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

[spanone]

South Korea, Cuba, Malaysia, Lithuania, Poland and Israel all outrank the U.S.

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.
Some of the countries that outrank the United States in terms of newborn death risk are South Korea, Cuba, Malaysia, Lithuania, Poland and Israel, according to the study.
Researchers at the World Health Organization estimated the number of newborn deaths and newborn mortality rates of more than 200 countries over the last 20 years.
The results show that, while newborn mortality rates have decreased globally over that period, progress to lower these rates has been slow, the researchers said.

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

[nadinbrzezinski]

1. Well it helps

when you have as policy baby well visits.. oops they benefit from a single payer... SOCIALIST, system.

[RKP5637]

2. This country is working hard, very hard, to be #1 at the bottom in

just about everything.

[nadinbrzezinski]

5. But, but, but WE ARE NUMBER ONE!

why do you hate Murika?

:hi:

[roguevalley]

11. I heard it went up 43% in the pacific northwest right after the new

years and everyone being broke.

[murphyj87]

3. The United States lags way behind the developed world......

No only in infant mortality. The United States lags way behind the rest of the developed world in maternal mortality, and overall lifespan as well. A handful of Americans have adequate health care. Every single person in the rest of the industrialized world is guaranteed whatever health care they need.

Canadians, for example, live an average of four years longer than Americans.
Canada has an infant mortality rate which is 81% that of the United States.
Canada has a maternal mortality rate which is 50% that of the United States.

2 million Americans come to Canada each year to get the health care they are denied by the insurance company bureaucrats wedged between Americans and American physicians.

One in every five people admitted to the hospital here are Americans.

[nadinbrzezinski]

4. And while I hear from my brother

he is a doctor... fo the Canadians who fall through the cracks who go to see him... I tire of reminding him that yes people fall through cracks. In Canada it is less than 5%... in the US, last time i checked, and these are published figures... it is 45 million souls. I suspect those numbers are higher now. I would not be shocked if the numbers reach over 60n, which is about one third of the population.

For the record I could see how he gets to see a few canucks. What he treats is not easy... so they may not fall through cracks but Health Canada sometimes does pay for care abroad.

And I used to be a medic in Tijuana... and every patient that fought me going to the hospital, almost, every patient... was an American who did NOT have insurance. They were surprised as hell though when they learned the Red Cross don't charge for the service... our billing department was a donation box at the door. No, I am not kidding. Running a hospital that way has it's issues, take my word on this... but we did not charge. And at times we TRANSPORTED to US Hospitals to save families oh 5K buckaroos from an international transport that the insurance would not pick up, or after we arranged to have social workers meet us at the ER... for real charity cases. Oh did I mention this was in the late 80s and early 90s? My partner is still doing this and it has only gone up. Of course anecdotally we also had a few diabetics who came to OUR ER once a month for care... from oh Chula Vista and San Isydro...

[murphyj87]

20. It is correct that ...

For any Canadian who LEGITIMATELY needed treatment in the US (and there are very few - A HANDFUL each year) all treatment is paid by the province that the patient comes from, just as if it were in Canada. Most Canadians who go to the US for treatment are those who think they are sicker than THEIR OWN PHYSICIANS determine them to be. Those Canadians who "fall through the cracks" as you claim, are these hypochondriacs who would be treated in Canada if they were as ill as they claim they are (and which their own physicians have found them not to be) or people deluded into the false thinking that they would get better treatment in the US (which they do not). No educated Canadian would go to the US for treatment. Treatment in Canada for rich or poor, young or old is far superior to what the majority of Americans have in the United States, and the medical outcomes in Canada are equal to or in many cases better than those in the United States. Only an uneducated Canadian would go to the US for medical treatment. No educated Canadian would go to the US for any of the inferior health care that Americans have.

We identified 38 studies comparing populations of patients in Canada and the United States. Studies addressed diverse problems, including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies that included extensive statistical adjustment and enrolled broad populations, 5 favoured Canada, 2 favoured the United States, and 3 showed equivalent or mixed results. Of 28 studies that failed one of these criteria, 9 favoured Canada, 3 favoured the United States, and 16 showed equivalent or mixed results. Overall, results for lower mortality favoured Canada by 5%.

Gordon H. Guyatt, MSc, MD

One out of five people admitted to this Canadian hospital here are Americans, and 2 million Americans a year come to Canada from the United States to get the health care they are denied by the insurance company bureaucrat wedged between Americans and their physicians.

Large numbers of Americans have to come to Canada for any treatment, but particularly for cancer treatment, because they can't afford or are denied the treatment the need in the United States.

Liberal MP Carolyn Bennett, who is also a doctor, said the Palin family’s story is not unique {of Americans coming to Canada for health care in preference to American health care}.

“Certainly as a family doctor I treated lots of Americans {coming across the border from the U.S. for Canadian health care}.”

When she testified before a U.S. Senate committee in September, Bennett told the story of U.S. Vietnam veterans who had to go to Canada for cancer treatment because they couldn’t afford medical care in the country they fought for.

Bennett said Palin should bear in mind the high cost of medical care is a leading cause of bankruptcies in the U.S.

“Criticizing our system isn’t helping her fellow Americans.”

{The Canadian single payer health care system was instituted January 1, 1966, when Sarah Palin was 22 months old}

[nadinbrzezinski]

22. I know and he gets to treat some of those patients

Chrohns can be stubborn. While there are very good doctors in Canada at times he gets a really stubborn case.

While I trained in history health policy is a side interest. As an aside north America has three very different medical systems...a single payor with extremely limited insurance...things like private rooms...a "free market system," and a poorly funded hybrid. Sad but outcomes in the poorly funded hybrid are as good as the free market one. In a few respects even better. That should be a lesson to the pure market with very little single payor. Gets worst, when you compare outcomes in the single payor section of it, tricare and Medicare, they do better than in the dominant private system.

No, don't expect our politicos, in the care of the single payor, to want to share...

[Mimosa]

14. Nadia, there you go again, professional 'leftist'!!

Spank you! ;)

[nadinbrzezinski]

16. I know, I know, bad me

I do not bow to the caricature of the free hand of the market place enough!

[joshcryer]

6. There's been shown a tie between infant mortality and obesity.

I think it applies here.

[cherokeeprogressive]

7. 196 countries in the world.

I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States. I hate the United States.

Okay, I tried repeating it thinking if I repeated it to myself it might become true.

Not working.

http://geography.about.com/od/countryinformation/a/capitals.htm

[spanone]

9. but only one 'super power'....i love the u.s. we can do better

[cherokeeprogressive]

10. We can. I wholeheartedly agree.

"super power" is a term that I apply to military might. We are NOT the only "super power". We are but one out of 196 countries, and we rank in practically in the first quartile, and given the differences in record keeping between different countries we rank higher than that.

Yes we can do better. There are individual citizens who are working their fingers to the bone to do just that. Your post doesn't intend to disrespect those people, but it does.

[nadinbrzezinski]

13. Actually we are no longer a superpower

but a shell of one. This is one of the signals...

[cherokeeprogressive]

18. The word superpower refers to military might, and that went out the window with the advent of

guerilla warfare.

No uniformed military will ever win another war, and that has been true since Korea. The US made quick work of The Republican Guard and the Taliban, and after that lost thousands of troops to guerillas. Bush #1 boasted about his 100 hour ground campaign. What followed was decades of guerilla warfare that still hasn't seen "victory".

[nadinbrzezinski]

21. It goes well beyond the military

If your economy can't sustain it...well ask the Soviet Union.

[spanone]

19. superpowers - opinions differ

The criteria of a superpower are not clearly defined<2> and as a consequence they may differ between sources.
According to Lyman Miller, "The basic components of superpower stature may be measured along four axes of power: military, economic, political, and cultural (or what political scientist Joseph Nye has termed “soft power”).<1>

In the opinion of Kim Richard Nossal of Queen's University, "generally this term was used to signify a political community that occupied a continental-sized landmass, had a sizable population (relative at least to other major powers); a superordinate economic capacity, including ample indigenous supplies of food and natural resources; enjoyed a high degree of non-dependence on international intercourse; and, most importantly, had a well-developed nuclear capacity (eventually normally defined as second-strike capability)."<2>

In the opinion of Professor Paul Dukes, "a superpower must be able to conduct a global strategy including the possibility of destroying the world; to command vast economic potential and influence; and to present a universal ideology". Although, "many modifications may be made to this basic definition".<26> According to Professor June Teufel Dreyer, "A superpower must be able to project its power, soft and hard, globally."<27[br />
http://en.wikipedia.org/wiki/Superpower

[Yo_Mama]

8. Some of this is due to the way infant deaths are counted

A lot of countries don't count early prematures that had no chance of survival. That raises the US death numbers.
http://en.wikipedia.org/wiki/Infant_mortality#Comparing_infant_mortality_rates

[Harmony Blue]

12. A lot of RW have used this argument before

reality is, even if we take that into consideratoin the Untied Sates is still way behind all other Western Democracies in the world.

[nadinbrzezinski]

15. You know them crazy socialists south of the border

do a thing we really don't do here... and I will use that one as an example. When was the last time you heard of a national vaccination campaign for the kids? You know where you go park at malls and provide the vaccines right there? That is an example of a policy decision that we decided to let the free market cover. And that is one of the reasons for that. You also forget that infant mortality also incudes deaths in the first two years of life.

Of couse we have to content with idiots who refuse to vaccinate them kidos... and I had to get a boster for whooping cough because of that idiocy, but that is another story.

[moc]

24. To a certain extent, you are correct.

The paper I use in class when I talk about this issue is Kramer et al., Paediatric and Perinatal Epidemiology 2002, 16 (1), 16-22. The issue has to do with babies born at the limit of viability. The official WHO definition is that a live birth is any product of conception that shows signs of life regardless of gestational age. However, how the definition of a live birth is implemented by a jurisdiction or by a specific doctor in the delivery room can be very different. A 19w spontaneous abortion with a pulsation of the umbilical cord may fit the official definition of a live birth, but every OB I know would declare it a fetal loss. Fetal losses are not counted in the IMR. So, you are correct, if the U.S. is more likely to count a particular case as a live birth vs. another country being more likely to declare it a fetal loss, then this would inflate the IMR in the U.S. relative to other countries.

You can address this bias in two ways. You can exclude infants born weighing below a certain birth weight (usually 500g). When you do that, there are still disparities in the U.S. IMR. You can also calculate a perinatal mortality rate which includes fetal losses after 27 weeks. That way, whether an infant is counted as a live birth or fetal loss doesn't bias the overall estimate. The U.S. looks bad again in this approach with higher perinatal mortality rates.

The other thing is that the IMR for African Americans in the U.S. is 2.5 times that of white infants. Unless you are willing to believe that AA infants at the viability are more likely to be declared a live birth and white infants more likely to be declared a fetal death, it's hard to get around the disparity.

Anyway you cut it, we have nothing to be proud of as a country when it comes to ensuring the well-being of the most vulnerable among us.

Hope this helps.

[Yo_Mama]

25. I agree

The study cited is a guesstimate, because they simply don't have one-month data to work from.

One of the issues in the US is that we have much higher infant mortality among certain populations.

We also have other social ills, like drug addiction. Low birth weight infants are particularly at risk. The preterm birth issue I think is real, because the CDC thinks so:
http://www.cdc.gov/nchs/data/databriefs/db09.htm

In 2005, 68.6% of all infant deaths occurred to preterm infants, up from 65.6% in 2000.

Very preterm infants accounted for only 2% of births, but over one-half of all infant deaths in both 2000 and 2005. Because the majority of infant deaths occur to very preterm infants, changes in either the percentage of these infants or in their infant mortality rate can have a large impact on the overall infant mortality rate.

The infant mortality rate for very preterm infants was 183.24 infant deaths per 1,000 live births in 2005, not significantly different from the rate in 2000 (180.94), halting a long-term decline (1,2).

The plateau in the U.S. infant mortality rate from 2000 to 2005 was largely due to the combination of the increase in the percentage of very preterm births and the lack of decline in the infant mortality rate for these births. However, the increase in the percentage of late preterm births has also had an impact. In 2005, the infant mortality rate for late preterm births was three times that for term births (37-41 weeks) (1)

One interesting aspect of the US failure to make progress is that premature birth rates are much higher among women of African genetic heritage, and it probably isn't due to anything in the US, because the rates between the UK and US are very comparable for this group.

Here's a study on the issue - we need to do more work on this. If we could find an address the causes of this excess premature birth rate, our infant mortality rate would look much more like that of Sweden.
http://www.emekmed.com/pictures/files/Epidemiology%20and%20causes%20of%20preterm%20birth.pdf

I've read studies attributing premature births to everything from stress to smoking, but at least in the US, black women have lower smoking rates than other groups with much lower premature birth rates. The huge disparity in preterm birth rates is very frustrating, and it is worth while putting a lot more money into it:

In the USA and in the UK, women classified as black, African-American, and Afro-Caribbean are consistently reported to be at higher risk of preterm delivery: preterm birth rates are in the range of 16–18% in black women compared with 5–9% for white women. Black women are also three to four times more likely to have a very early preterm birth than women from other racial or ethnic groups.22,23 Part of the discrepancy in preterm birth rates between the USA and other countries might be explained by the high rate of preterm births in the USA black population. Over time, the disparity in preterm birth rates between black and white women has remained largely unchanged and unexplained, and contributes to a cycle of reproductive disadvantage with far-reaching social and
medical consequences.24

[moc]

29. You are absolutely correct; the core issue is reducing PTB.

I think estimates I've seen has put the increase in PTB at 20% over the last 10 years. Virtually all the reduction in infant mortality we've seen in the last 40 years has been due to reductions in birthweight specific mortality rates, e.g., better NICU technology to improve survival of very small infants. In other words, we're better at saving small babies but we have not figured out how to reduce the number of them that are born in the first place. Figuring out how to decrease PTB, especially those before 32w, is critical for reducing IM in this country.


If you are interesting in more information on preterm birth, I highly recommend the IOM report from a couple years back: http://www.nap.edu/openbook.php?isbn=030910159X.

Take care.

[slipslidingaway]

17. And the Dems, Clinton and Obama, blocked discussion of health care for all...

they did not even advance the issue while while making concessions to the for profit companies.

Rather disgusting :(

[no_hypocrisy]

23. Hypocrisy. States "regulating" abortions to the point of banning any facility that

performs them yet allows the babies to die once they're born.

[Yo_Mama]

26. It's not "allowing" babies to die once they're born

In general, most infants get good medical care, and imperiled infants get very good medical care in hospitals.

Most of the deaths are correlated with population factors for premature births.

Now, why we can't get off our duffs and really study this, I can't imagine. It's a very real problem. It's mostly confined to one demographic, which hasn't been well studied and is poorly understood. So we don't have a clue as to causation.

And it has very far reaching implications. For example, in the US at least, African-American children have higher disability rates. But when you look at the higher rates of preterm births, that is hardly surprising.

Edit: Here's one link to substantiate that:
http://www.reuters.com/article/2011/02/21/us-blacks-higher-cerebral-idUSTRE71K3OL20110221

[Quantess]

27. No, all it means is that mommy and baby are still eligible to go to heaven.

Think of it as a favor to the mother. Everyone knows she'd go to hell if she'd had an abortion. Now she gets everyone's sympathy, instead. See, I'm always seeing the glass as half-full.
:evilgrin:

[Bucky]

28. We're Number Forty-One!! We're Number Forty-One!! We're Number Forty-One!!

Yoo - Ess - Aay!!         Yoo - Ess - Aay!!         Yoo - Ess - Aay!!         Yoo - Ess - Aay!!         Yoo - Ess - Aay!!         Yoo - Ess - Aay!!         Yoo - Ess - Aay!!         Yoo - Ess - Aay!!         Yoo - Ess - Aay!!