Tuesday, September 3, 2019

The Economics of Healthcare in America #2: Another Myth that Won’t Die: “U.S. Infant Mortality Rates are Among the Worst in the Developed World”

Click here to read the original Cautious Optimism Facebook post with comments

6 MIN READ – The Cautious Optimism Correspondent for Economic Affairs and Other Egghead Stuff is continuing his overseas holiday... which won't stop him from continuing the CO series on healthcare economics and disparaging the legend of America's allegedly subpar infant mortality rate.

CBS laments that "U.S. infant mortality rate
 worse than other countries"

In Part 1 of this Economics of Healthcare in America series we discussed why allegations that average lifespans in America rank among the lowest of industrialized nations are fictitious, and why in fact the USA is the best country in on earth for anyone interested in living as long as possible.

In Part 2 we examine another common false indictment of the American medical system’s allegedly poor outcomes: U.S. infant mortality rates are the worst among industrialized nations.

Here are a few typical headlines that propagate what is in effect a myth, most dispatched with socialized medicine or at minimum more government control of healthcare as the prescribed solution:

“Among 20 wealthy nations, US child mortality ranks worst, study finds”

-CNN, 2018

“America's Infant Mortality Rate Higher Than Other Rich Countries”

-Time, 2018

“Our infant mortality rate is a national embarrassment”

-Washington Post, 2014

“Why Infants May Be More Likely to Die in America Than Cuba”

-New York Times, 2019

“Newborn survival rates in US only slightly better than in Sri Lanka” (The Guardian—UK, 2018)

As is the case with average lifespans, the conclusion is derived from another example of ripe apples vs rotting oranges statistical comparisons, the gap between the apples and oranges being so expansive that it’s mindboggling anyone would use such statistics to draw infant mortality disparities at all. For example, the U.S. counts all infant deaths whereas other developed nations exclude many of their frailest births. Thus when overseas infants expire their deaths aren’t counted in what would otherwise be a subsequently raised mortality rate.

Most of the key differences in statistical collection methods can be found in three sources (links below):

-The Washington Times

-Science Daily citing research from Texas A&M University’s Medical and Public Health schools

-Occupational Medicine and Family practice Physician and health policy writer Dr. Walt Larimore

And although the COCEA enjoys authoring his own annotations for CO Nation readers, this column is an occasion where citations from those articles/studies will illustrate the vast differences in measurement methods between nations more capably than the COCEA’s own prose.

So as you read on, note that the gap between American statistical approaches and those of other advanced economies becomes so great that citing “the developed world's worst infant mortality rate” devolves into a proverbial farce. Anyone who invokes that rallying cry simply lacks even a cursory understanding of other nations’ lax measurement standards.

We begin with...

I. Establishing the definition of infant mortality:

“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.”

-Dr. Walt Larimore

II. “The CDC ranks the United States 27th of the 34 developed nations, with 6.1 infants of every 1,000 live births dying within their first year of life… [but] there’s a statistical explanation for America’s standing in the CDC rankings. It may be that Americans put a higher value on human life among the least fortunate among us. In most developed nations, premature births are recorded in the statistics as miscarriages or stillbirths. The lives that doctors in those places don’t attempt to save are never recorded as ‘live births.’”

-Washington Times

III. American doctors’ attempts to save premature babies yield higher official mortality rates that don’t burden countries that simply let their infants die:

“Many countries don’t try to save infants born prematurely or with severe birth defects. U.S. doctors go to extraordinary lengths to give these infants a chance at life. Such best efforts often fail, and the death becomes a misleading statistic…

“When the CDC excluded births before 24 weeks of gestation, the American infant-mortality rate fell from 6.1 infant deaths per 1,000 live births to 4.2, a number comparable to the rest of the developed world’s figures.”

-Washington Times

IV. Other countries exclude births under a certain weight or length while the U.S. does not:

“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, [former NIH Director and former President and CEO of the American Red Cross Bernadine] Healy notes.”

-Washington Times

“In other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long, [Bernadine] Healy notes. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless, and are not counted…”

-Dr. Walt Larimore

V. The U.S. counts babies that die within their first 24 hours of life while other countries do not:

“…Some countries don’t reliably register babies who die within the first 24 hours of birth…”

-Dr. Walt Larimore

VI. Excluding underweight babies from the statistics makes at least one of the “leading” nations’ mortality rates appear more favorable:

“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 [source: Nicholas Eberstadt, American Enterprise Institute].”

-Washington Times

VII. Higher availability of fertility drugs in the U.S.—itself an indication of a more obliging system—skews infant mortality statistics:

“And the US has more mothers taking fertility treatments, which keeps the rate of pregnancy high due to multiple-birth pregnancies [which have lower survival rates].”

-Dr. Walt Larimore

VIII. Bad health habits of pregnant teens and expectant mothers drive infant morality rates up, but have nothing to do with the quality of American medical care:

“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.”

-Dr. Walt Larimore

IX. Once again comparing ethnic apples to apples produces more valid correlations than monitoring national averages since countries like Sweden, Japan, and Iceland don’t have large African or Native American populations that are more prone to SIDS:

“There are racial and ethnic differences in infant mortality that might help explain the differences between the United States and Europe. For example, African American and American Indian/Alaska Native babies are at higher risk of SIDS than Caucasian, Hispanic or Asian American babies. As most other developed countries have a comparatively small population with African heritage (and very few people of American Indian descent) these statistics might also help explain the numbers.”

-Science Daily

X. American ethnic diversity goes beyond just SIDS when counting infant deaths:

“The ranking doesn’t take into account that the U.S. has a diverse, heterogeneous population… …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 million-plus citizens.”

-Dr. Walt Larimore

XI. The OECD warns that it’s misleading to compare countries with such widely differing methods for tabulating infant mortality metrics, but that doesn’t stop American socialized medicine proponents from doing it anyway:

“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.”

-Dr. Walt Larimore

XII. And finally more American infants die in car accidents per-capita than other developed nations:

The U.S. has a much higher rate of per-capita infant deaths in car accidents since car ownership and usage rates in the U.S. far surpass that of other industrialized nations. While infant deaths in accidents are a tragedy, they have nothing to do with the quality of America’s medical system.

-COCEA’s note

So when summing up all the ways in which other developed countries exclude infant deaths to pad their statistics, it’s plainly obvious that allegations the United States ranks near worst in infant mortality rates among developed nations are simply false.

When adjusting for such statistical differences, America’s much lower infant mortality rate reflects even more favorably when factoring out higher uses of infertility drugs (more readily available in the U.S. than in the allegedly superior medical systems of other countries) and high teen pregnancy rates and pregnant teen drug usage. Nevertheless the USA’s supposedly abysmal infant death rate endures as a perennial myth—dispatched from the lips of the establishment media to the ears of progressive readers/viewers who recycle it uncritically and repetitively.

And of course those statistical padding/differences between countries are never mentioned in those same news stories in an another example of FDR Secretary of State Cordell Hull’s famous quip that “A lie will gallop halfway round the world before the truth has time to pull its breeches on."

For more detailed reading on the art of statistically compiling infant mortality rates, go to:




ps. The COCEA chanced upon the infant mortality myth once again while reading “The Myths of Modern Medicine: The Alarming Truth about American Health Care” by healthcare consultant John Leifer. His insert credits include consultant to healthcare firms and founding a newsletter that featured contributions from Bill Clinton and Newt Gingrich. In his first chapter Leifer slams the U.S. healthcare system for its inferiority to countries with socialized medicine.

His proof?

You guessed it, a few paragraphs on America’s poor life expectancy and atrocious infant mortality rates. Nowhere was there any mention of America’s #1 ranking for life expectancy when comparing like ethnicities across developed countries (not even an attempt to dispel the counterargument, he just didn’t bring it up) or the widely different methods for calculating infant mortality in statistically stringent America versus laughably lax other countries. Instead Leifer simply writes “our national ranking of twenty-fifth in life expectancy” which places us “behind all the other rich countries and a few poor ones” and “our infant mortality rate, as measured against other wealthy nations, is the highest in the world.”

As a supposed “authority” on healthcare, one would expect Mr. Leifer to know better than simply peddling recycled one-liner myths without diving just a little deeper into the numbers. So what kind of expert is this author? Or does he really know better but prefers concealment and dishonesty?

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