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July 8, 2009Health Myth #1: “The U.S. has one of the highest infant mortality rates in the developed world.”
This is the first in a series of commonly reported, and even more commonly believed, health myths. This series is based upon the research from Fox News analyst James Farrell.
More Information:
Talk about stretching a point until it snaps. This ranking is based on some very flawed data and assumptions.
The U.S. ranks high on this list largely because this country numbers among those that actually measure neonatal deaths, notably in premature infant fatalities, unlike other countries that basically leave premature babies to die, notes health analyst Betsey McCaughey.
Other statistical quirks push the U.S. unjustifiably higher in this ranking compared to other countries.
The Center for Disease Control says the U.S. ranks 29th in the world for infant mortality rates, (according to the CDC), behind most other developed nations.
The U.S. is supposedly worse than Singapore, Hong Kong, Greece, Northern Ireland, Cuba and Hungary. And the U.S. is supposedly on a par with Slovakia and Poland.
CNN, the New York Times, numerous outlets across the country report the U.S. as abysmal in terms of infant mortality, without delving into what is behind this ranking.
The Commonwealth Fund, a nonprofit research group, routinely flunks the U.S. health system using the infant mortality rate.
“Infant mortality and our comparison with the rest of the world continue to be an embarrassment to the United States,” Grace-Marie Turner, president of the Galen Institute, a research organization, has said.
First, let’s start with the definition. The World Health Organization (WHO) defines a country’s infant mortality rate as the number of infants who die between birth and age one, per 1,000 live births.
WHO says a live birth is when a baby shows any signs of life, even if, say, a low birth weight baby takes one, single breath, or has one heartbeat. While the U.S. uses this definition, other countries don’t and so don’t count premature or severely ill babies as live births-or deaths.
The United States counts all births if they show any sign of life, regardless of prematurity or size or duration of life, notes Bernardine Healy, a former director of the National Institutes of Health and former president and chief executive of the American Red Cross (Healy noted this information in a column for U.S. News & World Report).
And that includes stillbirths, which many other countries don’t report.
And what counts as a birth varies from country to country. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) before these countries count these infants as live births, Healy notes.
In other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long, Healy notes. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless, and are not counted, Healy says.
And some countries don’t reliably register babies who die within the first 24 hours of birth, Healy notes.
Norway, which has one of the lowest infant mortality rates, shows no better infant survival than the United States when you factor in Norway’s underweight infants that are not now counted, Healy says, quoting Nicholas Eberstadt, a scholar at the American Enterprise Institute.
Moreover, the ranking doesn’t take into account that the US has a diverse, heterogeneous population, Healy adds, unlike, say, in Iceland, which tracks all infant deaths regardless of factor, but has a population under 300,000 that is 94% homogenous.
Likewise, Finland and Japan do not have the ethnic and cultural diversity of the U.S.’s 300 cm-plus citizens.
Plus, the U.S. has a high rate of teen pregnancies, teens who smoke, who take drugs, who are obese and uneducated, all factors which cause higher infant mortality rates.
And the US has more mothers taking fertility treatments, which keeps the rate of pregnancy high due to multiple-birth pregnancies.
Again, the U.S. counts all of these infants as births. Moreover, we’re not losing healthy babies, as the scary stats imply. Most of the babies that die are either premature or born seriously ill, including those with congenital malformations.
Even the Organization for Economic Cooperation and Development, which collects the European numbers, cautions against using comparisons country-by-country.
“Some of the international variation in infant and neonatal mortality rates may be due to variations among countries in registering practices of premature infants (whether they are reported as live births or not),” the OECD says.
“In several countries, such as in the United States, Canada and the Nordic countries, very premature babies (with relatively low odds of survival) are registered as live births, which increases mortality rates compared with other countries that do not register them as live births.” (Note: Emphasis EMac’s).
The U.S. ranks much better on a measure that the World Health Organization says is more accurate, the perinatal mortality rate, defined as death between 22 weeks’ gestation and 7 days after birth.
According to the WHO 2006 report on Neonatal and Perinatal Mortality, the U.S. comes in at 16th-and even higher if you knock out several tiny countries with tiny birthrates and populations, such as Martinique, Hong Kong, and San Marino.
Here are the topics for the entire series:
- Health Myth #1: “The U.S. has one of the highest infant mortality rates in the developed world.”
- Health Myth #2: “About 46 million Americans lack access to health insurance.”
- New Analysis of the Myth: “46 Million Americans Without Health Insurance”
- Health Myth #3: “The uninsured can’t afford to buy coverage.”
- Health Myth #4: “Most of the uninsured do not have health insurance because they are not working and so don’t have access to health benefits through an employer.”
- Health Myth #5: “The estimated 45 million people without health insurance lacked health insurance for every day of the year.”
- Health Myth #6: “Government-run universal health care would increase the international competitiveness of U.S. companies.”
- Health Myth #7: “The cost of uncompensated care for the uninsured significantly increases hospital costs.”
- Health Myth #8: “Nationalized health care would not impact patient waiting times.”
- Health Myth #9: “Insurers cover less today than they did in the past.”
- Health Myth #10: “Preventive Medicine Saves Money”
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Dr Walt’s philosophy: Solve the problem by ignoring the problem.
Fred,
I’m not ignoring the problem at all. In fact, I’ve delivered over 1500 babies in my career and devoted much of my academic time to teaching residents and students how to care for the unborn child and the pregnant mom and the father of the baby just to reduce infant morbidity and mortality. For years I served on the ALSO (Advanced Life Support in Obstetrics) Board to educate my colleagues in reducing perinatal and newborn morbidity and mortality. And, I’ve written a number of articles and medical textbook chapters on the topic.
So, no ignoring here.
But also, no artificial inflating of numbers to make my country or my colleagues look bad either. And, that was the purpose of exposing this myth – to educate the public about the real problem, not an invented one.
Can we improve? I think so!
Should we improve? I think so!
Will we improve? I hope so!
Dr. Walt
Thanks Dr. Walt for that insight. Maybe you could comment on life expectancy. It is thrown around quite a bit lately that we rank around 50th in life expectancy. I looked at the CIA Factbook website (where the USA ranks 45th)and the top 10 in LE were Asian countries that have a better diet of fish and less red meat. When you drop out those 10 the next 35 are fairly close to the USA by mere months. I beleive the reason we do not have a higher life expectancy is because we are probably ranked first or near first in:automobile deaths, drug and alchol related deaths, obeisety related deaths, and homicide (in a developed country)It seems to me that it is because of our culture we are not ranked higher rather than because of a lack of excellent health care. Your comments please.
I think you’re spot on, Steve. And, obesity is sure a big one (pun intended). A recent report estimated 10% of healthcare spending was on obesity-related illness.
I spent the first 30 years of my life growing up in England. There are some things to consider about how “good” a health care system is. Just because we have the best capacity for health care in America does not mean that it is available to most people. As long as our health care is run so that people make a lot of money then the emphasis will not be on prevention. Drug companies want patients to be on their product for as long as possible… that’s business. It’s often an incentive for a doctor to choose a more expensive procedure so they can make more money.. ie chemotherapy for prostate cancer verses ultra sound therapy. Our system is focused on treating sick people not making people healthy. In Britain the system covers everyone. Those who want better service can buy supplemental insurance, those who can’t can always get treatment… but nobody loses their life savings to pay for it.
The only people in this country who don’t want universal health care are people who are worried about themselves and their money… it’s always about their money… such a lovely Christian value… what would Jesus do!
Dr. Walt so easily busts those myths without facts. Those other countries can’t count. Only the U.S. can count. Does Dr. Walt really exist? I’d prefer my physician to rely on science. How convenient the timing of his baseless conclusions. Let me guess, Dr. Walt does not want real health care reform and he thinks it’s a myth that health insurance companies make profits by letting people pay high premiums for high deductibles and limited coverage resulting in early deaths of many of us. He probably has some unsubstantiated or anecdotal evidence for that too. He’s brilliant!
Renee, keep reading darling. And, be sure to keep drinking that Kool-Aid! BTW, if you have any facts you wish to discuss, bring them on. My bet . . . you don’t.
Gareth, you say, that in England, “nobody loses their life savings to pay for it.” But, they may loose their life because of it.
As Newt Gingrich has pointed out, ” . . . as in the British system, once government becomes the single payer or even the main payer of health care, what were once intensely personal decisions become public decisions. And as costs rise, government will look for ways to contain them.
“The inevitable result of this pressure to control costs will be rationing, whether it occurs during this administration or the next. At some point, the government will be forced to deny care to those who don’t meet the latest ‘quality-adjusted life years’ cost-benefit analysis.
“So the decision on what treatment to pursue that once would have been made by you and your doctor is now made for you by a bureaucrat using a formula – a formula to literally determine if your life is worth saving.
“The British health care was nationalized soon after World War II, but NICE, the health care rationing agency, wasn’t created until the late 1990s as a way to control costs.
“Today NICE routinely denies Britons life-prolonging drugs that are deemed not ‘cost effective’- drugs that are widely prescribed in America to treat cancer, Alzheimer’s disease and other serious conditions.
“The result, studies show, is that Great Britain’s cancer survival rates are among the worst in Europe and lag behind the United States.”
Gareth, you write, “The only people in this country who don’t want universal health care are people who are worried about themselves and their money …”
Not true. I’m concerned about my patients and their families. And, I happen to think that’s how Jesus thinks.
Renee,
everything Dr. Walt presented is completely verifiable. Each of these countries has published standards for how they gather data and produce statistics. Where, pray tell, are facts lacking in that? You’ve offered only mere naysaying as opposed to a reasoned argument.
Gareth,
the greedy doctor claim is just silly. Any doctor looking to earn more can simply increase his caseload to the limits of his ability to manage. Far too many already do so, not out of greed but because they genuinely believe in their work and don’t like to turn anyone away. Numerous accounts have portrayed as a common problem among young ER physicians the need to be forced to leave when their shift ends, rather than making a dire mistake due to exhaustion. These people don’t endure long years of study and training to just walk away from suffering.
A person looking to enter medicine primarily for financial gain isn’t likely to go into fields like family practice or oncology. Shoving bags of silicone into womens’ chest is far more lucrative than dealing with genuine ailments of a non-aesthetic nature.
Dr. Walt,
I think it is interesting that instead of factoring in all of variations in which other countries measure infant mortality to develop your own ranking you remain somewhat vague with single point comparisons. I understand this would take a great deal of effort and may not be entirely necessary, since you conclude the article with rankings of Neonatal and Perinatal Mortality. Although this brigns up another question since you say it is a myth that “The U.S. has one of the highest infant mortality rates in the developed world.” how would you describe our N and P Mortality rate? maybe “The US, though not in the top 15 in terms of infant Mortality even in a more flattering and less widespread analysis of the problem, is still pretty good” or “We aren’t really worse than Singapore” ?
Do you agree with Ms. McCaughey that “other countries that basically leave premature babies to die”
Hi Keith. Appreciate your note and wish there was the data available to answer your question. (As an aside, if anyone knows if there is such data, please let me know).
Here are some of the details you need to know to understand the facts that destroy this myth. These come from Bernadine Healy, MD, in her U.S. News and World Report column of 2006:
First, it’s shaky ground to compare U.S. infant mortality with reports from other countries.
The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths.
In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long.
In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don’t reliably register babies who die within the first 24 hours of birth.
Thus, the United States is sure to report higher infant mortality rates.
For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country.
Infant mortality in developed countries is not about healthy babies dying of treatable conditions as in the past.
Most of the infants we lose today are born critically ill, and 40 percent die within the first day of life.
The major causes are low birth weight and prematurity, and congenital malformations.
As Nicholas Eberstadt, a scholar at the American Enterprise Institute, points out, Norway, which has one of the lowest infant mortality rates, shows no better infant survival than the United States when you factor in weight at birth.
Look at Iceland. It uses the same standards as we do. But it also has a population under 300,000 that is 94 percent homogenous, a mixture of Norse and Celts.
Similarly, Finland and Japan do not have the ethnic and cultural diversity of our 300 million citizens.
Even factoring in education and income, Chinese-American mothers have lower rates, and African-Americans higher, than the U.S. average.
Environment matters as well. Lower infant mortality tracks with fewer teen pregnancies, married as opposed to single mothers, less obesity and smoking, more education, and moms pregnant with babies that they are utterly intent on having.
As to whether “other countries that basically leave premature babies to die,” I have no doubt that in areas where there is no NICU care, that this happens.
Hope this helps.
Dr. Walt
Dr. Walt,
After hearing Tony Blankley make the claim that Europeans have similar life expectancies as those in the US if infant mortality is not considered, I started poking around and found your site. You are making a different but related argument – that our infant mortality rate is similar when certain types of births are not considered (since they are not considered equally in all countries). I haven’t found the WHO sorted ranking yet that shows the US at #16, but I did look over the (very long) report at http://www.who.int/making_pregnancy_safer/publications/neonatal.pdf which shows rates (per 1000) of perinatal death, stillbirth, early neonatal death and neonatal death. If I had time I could copy this table to a word processing doc, convert the spaces between numbers to tabs and paste it into a spreadsheet and then I could sort on any of these rates, but just taking US and France (a country that often ranks near the top of WHO health care rankings), the numbers are:
France 7,5,2,3
US 7,4,4,5
which is pretty close but France seems to be doing better.
I maintain my position as a steadfast single payer supporter (I’d be amenable to state employed doctors as well as in the U.K., but that seems even more out of the realm of possibility) since I don’t think any amount of reform is capable of getting insurance companies to behave as they should. The financial ruin they’ve caused many a family here in the US is reason alone to get rid of them, but then there is also the fact that our ridiculous way of funding health care in the US through your employer not only reduces choice (e.g., I could not find an insurance option to cover previous doctor’s used for me, my wife, and our kid), but makes us less competitive in the world market. It’s laughable that so many of our politicians that have excellent government funded insurance can criticize it when the rest of us want it. We need to vote all these hypocrites out of office – Republican or Democrat. However, I’m not beyond compromise, so if a public option with a strict set of regulations for the private plans is ultimately where we end up, I’ll support that. Anything less than that is probably worthless and I’m very happy progressive Democrats are finally showing some spine and saying they will vote against it.
Finally, I agree with you that there can be dominant cultural factors influencing mortality (what and how much we eat, dangerous behavior like teen pregnancy, etc.), but I think you should be careful in arguing that the more ethnically homogeneous countries are somehow at an automatic advantage on these cultural factors. Not only is it offensive to many people (including me), but the science behind most of these arguments is flawed.
Dara Parsavand
Dr. Walt,
Just an FYI…you don’t deliver babies, you assist. Mothers deliver babies and I think that’s part of the problem here. Many people use the statistics that show the US ranks 48th in infant mortality to prove a point…that care needs to improve with respect to the alarming rate of unnecessary c-sections and giving women the power to give birth naturally without intervention which would improve the mortality rate. Some of these deaths could have been prevented if a c-section wasn’t used and our rate of c-section keeps going up every day. The WHO recommends a c-section rate of between 10-15%; however, the US is at or above 33%! That’s twice the recommended rate and is also killing some babies.
Dr’s need to step back and calm down when it comes to birth. Women have been delivering their babies for centuries! This country really needs to go back to using midwives for normal, low-risk births, and only using Dr’s for high-risk pregnancies and that doesn’t mean we should increase the diagnoses for high-risk pregnancies. Let women have their babies normally and naturally, getting them off their backs for delivering and educating them that our bodies were designed to give birth and that the traditional methods used in hospitals to give birth are contributing to the problem.
Dr. Walt you say, “As Newt Gingrich has pointed out, ” . . . as in the British system, once government becomes the single payer or even the main payer of health care, what were once intensely personal decisions become public decisions. And as costs rise, government will look for ways to contain them.”
How is this different than the U.S. system where intensely personal decisions are made by insurance executives instead of a patient and their doctor? The profit motive of insurance companies is first and foremost in deciding whether someone in the U.S. gets the care their doctor prescribes or if they even get coverage at all.
Hi Stephanie. Thanks for your note. And, to answer your question, the difference between a government-run healthcare system and a private system is huge.
Here’s the bottom line of how it works in Europe and what O’Bama and others want to implement here: The federal government will decide your medical treatment with COST being the main consideration.
Tom Daschle argued in his book that instead of treating seniors, they will have to become more accepting of the conditions that come with age!
Betsy McCaughey, former Lieutenant Governor of New York and a health care analyst, points out that this socialized medicine approach would be disastrous.
For example, in 2006, in England, the health care board ruled that elderly citizens with macular degeneration could not receive treatment with a new drug until they were blind in one eye! It took three years of public protests to reverse the policy. But that was just the tip of the iceberg.
Last year, one thousand British doctors were fighting hard to reform Britain’s health care system because that “progressive” nation also has one of the highest cancer mortality rates in Europe. Why? Because some bean counting bureaucrats in the basement of the British Health Department decided it isn’t “cost effective” to treat cancer patients.
Like Nancy Pelosi trying to justify birth control in the stimulus bill, the Left sees people as a burden to Big Government’s bottom line.
Consider this irony. A powerful politician who has long championed government health care had a seizure last year. In Canada or Great Britain, “average Joes” might have to wait weeks for an MRI. Not this politician. In a couple of days, he was diagnosed with a rare form of malignant brain cancer.
Unlike “average Joes” in Canada and Great Britain, this politician didn’t have to wait months to see a specialist. Within two weeks of his seizure, he was treated by some of the world’s foremost experts on brain cancer.
The free market, while flawed, is still the best system man has devised.
There’s definitely room for improvement, but I’m equally sure that government isn’t the solution.
The Europeans and Canadians flocking here to get health care denied them by their socialist governments obviously agree. But where will Americans flee under Obama’s new socialist order?
Good point, Elizabeth. My bad. To be accurate, I’ve attended the births of over 1500 babies – and am honored to have done so.
I’ve also been a strong advocate of patient- and woman-centered birthing. In one of my more popular articles, “Keeping Normal Labor Normal,” (http://www.ncbi.nlm.nih.gov/pubmed/10739466?ordinalpos=19&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum), I wrote:
Labor and delivery have been viewed by physicians as processes that can and must be managed by physicians for their pregnant patients. This article asserts that most births do not need to be interventionally managed and that a birth attendant’s highest order skill is knowing when and how not to intervene. Further, the article looks at what birth interventions are likely to keep normal labor normal. The authors propose a new paradigm: The 10 “P’s” of keeping normal labor normal.
A timely article in the Canadian Medical Association Journal yesterday (8/31) asked the question, “ARE HOME BIRTHS JUST AS SAFE AS HOSPITAL BIRTHS?”
The researchers found that planned home births with registered midwives were as safe as hospital births.
Now, given that this was not a randomized study, self-selection could be playing a large role and the results should be interpreted cautiously.
Nevertheless, they found that women who planned a home birth had a significantly lower risk of obstetric interventions and adverse outcomes including augmentation of labor, cesarean section and infection.
Women birthing at home had similar or reduced outcomes for adverse maternal outcomes.
But, you’ve given me an idea. I think I’ll blog about my “10 P’s of Keeping Normal Labor Normal.”
Thanks for the note.