Infant Mortality Isn't A True Measure Of A Successful Healthcare

System

Walker Ray, MD and Tim Norbeck ,

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We provide a physician perspective on key U.S. healthcare issues

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The feet of a newborn (FRED DUFOUR/AFP/Getty Images)

The critics of the U.S. healthcare system are quick to point out that our
country does not fare well compared to other high-income countries
when it comes to infant mortality (IM) and healthcare costs.
In the latest reminder of our failures, a 2015 study from the
Commonwealth Fund found that the U.S. spends more on
healthcare than other high-income nations, but has lower life
expectancy, and worse health.

This, and other similar studies, rate the U.S. dead last when evaluated
against Australia, Canada, Denmark, France, Germany, Japan,
Netherlands, New Zealand, Norway, Sweden, Switzerland and the
United Kingdom. Unfortunately, critics everywhere trumpet those
statistics to back up their claim that our health system is inferior,
wasteful and costly.
Why do some analysts use infant mortality (IM) to prove their
point? It is a misleading statistic, at best, to compare the U.S. with the
aforementioned countries. In a 20-year analysis of newborn death
rates around the world, PLOS Medicine, a peer-reviewed weekly
medical journal, calls attention to these misconceptions. The study
says that the leading causes of newborn deaths worldwide are preterm
delivery, asphyxia and severe infection. More than a half million
babies in the United States one in every 8 are born premature each
year, which ranks the U.S. the highest and worst in the world for
premature births (131). In addition, low birth weight is defined as a
birth weight of a newborn infant of less than 2,500g (5lbs, 8oz.), and
the U.S. is ranked the lowest (67) in this category, just behind Kenya.
Other findings from the 20-year study confirm the flaws in these
statistics:
Unlike in the U.S., low birth weight infants are not counted against
the live birth statistics for many countries reporting low infant
mortality rates.
According to the way statistics are calculated in Canada, Germany
and Austria, a premature baby weighing less than 500 grams is not
considered a living child.
In the U.S., very low birth weight babies are considered live births.
The mortality rate of such infants 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. IM
statistics.
Since 2000, 42 of the worlds 52 surviving babies weighing less than
400 grams (0.9 lbs) were born in the U.S.
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. But in the U.S., all infants who show signs of life at birth (take a
breath, move voluntarily, have a heartbeat) are considered alive and
are reflected in our IM statistics.
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 it
does not affect the countrys reported IM rates.
In Switzerland and other parts of Europe, a baby born less than 30
centimeters long is not counted as a live birth. Therefore, unlike in the
U.S., such high-risk infants cannot affect Swiss IM rates.
According to the American Journal of Clinical Nutrition, low birth
weight infants account for much of the increased morbidity, mortality
and costs. Furthermore, low birth weight in general is thought to
place the infant at greater risk of later adult chronic conditions, such
as diabetes, hypertension and heart disease. In other words, low birth
weight not only greatly impacts infant mortality but ones health and
healthcare costs later in life.
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This information is not intended to minimize the problem or impact of

infant mortality, but it is misleading at best for critics of any
healthcare system to use it as an accurate gauge of its success or

failure. Clearly it is an apples to oranges argument, and the only good

measure of IM stats would be if all countries around the world
conformed to the same collecting and reporting measures. Clearly they
dont even come close, and we, along with many others, are very tired
of these time-worn and invalid comparisons. Unfortunately, it is
evident that people start believing them if they are utilized often
enough.
The U.S. standing in infant mortality, regardless of the reporting
inaccuracies and differences in country comparisons, should not be
taken lightly. We must work toward improving IM stats, however, the
problem has little to do with the healthcare rendered and has
everything to do with social issues. For example, improving education
for young mothers who lack prenatal care is a priority. And, as the
PLOS study notes, we must make a bonafide effort to address the
epidemic of babies having babies. That, in and of itself, would go a
long way to lowering our infant mortality rate, increase life expectancy
and have a direct impact in providing better health outcomes and
lower health care costs for todays infants and future adults.
Action expresses priorities, said Gandhi, and we must put our
collective energies into solving the real problem of infant mortality
instead of taking the easy and convenient route of just blaming it on
our healthcare system. The stats will never change as long as we ignore
their real causes.
Our next post will deal with the issue of life expectancy, and
how the U.S. really compares with other countries
APR 12, 2016 @ 05:17 PM