Published October 02, 2013
The Financial Times did it again.
Once again, a columnist there got U.S. health statistics wrong, apparently taking his cue from HBO’s also fact-challenged series, “The Newsroom.”
In arguing that the U.S. health system is the costliest in the world, Martin Wolf wrote in his column today: “What does the U.S. get in return? Life expectancy at birth is the lowest of these countries (other large high income countries), while infant mortality is the highest.”
As I’ve said before, I usually enjoy reading Wolf’s columns. And as I have said before, Wolf is repeating a myth that has already been roundly debunked by government health officials, economists and medical experts.
Lazy analysts use badly researched listings that show the U.S. ranks poorly on the infant mortality list. But it’s largely because America actually counts more neonatal deaths than other countries, including premature infant fatalities, when other nations do not count infant deaths.
This isn’t the first time Wolf made such a mistake. He made the same error in an April 12, 2011, column: “The US has the highest maternal and infant mortality rates among the high-income countries, and among the lowest life expectancies. The result of these cutbacks in spending on health for the poor and the old would be further deterioration. Is this really politically acceptable?”
Meanwhile, the Organization for Economic Cooperation and Development has already dismissed such findings: "In several countries, such as in the United States, Canada and the Nordic countries, very premature babies (with relatively low odds of survival) are registered as live births, which increases mortality rates compared with other countries that do not register them as live births.”
The problem also lies with the definition of the infant mortality rate.
The World Health Organization defines a country's infant mortality rate as the number of infants who die between birth and age one, per 1,000 live births. The WHO says a live birth is when a baby shows any sign of life, even if, say, a low birth weight baby takes one single breath or has one heartbeat.
The U.S. uses this definition. But like I’ve said before, other countries do not -- so they don't count premature or severely ill babies as live births or deaths.
The U.S. actually counts all births if they show any sign of life, regardless of prematurity, or size, or duration of life, Bernardine Healy, former director of the National Institutes of Health and former president and chief executive of the American Red Cross, has also reported.
That means the U.S. even counts stillbirths, while many other countries do not count stillbirths, much less report them.
Moreover, countries differ in how they define live births. 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, Healy has noted.
In other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless, and are not counted, Healy has said.
On top of all this, some countries don't reliably register babies who die within the first 24 hours of birth.
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 who are not now counted, Nicholas Eberstadt, a scholar at the American Enterprise Institute, has reported.
Moreover, the ranking doesn't take into account the fact 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.
Also, 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.
Moreover, the U.S. is not losing healthy babies, as the scary stats imply. Most of the babies who die are either premature or born seriously ill, including those with congenital malformations.
The OECD has cautioned against these country-to-country infant mortality comparisons, because they are unfair.
"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 has said.