately five pounds, are about twice as common among African Americans as among (non-Hispanic) Caucasian and Hispanic babies, occurring at a rate of 13 percent among the former and at a rate of only 6.5 percent among the latter. Among the factors contributing to these lopsided outcomes are disparities in prenatal care, nutritional supplementation for pregnant women, and inadequate social welfare. Yet even if we eliminate this racial disparity and compare only the infant mortality rate of Caucasian Americans, our ranking versus the competitor countries is unaffected.
Infant mortality is just one of many metrics where the US used to be a world leader and has slipped in the last few decades. Other countries have identified leading practices that United States can learn from and adopt to improve its health care system. The idea of applying competitive intelligence and identification of best practices to countries is explored in detail in Measure of a Nation, where the publicly available data is displayed, links are provided and suggestions for improving America based on this competitive intelligence are discussed.
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But in the U.S., such very low birth weight babies are considered live births. The mortality rate of such babies - considered "unsalvageable" outside of the U.S. and therefore never alive - is extraordinarily high; up to 869 per 1,000 in the first month of life alone. This skews U.S. infant mortality statistics.
Some of the countries reporting infant mortality rates lower than the U.S. 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.
Forty percent of all infant deaths occur in the first 24 hours of life.
In the United States, 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. Differences in reporting practices go on and on leaving the statistics fairly unreliable. We need to make prenatal care available to all who need it. Period.
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There has been trouble with federalism versus confederalism in the United States as well.
As it is now, the point sort of appears to be that it is the health care system that is the cause, but just in passing, in the last paragraph, with no detail.
Also correct the statement about racial disparities referred to earlier, there are none referred to earlier.
Yes and if there was an impartial assessment of those metrics, one would find many characteristics in common with failed and failing States.
Unfortunately, America is not mature enough to accept reality and change accordingly.
Our system is insane and completely broken and at least Obama and the Democrats have TRIED to do something about it. I'm STILL WAITING for the Republican alternative.....
Nobody argues that American hospitals are first class. Its not the hospitals but the wretched health Insurance companies who are now so powerful that they often over rule a doctor's treatment plan.
The GOP is really pro-death, not pro-life.
The GOP conservatives follow the strict doctrine dictated by Frederick von Hayeck a disciple of Austrian Free market economics .
Read Hayek's book Road to Serfdom and you will understand where much of this
neoconservative free market minimal government thinking comes from.
Many american conservatives see govt as a burden and taxation as theft.
And the free market should determine who receives healthcare. If you can't pay you are out of luck. In the conservative world govt should not be assisting the poor even when they are chronically sick - The conservatives believes that unregulated free markets and competition better serve the sick than the state which in my view is appalling.
I just don't think that they don't want government, but that they want their brand of government and to be in a position to benefit enormously for decades to come.