The Doctor Is In: Infant Mortality Comparisons a Statistical Miscarriage
Q: If socialized medicine is so bad, why are infant mortality rates higher in the U.S. than in other developed nations with government or single-payer health care?
A: U.S. infant mortality rates (deaths of infants <1 year of age per 1,000 live births) are sometimes cited as evidence of the failings of the U.S. system of health care delivery. Universal health care, it’s argued, is why babies do better in countries with socialized medicine.
But in fact, the main factors affecting early infant survival are birth weight and prematurity. The way that these factors are reported — and how such babies are treated statistically — tells a different story than what the numbers reveal.
Low birth weight infants are not counted against the “live birth” statistics for many countries reporting low infant mortality rates.
According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500g is not considered a living child.
But in the U.S., such very low birth weight babies are considered live births. The mortality rate of such babies — considered “unsalvageable” outside of the U.S. and therefore never alive — is extraordinarily high; up to 869 per 1,000 in the first month of life alone. This skews U.S. infant mortality statistics.
When Canada briefly registered an increased number of low weight babies previously omitted from statistical reporting, the infant mortality rose from 6.1 per 1,000 to 6.4 per thousand in just one year.
According to research done by Canada’s Bureau of Reproductive and Child Health, “Comparisons of infant mortality rates by place and time should be adjusted for the proportion of such live births, especially if the comparisons involve recent years.”
Norway boasts one of the lowest infant mortality rates in the world. But when the main determinant of mortality — weight at birth — is factored in, Norway has no better survival rates than the United States.





In the US, federal and state government seem to be picking up a higher percentage of the health care bill every year. Because the government does not have enough money to pay the reasonable cost of care, health care providers must rely on the dwindling number of private payors, primarily health insurers. (Hardly anyone is responsible for paying most of their own medical bills these days.) Meanwhile, the government is putting more restraints on private insurers, mandating that all policies include certain coverages, etc. Private insurance is, in turn, paid mostly by employers, many of whom think they would be better off if the government took complete control of the system. Both Presidential candidates promise more, not less, government involvement in health care. In other words, we have been getting socialized medicine in small doses for at least 40 years (since Medicare) and the trend shows no sign of improving. It’s probably just a matter of time before our government adopts the method of counting (or not counting) infant deaths used in other countries so that our increasingly more socialized system can be competitive with the other socialized systems in measuring infant mortality.
Damn, Bob, those monthly payments by these people don’t cover any of the cost?
As someone who knows a good bit about statistics and how they are used, this issue has always bothered me. When I travel overseas, one of the things that officials from other countries like to throw around is infant mortality and how their ranking in the world is so much higher than the US. For the most part, I guess it makes them feel superior and that they are getting something for their high taxes.
However, for those in the US who can’t wait for socialized medicine, they don’t understand what they would be giving up. The idea of making an appointment with a specific doctor, going to a doctor when you don’t “feel well,” elective procedures often included under insurance, therapy outside of the hospital, damages from malpractice etc … do not exist in all countries with socialized medicine. The only way that a national health care system would work in the US is if a) doctors would restrict the level of services they provide to patients b) patients would NOT go to the doctor every time they have the problems that would be considered minor in other countries (i.e. virus/flu, back pain, arthritis pain, and depression) c) Americans would drop the idea of suing a hospital or doctor.
Would it have killed Dr. Linda Halderman to have thrown in some footnotes, or links to back up her numbers?
All this article is good for without them is as a starting point for one’s own research or as anecdote.
Nick Eberstadt of the Harvard University Center for Population Studies and the American Enterprise Institute cited a lot of infant mortality statistics for Communist countries (he had to ferret them out of the intentionally misleading official figures) in his 1988 book “The Poverty of Communism” (Transaction, New Brunswick). The Soviets and Chinese used the same fudging tactic of not counting at-risk births as live.
Never mind the fact that it’s irrelevant in the end – Europe as we know it doesn’t care about their birth rates and the class of people who make up this non-sensical approach to counting life will be gone with no progeny. Too bad Europe and Japan will cease to exist as we know them in less than a century! Simply amazing -
Considering how ob/gyn practice has taken such a hit over the years mainly due to insurance, is this the right issue?
Mikielikes:
You make no sense, you are simply reading the graph off the right edge, making no allowances for any variations in rate. But then again, this is a right wing blog so stupid things like that are considered proven facts.
Javelin – Would it hurt your little brain nugget to think a little harder? Trends are valid discussion – why don’t you read Mark Steyn’s “America Alone” instead of that little red book you’ve been memorizing?
There’s nothing so flaccid as the liberal mind preening itself…
I just read recently that 49% of the kindergarten-age children in the USA are non-white. Since blacks have a lot more venereal disease than whites, and venereal disease is strongly associated with premature birth, it is no surprise that the USA has worse infant mortality rates than someplace like Switzerland, which has very few blacks, and very few impoverished illegal aliens. Blacks also give birth to their children at earlier ages than whites do, and the article points out that teenagers have more premies & low-birth-weight babies.
If you compare the health outcomes of whites in this country to that of whites in European countries, I doubt that socialized medicine would come out looking too good. You also have to consider levels of cigarette smoking, etc., which can vary a lot from country to country and from ethnic group to ethnic group.
The way that elderly people are treated in Britain is NOT something that I would want to see in the USA. They wait years for hip replacement surgery, etc. Very sad.
Never trust social science “statistics.” They are nearly always misleading at best.
This article could have been useful if it published two tables: the reported figures, and the corrected homogenized figures.
As it stands, it is just tendentious cherry-picking, hoping to gull the gullible to a pre-determined conclusion.
And I see it worked with some of the “low information” regressives.
The “counting” of infants born alive in the U.S. illustrates the respect, value and dignity accorded individuals in this country. Its chilling that other nations dismiss these babies as “stillborn” or “miscarried.” How are their elderly treated when no longer “useful” to the state?
The article is a keeper, But the desert is the lefty squealing that informs us of a bulls-eye.
They cannot stand even the momentary thought that the world is independent of their will.
Hey Javelin, regarding “simply reading the graph off the right edge, making no allowances for any variations in rate.”, kind of like Al Gore’s temperature curve?
A feriend of mine, a statistical analyst, commented that many Japanese insurance companies use American statistics rather than Japanese because many Japanese doctors ‘fudge’ deaths so that more people die of ‘heart attacks’ (an honourable death) rather than things like stomach and bowel cancers (seen as shameful) or trusting in the veracity of birth certificates (they are fudged to appear older and therefore wiser)
This article was great. Nice to see someone telling it like it is for a change.
Murph
I always knew these differences in how child mortality is counted existed. So, to use this as an argument that Europe’s healthcare system is silly. Not that I disagree with Europe’s approach to premature babies. US spends too much money and effort on these babies, majority of whom will grow up to be profoundly disabled adults who will be subjected to unending medical care. Sometimes the most humane thing to do is to not do anything.
Where are the actual numbers to support these claims? In God we trust. All others bring data.
Statistics are like bikini bathing suits – What they reveal is suggestive; what they conceal is vital.
This article is a Godsend to those of us who were subliminally certain that something is wrong with the infant-mortality comparisons the socialized-medicine nations are forever trumpeting. Thank you eternally, Dr. Halderman.
A socialized economy is capable of representing itself as anything it wants to be perceived as being, because it controls the collection, analysis, and dissemination of all information. But reality is indifferent to opinions and preferences. That’s why the Soviet Union is dead, socialized Europe is dying, and capitalism remains the preferred economic system of persons who’d rather not starve or freeze in the dark.
“If you call a tail a leg, how many legs has a dog? Five? No. Calling a tail a leg doesn’t make it a leg.” — Abraham Lincoln.
This isn’t new information. I read a study a few years back that illustrated this.
However, what this article fails to do is point out that, considering what we count as viable, the US has an astoundingly low infant mortality rate.
Do liberals not know this? If so, why do they still wish to inflict this on innocent children? Is it for the same reason they tend to be pro-abortion and anti-death penalty (i.e., insanity)?
This is a useful article for the layman; but anyone working in Labor and Delivery already knew it.
The sad part is that people like Anon represent the prevailing attitude of UHC advocates. The dirty little secret of UHC is that it is not actually U. There are always conditions; citizenship, overall health, risky behaviors, severity of condition, there’s _always_ some level of triage–and there’s always someone marked “beyond help”.
Comments about STD aside, African American population, for whatever reasons, has higher incidence low birthweight babies, hence higher infant mortality rate. Would US infant mortality rate compare favorably with the rates recorded in homogeneous countries like Switzerland or Norway if they were calculated the same way and US rate was calculated for whites only? I tried to figure this out with available information. I would not swear by my figures because I am not a statistician and I may have made errors, but it appears the US white IM rate is the same as that for the Scandinavian countries.
I would like to see real reported information on this — statistics and the like. I’m not going to dismiss it, but I definatly want some hard evidence, not just someone claiming something or other.
Matt: Consider that a great proportion of the African American population here in the United States is in poverty and cannot afford proper pre-natal care — I think a more illustrative study might demonstrate the differences between different levels of income than different ethnicities.
Agreed re; need for more data.
Dr. Halderman, is there anywhere we can see “normalized” comparisons, or at least data which would allow someone to extract *truly* comparable figures?
Hmmm… notice how France isn’t mentioned. Very convenient.
Okay, one mention. But no actual numbers to back it up. Bah.
Also interesting that while she’s no longer practicing, Dr. Halderman won’t provide an e-mail to share facts with concerned citizens. What agency is paying your salary, Dr. Halderman? Why not come out and give us a means to e-mail you, rather than hiding behind this conservative web firewall?
She really should have provided footnotes on the figures. I did find some confirmation on Wikipedia, though:
http://en.wikipedia.org/wiki/Infant_mortality#Comparing_infant_mortality_rates
When you think about it, how can the nature of that measurement not vary from country to country? I also suspect that since it is a “benchmark” measurement there is much incentive to game the results.
ANON –
My best friend’s son was extremely premature. He spent a couple months in a NICU as an infant, then grew up to be a strong, intelligent wonderful young 16 yr old who I’m confident has much to offer our country. Would you like to tell him or his parents we wasted too much on him? What if that had been your own child? Wouldn’t you want to at least have the option to go to extra-ordinary measures to save them? This country values individual choice – should we now throw it away for your – or someone else’s – ‘better’ judgement of what is ‘worthwhile’?
I knew this data was crap. The US & WHO definitions are the same:
From CDC.gov (Technical Appendix From Vital Statistics of the US)
“Definition of live birth: Every product of conception that gives a sign of life after birth, regardless of length of pregnancy, is considered a live birth.
This concept is included in the definition set forth by WHO …In interest of comparable natality statistics, both the Statistical Commission of the UN and the CDC have adopted this definition.”
What can you expect from a blog titled pajamas.
Good article and discussion here. So, a few questions that I have not been able to find answers to. Given the discrepancies in reporting is there any reason to believe that infant mortality in the US is any better than in other developed countries? Or is the data not consistent enough to make any comparisons?
Next question is that it is clear from a study in the 1990s that the reporting was in fact different, however, as per the previous comment, is there any reason to believe that reporting is more consistent now among developed countries?
Apparently, the World Health organization has defined “live birth” as
If low birth weight babies aren’t being counted in a nation’s statistics, it is at odds with this definition. I’d love to see a link to a definitive source.
Karl: http://www.who.int/healthinfo/statistics/indneonatalmortality/en/
“Neonatal Mortality Rate: Number of deaths during the first 28 completed days of life per 1,000 live births in a given year or period.”
And they have the same definition of “live birth” you give. So a delivered fetus that requires resuscitation is not a live birth. And if it’s not a “live birth” then it doesn’t count for the statistics. So if a doctor declares a vastly-premature or stillborn infant “nonviable” and refuses to provide supporting treatment, that doesn’t count as infant mortality. But if the doctor does provide treatment and the baby dies anyway, then it does count.
Let’s now see you explain away why the “living” here have one of the lowest life expectancies of developed countries.
Death by violence. If four men live to 75, the “average life expectancy” is 75. If three men live to 90 and one dies at 20, the “average life expectancy” is 73. Which of these two situations implies a healthier population?
And we do get some medical “tourism” from Canada for exactly this issue – women told by their doctors that there is no better care than in the U.S. for their troubled pregnancy – likely premie.
And we never seem to discuss that the first thing that’s cut when budgets are tight is research. And like defense, if the U.S. doesn’t do it (sadly) no one will. I hope we’re all happy with the state of today’s medicine because not only are we regulating ourselves to stasis (trying to avoid a few more deaths by testing regimes that restrict the ability the wealthy to suffer and spend their own money to try to live another three miserable months – and sometimes extend the science) but when there is no profit there will be no research. The research that still exists in these other countries is largely driven by the opportunity to sell in the U.S. When that opportunity to make a ROI on significant risk evaporates, so will those companies.
If we don’t shackle the medical profession, we’ll look back at today in 100 years the same way we look back at leaches and worse – primitive medicine (if not snake oil) at its best.
The Us is exceptional in spending twice what civilized countries spend for health care, Let’s hear the anti-Obama Government Hands off my Medicare idiots buy into that one.
After reading this article, I can either assume that the author just made up ‘facts’ or was referring to old/outdated birth reporting procedures. Either way, this seems a little disingenuous.
According to the Federation of American Scientists, almost all countries follow the WHO live birth requirement to report ALL live births as live births.
There are some reporting exceptions:
By Gestation:
Norway only reports them live if they have passed 12 weeks gestation
By Birth Weight
Poland and Ireland only report a birth as live if they weigh 500g or more.
Combination of Birth Weight and Gestational Age:
France and Netherlands 22 weeks gestation OR 500g
Other:
Czech Republic is the ONLY country to be known to report births as stillborn if they die within the first 24 hours
It is also suspected that some Japanese hospitals do the same, but this has not been proven
The report concluded that
“Differences in how live births are recorded may affect international IMR comparisons; however, it is unlikely that these recording differences would entirely explain the high U.S. IMR or the variation between the U.S. IMR and those of some European countries. This is because of both the widespread use of the WHO definition of live births and the small number of births that fall outside the WHO definition.”
This information comes from the report “The US Infant Mortality Rate: International Comparisons, Underlying Factors, and Federal Programs” that can be found on the web site of the Federation of American Scientists (http://www.fas.org)