http://www.theatlantic.com/health/archive/2014/10/why-american-babies-die/381008/
I recently read this article and found it very pertinent to our class, and to what I want to use in presentation. The article states how the United States is ranked 56 in the world in infant mortality and sandwiched between Serbia and Poland, which I personally found surprising as I figured the US would be lower, but I didn’t think that low.
The article states however that the US has lower neonatal death rates than Finland and Austria (two countries with low infant mortality rates) but relatively high postneonatal rates. So the problem is not when a child is born and is in the hospital and when they immediately get home, but later on.
But the one paragraph I found most interesting was this:
“The effects of socioeconomic status on health have been well-documented, and infant mortality is no exception: Unsurprisingly, the states with the highest rates are also among the poorest. “IfAlabama were a country, its rate of 8.7 infant deaths per 1,000 would place it slightly behind Lebanon in the world rankings,” Christopher Ingraham recentlynoted in The Washington Post, while “Mississippi, with its 9.6 deaths, would be somewhere between Botswana and Bahrain.””
The comparison to Botswana and Bahrain really puts the global problem of infant mortality in perspective in that it is a global problem which includes the United States. This article ultimately suggest how one must look critically at health statistics, but certainly for something as complex infant mortality.
I am not surprised by these statistics mostly because I took another global health class where we established that America pretty much sucks at everything health wise, especially if you are African American, poor or female and worst yet, all three. I quite suspect the worse numbers that arise from Southern states to be due in part to institutional and a racist mentality that is passed down by both the oppressor and the oppressed. Further, these states tend to have more rural and remote populations who don’t have the same access to health care that is seen in Northern and Western states. Even their major cities are find behind New York or even Atlanta. This could also be due to the smaller number of hospitals per area (I can think of at least 7 hospitals just in the metro area) while that’s not the case in a lot of places. I think I’m kind of rambling on at this point but basically I think it goes back to my first post about a holistic view. America has great numbers in some areas and terrible numbers in others which averages out to still not so good.
I agree with Stella’s reasoning and I also want to point out that I really like that this article presented America in a more separate light in terms of healthcare statistics. I especially like the line saying “if Alabama were a country” A lot of the time people speak about the US as one entity in these kind of conversation so it is understandable that one would be shocked about America not having the best infant mortality. However, the reality of the situation is that the United States has a lot of holes in its system in terms of getting coverage to everyone and mothers are not an exception. Especially in rural areas, these women have the same kind of delays as women living in a rural village in Haiti. This shows that disparities in health are not unique to those in developing nations but happen right in our backyard.
I found the article interesting as well, especially the section about reporting infant deaths. The question of how we report infant deaths made me think about what we consider an infant and where the line is drawn between stillborn/miscarriage and infant death.
I am glad The Atlantic included a discussion about socioeconomic status and infant death. I am from Mississippi, the state with the highest infant death rate. I have done work in hospitals in the state- in both areas of primarily low-income patients and middle to upper-middle class patients. The difference in birth outcomes was devastating. In the hospital that served the suburbs of Jackson, the capital city, birth went smoothly and was a time of celebration. In the hospital in the poorest part of Jackson, most of the babies were born preterm and mothers often had preexisting health complications. I think there are many reasons for this large gap in Mississippi and in the rest of the United States. In response to Stella’s comment about racism, I do think racism plays a large part in the socioeconomic status and thus health outcomes of black people in Mississippi. However, I firmly believe that racism is everywhere in the United States, and Mississippi is often used as a scapegoat for the racism that exists in every region of the country. Also, as has been, Mississippi is an extremely poor state. Impoverished mothers in Mississippi rarely have access to prenatal care before the delivery because Medicaid may not be accessible or they may not have the means to visit the hospital. Prenatal conditions largely influence infant health. Even after the infant is brought home, the welfare provided combined with the family’s resources is rarely enough to provide food and healthcare for the infant. Obviously, this is a symptom of Mississippi’s failing welfare system. More indirectly, Mississippi has some of the most restrictive abortion laws in the state and only one abortion clinic. Thus, many women are delivering babies they may not have wanted to keep or who they struggle to provide for.
This article and the above discussion shows how strong social determinants can be on the outcome of health. In some of my other global health classes we have talked about the Robin Hood Index and the Gini Coefficient. The Robin Hood index measures the difference in wealth between the richest 20% in a country and the poorest 20%, and the Gini Coefficient rates the equality of income distribution in country with 0 being perfect equality and 1 being perfect inequality. In both these measurements, when the US is compared to other developed countries, it usually has some of the highest difference in wealth between its richest and poorest citizens. It has been shown that nations that have more equal distributions of wealth, have consistently better health outcomes especially in reference to child well-being. Those on the lower end of the socioeconomic divide often do not have access to better housing, nutritional food, higher education, or medical care. They and their children then are prone to worse health outcomes. This is because inequality becomes ingrained in the social structure of unequal societies, and creates an oppressive institutional structure that often works against certain groups in a society, usually minority groups. I am reminded of an exhibition at the CDC last year called Health as a Human Right. It addressed health disparities in the U.S. showing that legislation and attitudes in the U.S. have led to minority racial groups, particularly African Americans consistently having the worst health outcomes. These policies included segregation, 37 states that sterilized all Hispanic women that gave birth in a hospital in the 1960s, placing black communities near industrial waste sites or contaminated water sources, food deserts seen in many black or Hispanic communities, and many more. These are all examples of institutionalized racism that not only has effects on access to physical health determinants, but emotionally oppresses people which has been shown to have a huge effect on health outcomes. This societal inequality is in my opinion the main reason that the U.S. has such a high infant mortality rate and falls short in many other areas of health. It definitely explains why post natal infant death rates are higher and why states such as Alabama and Mississippi have the highest rates in the country. These are the poorest states, and historically the most segregated and unequal states.