I was trying not to go into too much detail in this thread as it's about obamacare, but being as
@Narmerguy asked ... Okay
I apologize in advance for the HUGE amount of text I know I'm going to type.
You're right, the
primary explanation for the disparity in IMR between the US and other developed countries cannot be explained solely by lax record keeping in other countries vs. the US, and by stricter definitions in the US as to what constitutes a live birth vs. in other countries. Although these are an important part of the explanation, it's difficult to quantify exactly how much variation those factors contribute. Also, when studies were done trying to account for as many of those differences as possible, the US's ranking was still lower than we would have expected. We did
better than when we weren't controlling for those variables, but not "good enough."
So, assuming we aren't completely inept, why is the US's IMR ranking low (relatively speaking)? The first thing we need to understand is that IMR is fundamentally different than it was in the past. Throughout most of history, the leading causes of infant mortality were respiratory infections, gastrointestinal infections, and untreatable diseases (like measles). Those factors were compounded by unsanitary living conditions and a lack of proper nutrition. Common sense tells us these were not infant specific problems, but fundamental weaknesses in the structure of society. That was precisely what made the IMR such a good indicator of a nation’s general state of health: infants, being far more susceptible to health hazards than adults, would strongly reflect the health of the entire population. This is why you hear the US's (relatively) low IMR ranking thrown around as a criticism of our country.
Since the beginning of the 20th century, however, society has advanced at an incredible pace. The development of antibiotics, vaccines, fluid and electrolyte replacement therapy, etc., coupled with multiple environmental interventions (access to safe drinking water and proper nutrition, improved sewage and refuse disposal, etc.), have practically eliminated the foremost causes of infant mortality mentioned above. Unsurprisingly, infant mortality rates around the world plummeted to unparalleled lows. America’s IMR dropped approximately 93%, from 100 deaths per thousand live births in 1900, to 6.89 in 2000!
Like I said, IMR is now an intrinsically different problem than it was in the past. Babies are no longer dying en masse from preventable causes that also affect the general population, rather, the overwhelming majority of infant deaths in the developed world are due to infant specific problems like congenital abnormalities, disorders related to short gestation and low birthweight, SIDS, maternal complications, and cord complications.
The two
leading causes of infant mortality in developed countries today are congenital abnormalities and disorders related to short gestation and low birthweight. Out of those two, #1 is congenital abnormalities, however, the prevalence of birth defects in the top twenty countries are all within ten points of each other, and deaths from congenital abnormalities have actually decreased in the United States in recent years. This effectively eliminates congenital abnormalities as the primary explanation for the disparities in IMR between the US and other countries.
The second leading cause of infant death is disorders related to short gestation and low birthweight, and it is here that the primary difference between America and other developed countries becomes obvious. Unlike congenital abnormalities, preterm births in the United States have risen 36% since 1984. The preterm birth rate in the United States is now 65% higher than England’s, nearly double Sweden’s, and
more than double Ireland’s, Finland’s, and Greece’s (all of whom are ranked higher than the US on the IMR chart).
Since there are more preterm births in America, there are more high risk babies, and thus more infant deaths.
The question then becomes:
Why does the United States have such a high percentage of preterm births? Unfortunately, there is no one simple answer. There are multiple known risk factors that contribute to preterm births, and the United States leads in many of them. For example, America ranks number one in obesity rates and number one in teen pregnancies, both definite risk factors for preterm births.
Not all risk factors are due to unsafe lifestyle choices though. Assisted Reproduction Technology has helped many older women and couples who otherwise could not have children to conceive, yet the instances of triplets and higher order births in the United states have quadrupled since it was introduced in 1980. These pregnancies have a much higher risk for preterm and low birthweight delivery, and are known to be one of the major contributing factors to America’s high preterm birth rate.
Another, slightly controversial, contributing factor to the higher percentage of preterm births in America is the prevalence of racial and ethnic minorities. While many of the countries that rank higher on the IMR chart are largely homogeneous, America is arguably the most diverse nation in the world, with immigrants from multiple countries contributing to its makeup and culture. This is a praiseworthy accomplishment, but it is an undisputed truth that certain minorities have higher infant mortality and preterm birth rates.
Some people dismiss these differences in outcomes as purely a socioeconomic issue. They claim it is because these minorities are usually poorer and less educated than other racial/ethnic groups. Sadly, it is not that simple. Researchers studying the global picture of infant mortality have determined that in high income countries like the United States, there was no significant correlation between socioeconomic factors and IMR. Unfortunately, many of the differences in outcomes between races and ethnicities simply cannot be currently explained.
These are only a few of the risk factors for preterm and low birthweight births plaguing American mothers and babies. Many of these risk factors are not present, or are significantly lower in other countries, and that contributes to their lower IMR. It is not that the United States is doing a bad job of protecting its most vulnerable citizens, it is just that the United States has to deal with a considerably larger number of high risk infants than other countries do.
In actual fact, there might not be anything further America can do to meaningfully lower its IMR. Due to all of the inherent risk factors among the population, some experts think the United States might be approaching an “irreducible minimum” in our infant mortality numbers.
Obviously this is an incredibly complex and complicated topic. I just don't like when people casually throw the numbers around and criticize the US / its medical system / everything. Of course we're not perfect, but let's focus on the legitimate complaints rather than the easy but inaccurate "soundbites."
