Dubious ranking: US worse than 40 other countries in newborn deaths

[curt656]

"Babies in the United States have a higher risk of dying during their first month of life than do babies born in 40 other countries, according to a new report. "


http://www.msnbc.msn.com/id/44333054/ns/health-childrens_health/

This is one of those things that should not be so here in the US. I do not pretend to know the answers about how to fix our problems. Surely there is a better way. For me, this is the most revealing quote of the article:


"One of the bigger challenges in the U.S. is complications from preterm birth, Lawn said. The U.S. rate of preterm birth is double that of countries in Europe and Northern Africa, she said. Babies who are born preterm need extra care that is often expensive. While there are few things that can reduce preterm birth, she noted that disadvantaged people in the United States may be less likely to receive proper care for preterm infants."


No matter what each of us believe, our lives are the most precious gift that we are given. Money should NEVER be the determining factor of whether or not someone lives or dies.

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[DrArete]

Gini coefficient, look it up

 

[Law2Doc]

"Babies in the United States have a higher risk of dying during their first month of life than do babies born in 40 other countries, according to a new report. ".

it's called faulty logic. A lot of babies make it to term in the US that would not have in less developed nations. So a lot of the ones who don't make it as newborns in the US wouldn't have even been viable pregnancies elsewhere. It's the curse of advanced technology -- we are able to give them more of a chance here than they would have elsewhere. And as a result many don't make it.

 

[phltz]

it's called faulty logic. A lot of babies make it to term in the US that would not have in less developed nations. So a lot of the ones who don't make it as newborns in the US wouldn't have even been viable pregnancies elsewhere. It's the curse of advanced technology -- we are able to give them more of a chance here than they would have elsewhere. And as a result many don't make it.

Do you really think that the reason the US has a higher infant mortality rate than Canada, France, Sweden, Japan, Germany, South Korea, Australia, New Zealand, etc etc is that those countries aren't getting enough prenatal care to women, and they're letting possibly viable pregnancies slip through the cracks? Because that's not even remotely grounded in reality.

 

[EdLongshanks]

Do you really think that the reason the US has a higher infant mortality rate than Canada, France, Sweden, Japan, Germany, South Korea, Australia, New Zealand, etc etc is that those countries aren't getting enough prenatal care to women, and they're letting possibly viable pregnancies slip through the cracks? Because that's not even remotely grounded in reality.

There are several factors here that someone with more a statistics background can explain. Simply quoting a single statistic and acting like it has a simplistic cause would work in a less scientific oriented forum. A peer-reviewed article would require you to list several reasons why your statistic might not be significant.

1) It is not prenatal care, but the extraordinary prenatal interventions that aren't even considered in other countries.

2) Reporting bias. The US tracks this statistic very strictly and punishes hospitals for under-reporting. Other countries are much less careful

3) Drug use by the underclass. The underclass in the other developed countries are immigrants from more conservative third-world nations. For historical reasons, our underclass has different behavior patterns

I've done some statistics reporting work for one of the free clinics in our town, and the difference of infant mortality is not just between the US and other countries, but differs dramatically by zip code and tracks exactly with income. This is correlation, not causation. The factors that make for low income also make for drug use, smoking and drinking during pregnancy, high risk behaviors, etc. (Statistics easily available from you county health department will show this) This is not a simple case of access to medical care. Pregnant women in urban centers in the US have unlimited free access to prenatal care if they can't afford it. They don't seek it. Much of the money in the free medical clinics is spent begging young mothers to come in and get care.

Update:
In our country, we have chosen to give maximum priority to liberty, rather than conformity to the societal ideal. This has some statistically negative results. For example, in the Muslim enclaves of London, a girl who loses her virginity by choice or force, will be murdered by her family and a family that does not conform to this will be persecuted and driven out of the community (or possibly murdered, themselves). Therefore, all babies are born to protected females who are not allowed to smoke, drink or use drugs. This reduces the infant mortality rate. I don't think most Americans would believe that this would be a good trade off.

 

[phltz]

2) Reporting bias. The US tracks this statistic very strictly and punishes hospitals for under-reporting. Other countries are much less careful

Do you honestly think that the reason our stats look worse than, say, Switzerland is that they're playing fast and loose with reporting?

3) Drug use by the underclass. The underclass in the other developed countries are immigrants from more conservative third-world nations. For historical reasons, our underclass has different behavior patterns

I've done some statistics reporting work for one of the free clinics in our town, and the difference of infant mortality is not just between the US and other countries, but differs dramatically by zip code and tracks exactly with income. This is correlation, not causation. The factors that make for low income also make for drug use, smoking and drinking during pregnancy, high risk behaviors, etc. (Statistics easily available from you county health department will show this) This is not a simple case of access to medical care. Pregnant women in urban centers in the US have unlimited free access to prenatal care if they can't afford it. They don't seek it. Much of the money in the free medical clinics is spent begging young mothers to come in and get care.

Bingo. Our worst public health problems all happen before people go to their doctors. If you were going to point fingers here, you'd wear them down to the bone. The fact that our health is so bad is a disgrace does not lie at the feet of just doctors.

OP: I don't think the reason they brought up expense was to suggest that premies should be left out to die if their families are poor and they look like they'll be expensive to treat. It's to highlight the ounce of prevention/pound of cure ratio. Our high preterm labor rate is itself a sign of huge societal ills and public health failings. Taking steps to address that might well pay for itself in other problems prevented.

 

[EdLongshanks]

Do you honestly think that the reason our stats look worse than, say, Switzerland is that they're playing fast and loose with reporting?

Bingo. Our worst public health problems all happen before people go to their doctors. If you were going to point fingers here, you'd wear them down to the bone. The fact that our health is so bad is a disgrace does not lie at the feet of just doctors.

OP: I don't think the reason they brought up expense was to suggest that premies should be left out to die if their families are poor and they look like they'll be expensive to treat. It's to highlight the ounce of prevention/pound of cure ratio. Our high preterm labor rate is itself a sign of huge societal ills and public health failings. Taking steps to address that might well pay for itself in other problems prevented.

If a country does not have a system for mandatory reporting of infant mortality, then the hospitals would be unlikely to make the effort to keep careful records on the issue - that's not playing fast and loose, it's just concentrating on the important. Few countries track newborn deaths as carefully as the US, therefore comparing the count in the US to the count in countries that do not track the statistic is a non-useful statistic.

But, given that, it is still true that the US has higher infant mortality, along with different populations.

The only way to "fix" the problem of infant mortality is to "fix" the culture of the populations that produce them. For some reason (surprising to certain kinds of people) some subcultures don't like to be "fixed" - although they wouldn't be averse to having large amounts of tax money imported into their communities.

 

[theseeker4]

There is one huge problem with these statistics. That being, if a child here is born with a heartbeat, it is counted as a live birth even if the chances of surviving more than a few hours is one in a hundred. In most other countries, if a child is born with very low survivability, (usually the babies born extremely prematurely who we throw everything we have against), they are not counted as a live birth and thus are not counted against the infant mortality rate. Extreme preemies are treated here in ways that amaze our European counterparts, due to the futility of spending tens of thousands of dollars to try to save a baby born several months early with virtually no chance of surviving.

 

[phltz]

There is one huge problem with these statistics. That being, if a child here is born with a heartbeat, it is counted as a live birth even if the chances of surviving more than a few hours is one in a hundred. In most other countries, if a child is born with very low survivability, (usually the babies born extremely prematurely who we throw everything we have against), they are not counted as a live birth and thus are not counted against the infant mortality rate. Extreme preemies are treated here in ways that amaze our European counterparts, due to the futility of spending tens of thousands of dollars to try to save a baby born several months early with virtually no chance of surviving.

Look, no one is saying that the reported numbers are exactly the same as the numbers God has for infant mortality. But I don't think there's anywhere to spin this data that doesn't show us doing surprisingly poorly. To help further put this into context for you, according to the data on Wikipedia, we're in 36th place for life expectancy. Of the 35 countries with better life expectancy than us, 27 of them also have better infant mortality rates. It's not some weird statistical fluke that makes these countries look healthier than us. They are actually healthier than us, in many ways. The differences are not just in the extent to which we're prepared to take heroic steps to try to save a baby that's probably going to die regardless.

It's worth noting that we are fatter than pretty much all of the countries with better infant mortality rates. Maternal obesity and type II diabetes are both big risk factors for babies. One easy step we could take would be to stop pouring huge amounts of money into the corn industry, thereby forcing the price for HFCS down and keeping the price for soda far below it's natural market level. People have the right to buy and drink soda if they want, but it boggles the mind that we're using public resources to subsidize it. Not only would cutting corn subsidies help the public health, but it wouldn't cost anything. It would save money. Last year we spent $3.5 billion on corn subsidies.

 

[blife]

The only way to "fix" the problem of infant mortality is to "fix" the culture of the populations that produce them. For some reason (surprising to certain kinds of people) some subcultures don't like to be "fixed" - although they wouldn't be averse to having large amounts of tax money imported into their communities.

Just curious, which subcultures would that be? Do you like people external to you and your life "fixing" you? Hmm, perhaps I am one of those "certain kinds of people"?

 

[EdLongshanks]

Look, no one is saying that the reported numbers are exactly the same as the numbers God has for infant mortality. But I don't think there's anywhere to spin this data that doesn't show us doing surprisingly poorly. To help further put this into context for you, according to the data on Wikipedia, we're in 36th place for life expectancy. Of the 35 countries with better life expectancy than us, 27 of them also have better infant mortality rates. It's not some weird statistical fluke that makes these countries look healthier than us. They are actually healthier than us, in many ways. The differences are not just in the extent to which we're prepared to take heroic steps to try to save a baby that's probably going to die regardless.

It's worth noting that we are fatter than pretty much all of the countries with better infant mortality rates. Maternal obesity and type II diabetes are both big risk factors for babies. One easy step we could take would be to stop pouring huge amounts of money into the corn industry, thereby forcing the price for HFCS down and keeping the price for soda far below it's natural market level. People have the right to buy and drink soda if they want, but it boggles the mind that we're using public resources to subsidize it. Not only would cutting corn subsidies help the public health, but it wouldn't cost anything. It would save money. Last year we spent $3.5 billion on corn subsidies.

Those corn subsidies were mostly for ethanol. Our ethanol subsidies are raising the price of sugar in the world, not lowering it.

But I'm all for ceasing government subsidies, but are you under the impression that if sodas were 3 times the cost that few americans would be fat? Since the price of the (very very unhealthy) energy drinks are three times the cost of soda, I suspect that raising the price isn't going to change much.

I'm all for people living healthier lives, but most people who talk about getting people to live healthier are talking about government action to MAKE people live healthier, and I have some problem with this. You know, that old problem with the "pursuit of happiness" phrase in our founding document.

 

[Simplify]

Disincentives to drink soda would work about as well as disincentives to smoke cigarettes or drink alcohol. The taxes on these products do little to curb demand and instead they take more money out of the pockets of the poor. Even outright abolition wouldn't work. Where there is a demand the supply will always follow. Look at the history of Prohibition or the so-called War on Drugs for examples.

 

[phltz]

Those corn subsidies were mostly for ethanol. Our ethanol subsidies are raising the price of sugar in the world, not lowering it.

But I'm all for ceasing government subsidies, but are you under the impression that if sodas were 3 times the cost that few americans would be fat? Since the price of the (very very unhealthy) energy drinks are three times the cost of soda, I suspect that raising the price isn't going to change much.

I'm all for people living healthier lives, but most people who talk about getting people to live healthier are talking about government action to MAKE people live healthier, and I have some problem with this. You know, that old problem with the "pursuit of happiness" phrase in our founding document.

On average, Americans are drinking about 45 gallons of soda per year. That's about 24 pounds of fat worth of calories from soda, every year. Given that energy drinks are a much smaller market than soda, it's not unreasonable to think that if soda was more expensive, consumption might drop to something closer to energy drink like levels. On average, Americans are gaining something like a pound a year - the fat just slowly accumulates. Lots of people have a healthy weight at 20, are chunky at 30, getting fat at 40, and unhealthily obese at 50. If soda consumption went down even 10%, you could reverse this, and have people losing a pound or so a year instead of gaining it.

There's a difference between the government intervening to make people healthier, and the government stopping existing interventions that make them unhealthier. In the first case, yes, you've got grounds to make an argument that it conflicts with life, liberty and the pursuit of happiness. In the second case, no such intelligible argument can be made. There are plenty of things we can do in the second category before we go at each other's throats about stuff in the first category.

 

[phltz]

Disincentives to drink soda would work about as well as disincentives to smoke cigarettes or drink alcohol. The taxes on these products do little to curb demand and instead they take more money out of the pockets of the poor. Even outright abolition wouldn't work. Where there is a demand the supply will always follow. Look at the history of Prohibition or the so-called War on Drugs for examples.

Raising the cost of tobacco has a definite impact on how much people smoke.

 

[DrArete]

Raising the cost of tobacco has a definite impact on how much people smoke.

Only to a certain point. After that, it just encourages tax evasion/smuggling. In NYC, cigs are very expensive. I'm not a smoker, but every so often, the smokers would buy their untaxed cigs en masse from someone who came by.

 

[Simplify]

Raising the cost of tobacco has a definite impact on how much [some] people smoke [and little or no effect on others].

Let me fix that for you. Smoking has been on the decline for a long time, and I don't think it has anything to do with how much the government decides to tax it. The waning convenience and societal acceptance of smoking is a much more likely culprit. I have, however, seen a couple hand waving "studies" containing more agenda than science which seem to support your alternate reality.

 

[EdLongshanks]

Let me fix that for you. Smoking has been on the decline for a long time, and I don't think it has anything to do with how much the government decides to tax it. The waning convenience and societal acceptance of smoking is a much more likely culprit. I have, however, seen a couple hand waving "studies" containing more agenda than science which seem to support your alternate reality.

Here is a case where the government has done a massive educational effort that has worked as well as any is likely to. The schools have been turned into propaganda centers against tobacco. I am very anti-tobacco and as a doctor, I suspect that I will do a lot of hand-waving about it. It is setting up to do the same thing with sugar.

I'm a little concerned about this, because tobacco was a single product with undoubted unhealthful effects. But turning the public schools into anti-sugar, anti-salt, anti-high fat, anti-HealthScareOfTheMoment is a little bothersome, considering that the schools need to continue to spend at least a few minutes a day teaching math.

 

[Simplify]

It is a slippery slope, for sure. I also don't think the obesity problem can be solely blamed on sodas, fatty food, etc. When I was younger I spent a lot of time overseas. One thing I noticed is that most food products come in significantly smaller packages overseas. In Thailand, a meal at McDonald's consists of a burger about the size of a White Castle slider and a packet of fries roughly the size of my 4 fingers squeezed together (with a very modest sized soft drink). That is in contrast to the mammoth meals that are available in restaurants stateside. Combine that chronic overeating with increasingly sedentary lifestyles and you have a recipe for the health epidemic we currently have in the United States. We simply eat way too much food and partake in far too little activity.

Here is a funny example. Calorie control can reduce weight even on a junk food diet. Amazing!
http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/index.html

 

[phltz]

Here is a case where the government has done a massive educational effort that has worked as well as any is likely to. The schools have been turned into propaganda centers against tobacco. I am very anti-tobacco and as a doctor, I suspect that I will do a lot of hand-waving about it. It is setting up to do the same thing with sugar.

I'm a little concerned about this, because tobacco was a single product with undoubted unhealthful effects. But turning the public schools into anti-sugar, anti-salt, anti-high fat, anti-HealthScareOfTheMoment is a little bothersome, considering that the schools need to continue to spend at least a few minutes a day teaching math.

Sugar isn't straightforwardly bad in the way that tobacco is, sure. But I think it's easy to underestimate the absurdly massive scale of US sugar consumption. In 2010, we averaged 132 pounds of sugar (including sucrose, HFCS, dextrose, and possible other minor contributors) per capita. That's more than a pound every three days, for every man, woman and child in the country. I'm not eating that much, and I imagine you aren't either, which means a lot of people are eating substantially more.

Is sugar toxic in the same way as tobacco? Not even close. But over 4/5 of a cup of sugar a day is a ridiculously, dangerously, mind-blowingly high amount.

 

[EdLongshanks]

Is sugar toxic in the same way as tobacco? Not even close. But over 4/5 of a cup of sugar a day is a ridiculously, dangerously, mind-blowingly high amount.

My mind is blown at this moment. I drink that much sugar in sweet tea just while typing on SDN!!!! Maybe if they would put a tax on pop, I would drink less tea.

 

[Ortho Guy]

It is a slippery slope, for sure. I also don't think the obesity problem can be solely blamed on sodas, fatty food, etc. When I was younger I spent a lot of time overseas. One thing I noticed is that most food products come in significantly smaller packages overseas. In Thailand, a meal at McDonald's consists of a burger about the size of a White Castle slider and a packet of fries roughly the size of my 4 fingers squeezed together (with a very modest sized soft drink). That is in contrast to the mammoth meals that are available in restaurants stateside. Combine that chronic overeating with increasingly sedentary lifestyles and you have a recipe for the health epidemic we currently have in the United States. We simply eat way too much food and partake in far too little activity.

Here is a funny example. Calorie control can reduce weight even on a junk food diet. Amazing!
http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/index.html

America is fat because of lifestyle and diet.

 

[Simplify]

I know, I said that, right?