The high US infant mortality canard

Another chapter in the “lies, damn lies and statistics” is the repeated claim from proponents of European-style socialized medicine that the US has the highest infant mortality rate of any first world country.  This is a scathing indictment, implicating American poverty, racism, prenatal and post-natal care.  The only problem is that it’s completely false, and is based on the fact that Europe, when it does its infant mortality statistics, ignores fragile infants that were doomed from their live births:

Infant mortality rates are often cited as a reason socialized medicine and a single-payer system is supposed to be better than what we have here. But according to Dr. Linda Halderman, a policy adviser in the California State Senate, these comparisons are bogus.

As she points out, in the U.S., low birth-weight babies are still babies. In Canada, Germany and Austria, a premature baby weighing less than 500 grams is not considered a living child and is not counted in such statistics. They’re considered “unsalvageable” and therefore never alive.

Norway boasts one of the lowest infant mortality rates in the world — until you factor in weight at birth, and then its rate is no better than in the U.S.

In other countries babies that survive less than 24 hours are also excluded and are classified as “stillborn.” In the U.S. any infant that shows any sign of life for any length of time is considered a live birth.

A child born in Hong Kong or Japan that lives less than a day is reported as a “miscarriage” and not counted. In Switzerland and other parts of Europe, a baby is not counted as a baby if it is less than 30 centimeters in length.

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  • Larry Sheldon

    In addition, the statistics don’t account for the children who would never have made it into the last trimester in other countries, the children born to mothers that would not have lived long enough in other countries, or children born here in a desperate attempt to save their lives, doomed with no hope “at home”.

    Ever wonder where babies with serious problems in Canada end up?

  • Charles

    Forget the statistics. How sad that “they don’t count.”

  • Deana

    We were repeatedly told in nursing school that the U.S. had the worst infant mortality of all industrialized countries. I did some research and discovered exactly what this article states: that European countries have a much more strict definition of “live births” that automatically excludes low-birth weight and other babies who are most likely to die.

    After hearing this canard over and over in class, I went to the nursing school’s Director of Instruction and asked that this little bit of information be included when we discuss this issue in class. I provided the evidence for my request.

    The Director denied my request. She never just said no, she simply spent a considerable amount of time suggesting that I did not know what I was talking about and that it really was not that important of an issue.

    But it was. If it hadn’t been, why the need to constantly bludgeon us over the head with the idea that the U.S. is a “terrible” country in which to have a baby?

    After that discussion, I no longer have much faith in academia. Truth is not the goal. Will deception is.

  • highlander

    Perhaps slightly off topic, but the survival rate of newborns seems not to be the same for males and females in all cultures.

    In Western societies the gender ratio is almost uniformly 51% female to 49% male, reflecting the somewhat longer life spans of women.

    Here are the ratios for some other countries:

    Bahrain — 43% female, 57% male
    Kuwait — 40% female, 60% male
    Oman — 43% female, 57% male
    Qatar — 34% female, 66% male
    Syria — 49% female, 51% male
    UAE — 32% female, 68% male
    Iran — 49% female, 51% male
    Pakistan — 48% female, 52% male

    (Source: Encyclopaedia Britannica Almanac, 2005 edition)

    Certainly there are a number of factors which contribute to the relatively lower number of females in these countries, but it is striking that these ratios are similar to those estimated for the Roman Empire in the 1st century when female babies frequently were “exposed”, that is, thrown out into the street to die of exposure. Archaeologists digging in Rome a few years ago found a sewer almost completely blocked up by the skeletons of mostly female newborn babies. (Source: The Rise of Christianity by Rodney Stark, Univ of Washington)

    Once again: where is NOW now?



    Good for you that you took the initiative to seek the truth.

    So few do.

    Academia like many cliques in the social strata of life have long suffered from cross contamination and cognitive inbreeding.

  • Ymarsakar

    Keep up the good fight, Deana. The good thing about our culture is that it doesn’t matter what others try to shame us with. If you know you are innocent, you have a duty to the truth to proclaim and defend yourself.

    Contrast this with the Democrat shame culture, in which so long as nobody accuses you of being guilty, you are innocent in the eyes of the Left.

    Btw, Book, I believe it is safe to say now that anything coming from the Left’s maw of despair can be accurately thought of as a lie, in one form or another.

    Trust nothing from a Leftist.

  • Danny Lemieux

    The fact that you refused to take other people’s allegations at face value and took the time to research the issue makes you a true intellectual, Deana, rather than the intellectual wannabees that populate academia today.

  • Mike

    From the X-Files

    “The Truth is Out There”

    “Trust No One”

  • Ymarsakar

    The truth isn’t out there. I got it right here. And I like to smash the Left’s teeth into the concrete of truth. Very useful, that Truth there.



    Where is NOW?

    They’re renamed themselves.
    NOW is now called GONE (Generation of No Equality).

  • BrianE

    Thank you BW for your post de-bunking the infant mortality myth. There are a couple of other popular reports often used to advance government-run health care.
    One is the supposed poor quality of health care standing of the US, and the other the amount of spending by the US compared to other countries.
    Here is an article from Cato Institute explaining the WHO quality of care issue. Sorry for the lengthy comment, but I think it is worth the lengthy explanation.

    Armed with supposedly objective reports showing the American medical system is among the worst in the developed world, candidates left and right — but mostly left — are plugging ambitious plans to “fix” healthcare. Invariably, their plans call for more government intervention
    But is lack of government really the problem — and if so, how would we know? Healthcare interventionists frequently cite the World Health Organization’s World Health Report 2000, which studied the performance of 191 countries’ healthcare systems — and awarded the U.S. a dismal rank of number 37. While the WHO rankings are touted as an objective measure of the relative performance of healthcare systems, in reality they depend on a number of ideological or logically incoherent assumptions.
    The WHO rankings are based on a constructed index of five factors. One factor is “health level,” defined as a country’s disability-adjusted life expectancy. Another is “health responsiveness,” which includes desirable characteristics of healthcare like speed of service, protection of privacy, and quality of amenities.
    Both of these are sensible indicators of health quality, but they constitute only 37.5 percent of each country’s score. The other 62.5 percent encompasses factors only tenuously connected to the quality of care — and that can actually punish a country’s ranking for superior performance.
    Take “Financial Fairness” (FF), worth 25 percent of the total. This factor measures inequality in how much households spend on healthcare as a percentage of their income. The greater the inequality, the worse the country’s performance.
    Notice that FF necessarily improves when the government shoulders more of the health spending burden, rather than relying on the private sector. To use the existing WHO rankings to justify more government involvement in healthcare is therefore to engage in circular reasoning, because the rankings are designed to favor greater government involvement.
    The ostensible reason to include FF in the health index is to account for people landing in dire financial straits because of their health needs. Yet the FF factor worsens for every household that deviates from the average percentage of income spent on healthcare, regardless of whether the deviation is on the high side or low side.
    That means the FF factor doesn’t just penalize a country because some households are especially likely to become impoverished from health costs; it also penalizes a country because some households are especially unlikely to become impoverished from health costs.
    The other two factors, “health distribution” and “responsiveness distribution,” are no better. Together worth 37.5 percent of a country’s score, these factors measure inequality in health level and responsiveness. Strictly speaking, neither measures healthcare performance, because inequality is distinct from quality of care. It’s entirely possible to have a healthcare system characterized by both extensive inequality and good care for everyone.
    Suppose, for instance, that Country A has health responsiveness that is “excellent” for most citizens but merely “good” for some disadvantaged groups, while Country B has responsiveness that is uniformly “poor” for everyone. Country B would score higher than Country A in responsiveness distribution, despite Country A having better responsiveness for even its worst-off citizens.
    What if the quality of healthcare improves for half of the population, while remaining the same for the other half? This should be regarded as an unambiguous improvement: some people get better off, and no one gets worse off. But in the WHO index, the effect is ambiguous because the improvement could increase inequality.
    The WHO rankings have also been adjusted to reflect efficiency: how well a country is doing relative to how much it spends. In the media, however, this distinction is often lost.
    Costa Rica ranks higher than the United States (number 36 versus number 37), but that does not mean Costa Ricans get better healthcare than Americans. Americans most likely get better healthcare — just not as much better as could be expected given how much we spend. If the question is health outcomes alone, without reference to spending, we should look at the unadjusted ranking, where the U.S. is number 15 and Costa Rica is number 45. (And even the number 15 rank is problematic, for all the reasons discussed above.)
    The WHO rankings implicitly take all differences in health outcomes unexplained by spending or literacy and attribute them entirely to health system performance. Nothing else, from tobacco use to nutrition to sheer luck, is taken into account. These variables were excluded largely because of underlying paternalist assumptions about the proper role of the health system.
    If the culture has a predilection for unhealthy foods, there may be little healthcare providers can do about it. Conversely, if the culture has a pre-existing preference for healthy foods, the healthcare system hardly deserves the credit. Some people are happy to give up a few potential months or even years of life in exchange for the pleasures of smoking, eating, having sex, playing sports, and so on. The WHO approach, rather than taking people’s preferences as given, deems some preferences better than others, and then praises or blames the health system for them.
    Those who cite the WHO ranking to justify greater government involvement in the health system are assuming what they’re trying to prove. The WHO healthcare ranking system does not escape political bias. It advances ideological assumptions that most Americans might find questionable under the guise of objectivity.

  • Cycle Cyril

    Another distortion this statistical practice creates is in the survival tables.

    Most other industrialized countries report much longer average survival from birth than America. But because they do not include those infants born alive but premature or underweight (who do have a high mortality rate), or die within a day of a normal birth, theses countries artificially have a longer average survival compared to the US.

    In the US, because of their inclusion, the children dying in their neonatal period creates an illusion of a shorter average survival and thus a worse healthcare system.

    I view this a way of the various governments hiding their dismal records concerning neonatal deaths and thus avoid paying for the research and material and the personnel for these neonates at the time of their births and any additional care they may need in the future.

  • Mike Devx

    Ymar, #9:
    >> And I like to smash the Left’s teeth into the concrete of truth.

    Dang, Ymar, your imagery has been getting harsher lately – this is the second reference to “smashing their teeth into the concrete” I’ve run across. You’ve said that your anger and hatred at what the Statists are up to has been growing ever larger… is the imagery an expression of that growing anger?

    Now to my aside. The “smashing teeth into concrete” imagery catches my eye because of the movie “American History X”. Was wondering if you’d seen it, and if so, what you thought of it. There’s the scene where Norton’s charismatic gang leader confronts the theives in his front yard, shoots at them – nailing one of them I think. He drags him to the curb, screams at him for a while, then crushes his mouth into the concrete curb with his booted foot. That moment of violence caused me to involuntarily spasm almost fetally in my theatre seat the first time I saw it. In later viewings – again in the theatre – I paid careful attention to that scene… and you can’t see anything violent. It is *suggested* with a brilliance I think even beyond that of the Psycho shower scene. (I’d also note that I saw “The Passion of the Christ” in the theatres several times, and the sense of incredible violence you get during the scourging scene from the screen is also, you’ll find, not evident on the screen, but much of it is again brilliantly *suggested* with careful editing.)

    In any case, my admiration for “American History X” – the last role I enjoyed Edward Norton in – stems from his incredible portrayal of leadership and how most other people can be led (by the nose) by that kind of charismatic, powerful leadership. (For better or for worse.)

  • Ymarsakar

    Dang, Ymar, your imagery has been getting harsher lately – this is the second reference to “smashing their teeth into the concrete” I’ve run across.

    I assure you, I’ve said it much more than twice by now on the nets ; )

    You’ve said that your anger and hatred at what the Statists are up to has been growing ever larger… is the imagery an expression of that growing anger?

    In part, yes, but it is also very convenient because I don’t have to come up with another expression to communicate my meaning. It has become one of my stock phrases, like “fake liberal”. Although Leftist and Demoncrat are my preferred descriptors recently. If only because many Republicans and so called conservatives cannot be called a fake liberal, for they never portrayed themselves as allies of liberty in the first place.

  • Ymarsakar

    And no, I have not seen that movie.

    Btw, what did you think of my response concerning your question about Nixon?

  • Mike Devx

    Hi Ymar,
    I thought I’d review your post again so I could be more cogent, but I can’t find that thread now. But in general I remember I liked what you wrote and agreed with it. I especially agreed with your response to my question as to whether the media had ever before acted in concert as the administration’s mouthpiece, where I thought “no”. You brought up the point about them covering for FDR, and acting as his administration’s mouthpiece, which from my limited knowledge of history is correct on your part.

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