[Vision2020] Infants Better Off in Cuba

[Nick Gier]

January 12, 2005, The New York Times
OP-ED COLUMNIST
Health Care? Ask Cuba
By NICHOLAS D. KRISTOF

Here's a wrenching fact: If the U.S. had an infant mortality rate as good 
as Cuba's, we would save an additional 2,212 American babies a year.

Yes, Cuba's. Babies are less likely to survive in America, with a health 
care system that we think is the best in the world, than in impoverished 
and autocratic Cuba. According to the latest C.I.A. World Factbook, Cuba is 
one of 41 countries that have better infant mortality rates than the U.S.

Even more troubling, the rate in the U.S. has worsened recently.

In every year since 1958, America's infant mortality rate improved, or at 
least held steady. But in 2002, it got worse: 7 babies died for each 
thousand live births, while that rate was 6.8 deaths the year before.

Those numbers, buried in a recent report from the Centers for Disease 
Control and Prevention, didn't get much attention. But they are part of a 
pattern of recent statistics dribbling out of the federal government 
suggesting that for those on the bottom in America, life in our new Gilded 
Age is getting crueler.

"America's children are at greater risk than they've been in for at least a 
decade," said Dr. Irwin Redlener, associate dean at the Mailman School of 
Public Health at Columbia University and president of the Children's Health 
Fund. "The rising rate of infant mortality is an early warning that we're 
headed in the wrong direction, with no relief in sight."

It's too early to know just what to make of the increase in infant 
mortality in 2002 for American babies. Reliable data for 2003 and 2004 are 
not out yet. Sandy Smith of the Centers for Disease Control says that the 
statisticians are pretty sure there was not a further deterioration in 
2003, but that it's too soon to know whether there was an improvement or 
just a leveling off at the higher rate.

Singapore has the best infant mortality rate in the world: 2.3 babies die 
before the age of 1 for every 1,000 live births. Sweden, Japan and Iceland 
all have a rate that is less than half of ours.

If we had a rate as good as Singapore's, we would save 18,900 babies each 
year. Or to put it another way, our policy failures in Iraq may be killing 
Americans at a rate of about 800 a year, but our health care failures at 
home are resulting in incomparably more deaths - of infants. And their 
mothers, because women are 70 percent more likely to die in childbirth in 
America than in Europe.

Of course, deaths in maternity wards occur one by one, and don't generate 
the national attention, grief and alarm of an explosion in Falluja or a 
tsunami in Sri Lanka. But they are far more frequent: every day, on 
average, 77 babies die in the U.S. and one woman dies in childbirth.

Bolstering public health isn't as dramatic as spending $300 million for a 
single F/A-22 Raptor fighter jet, but it can be a far more efficient way of 
protecting Americans.

For example, during World War II, the employment boom meant that many poor 
Americans enjoyed regular health care for the first time. So even though 
405,000 Americans died in the war, life expectancy in the U.S. actually 
increased between 1940 and 1945, rising three years for whites and five 
years for blacks.

True, infant mortality and many other American health problems are largely 
intertwined with poverty, and experience suggests that neither the left nor 
the right has easy solutions for intractable poverty. But some of the steps 
the government is now taking or talking about - like cutting back further 
on entitlements, particularly those giving children access to health care - 
would aggravate the situation. Last year, a study by the Institute of 
Medicine, a branch of the National Academy of Sciences, estimated that the 
lack of health insurance coverage causes 18,000 unnecessary deaths a year.

As readers know, I complain regularly about the Chinese government's 
brutality in imprisoning dissidents, Christians and, lately, Zhao Yan, a 
New York Times colleague in Beijing. Yet for all their ruthlessness, 
China's dictators have managed to drive down the infant mortality rate in 
Beijing to 4.6 per thousand; in contrast, New York City's rate is 6.5.

We should celebrate this freedom that we enjoy in America - by complaining 
about and working to address pockets of poverty and failures in our health 
care system. It's simply unacceptable that the average baby is less likely 
to survive in the U.S. than in Beijing or Havana.

"Modern physics has taught us that the nature of any system cannot be 
discovered by dividing it into its component parts and studying each part 
by itself. . . .We must keep our attention fixed on the whole and on the 
interconnection between the parts. The same is true of our intellectual 
life. It is impossible to make a clear cut between science, religion, and 
art. The whole is never equal simply to the sum of its various parts." 
--Max Planck

Nicholas F. Gier
Professor Emeritus, Department of Philosophy, University of Idaho
1037 Colt Rd., Moscow, ID 83843
http://users.adelphia.net/~nickgier/home.htm
208-882-9212/FAX 885-8950
President, Idaho Federation of Teachers, AFL-CIO
http://users.adelphia.net/~nickgier/ift.htm

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