The US's Infant Mortality Rate Is Abysmal for All But the Wealthiest Americans

A country's infant mortality rate, according to the CIA World Factbook, "is often used as an indicator of the level of health in a country." But the situation isn't necessarily the same across the whole of that country. New research on why infant mortality rates are higher in the United States than in other wealthy countries offers a snapshot of America as the land of unequal opportunities.

The disparity between infant mortality rates in the US and Western Europe is fairly well known. The CIA World Factbook shows that when it comes to the rate of deaths in the first year per thousand births, the US lags well behind much of Western Europe and quite a bit of Central and Eastern Europe, as well as Japan, South Korea, Australia, New Zealand, Israel, French Polynesia, Cuba, and—well, you get the picture. We rank close to Croatia, despite having a nearly three-fold difference in GDP per capita.

But one way to eliminate the gap is to compare just the well-off in each country. True to form with American health care, if you only look at what the rich are getting, it seems like a pretty viable system. For infants born to white, college-educated, married women, mortality rates are "essentially indistinguishable from a similar advantaged demographic in Austria and Finland," according to the study.

So there's your silver spoon lining: the top 25 percent of Americans, as defined by education, marital status, and race can run with the top 25 percent from anywhere. It's the other 75 percent that's being let down.

Now, some contend that the US's high number of preterm births is inflating the infant mortality rate. Finnish babies do, on average, weigh more than American babies, but even looking at just normal birth weight infants, the infant mortality rate is 2.3 deaths per 1,000 births in the US, versus just 1.3 for Austria and 1.5 for Finland.

One instructive thing the study revealed is that when you look at that group of American normal birth weight infants, they're actually slightly better off than their European counterparts for the first month of life, when neonatal care turns into "postneonatal care."

Something like 99 percent of Americans are born in hospitals, and Medicaid finances 40 percent of births in the United States, but it only provides postpartum care for two months after the pregnancy. This study documents that "the US postneonatal disadvantage is driven almost entirely by excess mortality among individuals of lower socioeconomic status," and that this postneonatal disadvantage begins shortly after individuals of lower socioeconomic status leave the hospital.

One other way that the US is a big outlier among wealthy countries is the incredible income disparity. It should come as no surprise that Austria and Finland scored "more equal" on the GINI coefficient, an indicator of wealth equality, than America, where access to health care is tied to income.

"Both Finland and Austria, along with much of the rest of Europe, have policies which bring nurses or other health professionals to visit parents and infants at home," the study states. "These visits combine well-baby checkups with caregiver advice and support. While such small scale programs exist in the US, they are far from universal, although provisions of the Affordable Care Act will expand them to some extent."

Of course the Affordable Care Act was decried as socialism, but sadly has yet to get the same results when it comes to infant mortality rates. The gold standard of infant health, of course, remains those "socialists" in Scandinavia, though even getting the US rate down to that of the communists down in Cuba would be an improvement.

Since this study came from both a medical and economic viewpoint, it also looked at how one might conduct a cost-benefit analysis of lowering the infant mortality rate in America.

The US has three deaths per 1,000 more than Scandinavia. "Aggregating 4 million annual US births and taking a standard value of life estimate of $7 million (as other such studies have estimated it to be it) suggests that reducing the US IMR to that of Scandinavian countries would be worth on the order of $84 billion annually," the authors calculate. "By this metric, it would be 'worth it' to spend up to $21,000 on each live birth to lower the infant mortality risk to the level in Scandinavia."

Looking at infant mortality as a snapshot of our healthcare system is illuminating: For all but the most advantaged of Americans, our healthcare system still doesn't rightfully belong alongside those of other wealthy countries.