USA #40

Motorcity Gator · Aug 31, 2011

Even Cuba and Malaysia have better infant mortality rates than does the U.S. who checks in at # 40 now on the world list as reported just now on GMA.

I would say we make good healthcare even harder to afford and access to our citizens........whaddya say?

Terry O'Keefe · Aug 31, 2011

Is it solely access to care that puts us at #40? I'll wait for Stu to opine on this.

George Krebs · Aug 31, 2011

We also are way down the list in academic achievement. Behind a lot of countries that would astound you.

Hope and change.

Motorcity Gator · Aug 31, 2011

George....any idea how these two statistics would improve under a GOP Congress and President?

Terry O'Keefe · Aug 31, 2011

This sheds some light on that number MCG. It's not solely an access to care issue. There are apparently issues with what and how infant deaths are reported. Our ranking at #40 may or may not be a fair assesment of our medical system and it's effectiveness with regards to infants.

The infant mortality rate correlates very strongly with, and is among the best predictors of, state failure.[4] IMR is therefore also a useful indicator of a country's level of health or development, and is a component of the physical quality of life index. However, the method of calculating IMR often varies widely between countries, and is based on how they define a live birth and how many premature infants are born in the country. The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat. Many countries, however, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and raises their rates of perinatal mortality.[5]

The exclusion of any risk infants from the denominator or numerator in reported IMRs can be problematic for comparisons. Many countries, including the United States, Sweden or Germany, count an infant exhibiting any sign of life as alive, no matter the month of gestation or the size, but according to United States Centers for Disease Control (CDC) researchers,[6] some other countries differ in these practices. All of the countries named adopted the WHO definitions in the late 1980s or early 1990s,[7] which are used throughout the European Union.[8] However, in 2009, the US CDC issued a report that stated that the American rates of infant mortality were affected by the United States' high rates of premature babies compared to European countries. It also outlined the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births of babies under 500 g and/or 22 weeks of gestation.[6][9][10] The report concluded, however, that the differences in reporting are unlikely to be the primary explanation for the United States’ relatively low international ranking.[10]

Another well-documented example also illustrates this problem. Until the 1990s, Russia and the Soviet Union did not count, as a live birth or as an infant death, extremely premature infants (less than 1,000 g, less than 28 weeks gestational age, or less than 35 cm in length) that were born alive (breathed, had a heartbeat, or exhibited voluntary muscle movement) but failed to survive for at least seven days.[11] Although such extremely premature infants typically accounted for only about 0.005% of all live-born children, their exclusion from both the numerator and the denominator in the reported IMR led to an estimated 22%-25% lower reported IMR.[12] In some cases, too, perhaps because hospitals or regional health departments were held accountable for lowering the IMR in their catchment area, infant deaths that occurred in the 12th month were "transferred" statistically to the 13th month (i.e., the second year of life), and thus no longer classified as an infant death.[13]

UNICEF uses a statistical methodology to account for reporting differences among countries:
“ UNICEF compiles infant mortality country estimates derived from all sources and methods of estimation obtained either from standard reports, direct estimation from micro data sets, or from UNICEF’s yearly exercise. In order to sort out differences between estimates produced from different sources, with different methods, UNICEF developed, in coordination with WHO, the WB and UNSD, an estimation methodology that minimizes the errors embodied in each estimate and harmonize trends along time. Since the estimates are not necessarily the exact values used as input for the model, they are often not recognized as the official IMR estimates used at the country level. However, as mentioned before, these estimates minimize errors and maximize the consistency of trends along time.[14] ”

Another challenge to comparability is the practice of counting frail or premature infants who die before the normal due date as miscarriages (spontaneous abortions) or those who die during or immediately after childbirth as stillborn. Therefore, the quality of a country's documentation of perinatal mortality can matter greatly to the accuracy of its infant mortality statistics. This point is reinforced by the demographer Ansley Coale, who finds dubiously high ratios of reported stillbirths to infant deaths in Hong Kong and Japan in the first 24 hours after birth, a pattern that is consistent with the high recorded sex ratios at birth in those countries. It suggests not only that many female infants who die in the first 24 hours are misreported as stillbirths rather than infant deaths, but also that those countries do not follow WHO recommendations for the reporting of live births and infant deaths.[15]

Another seemingly paradoxical finding is that when countries with poor medical services introduce new medical centers and services, instead of declining the reported IMRs often increase for a time. This is mainly because improvement in access to medical care is often accompanied by improvement in the registration of births and deaths. Deaths that might have occurred in a remote or rural area, and not been reported to the government, might now be reported by the new medical personnel or facilities. Thus, even if the new health services reduce the actual IMR, the reported IMR may increase.
Click to expand...

George Krebs · Aug 31, 2011

I'm not necessarily a GOP guy. I'm a registered republican who is generally disgusted with that party. I'm more of a Libertarian than anything.

For example, I think the Dept. of Education should be eliminated immediately. Tear the damn building down while you're at it. They are nothing but bureaucratic overhead and wasteful expense. Educational decisions should be made at the local, county and state levels only.

Motorcity Gator · Aug 31, 2011

Points taken George.

Terry, I figured there must be some mitigating reasons why the US fares so low probably one of which is drug abuse that runs rampant amongst the poor also who simultaneously are those that don't have good healthcare access either.....a double whammy.

JO'Co · Aug 31, 2011

:idea:
We also take in huge numbers of Cuban and Malaysian refugees. How many American refugees are they taking?

BuckeyeT · Sep 1, 2011

We also take in huge numbers of Cuban and Maylasian refugees. How many American refugees are they taking?
Click to expand...

....perhaps they go back when find themselves in need of healthcare?

Stu Ryckman · Sep 1, 2011

The problem in collecting proper data, Terry is as you have researched.

It even varies state to state.

It used to be (in Ohio) that any birth before 20 weeks or less than 500g was not classified as a live birth and a birth certificate or stillbirth certificate did not have to be generated. These were considered miscarriages. Sometimes one (birth certificate) would be generated out of compassion for the parents, which would artificially increase the IMR records at the state health dept.

I'm not sure where it stands now (out of the loop), but a few years ago a movement was started to generate a certificate of live birth (and thus a death certificate) for any fetus that showed any sign of life no matter how small or how early the gestation.

“Live birth” means the complete expulsion or extraction from its mother of a
product of human conception, irrespective of the duration of pregnancy, which,
after such expulsion or extraction, breathes, or shows any other evidence of life,
such as beating of the heart, pulsation of the umbilical cord, or definite movement
of voluntary muscles, whether or not the umbilical cord has been cut or the
placenta is attached. Heartbeats are to be distinguished from transient cardiac
contractions; respirations are to be distinguished from fleeting respiratory efforts
or gasps.
This definition distinguishes in precise terms a live birth from a fetal death [9,10].
The vast majority of registration areas use definitions of live births similar to this
definition [9]. All states require the reporting of live births regardless of length of
gestation or birth weight.
Click to expand...

http://wonder.cdc.gov/wonder/sci_data/natal/detail/type_txt/natal05/TechAppendix05.pdf

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USA #40

Motorcity Gator Well-Known Member

Terry O'Keefe Well-Known Member Administrator

George Krebs Well-Known Member

Motorcity Gator Well-Known Member

Terry O'Keefe Well-Known Member Administrator

George Krebs Well-Known Member

Motorcity Gator Well-Known Member

JO'Co Well-Known Member

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Stu Ryckman Well-Known Member

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USA #40

Motorcity Gator Well-Known Member

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