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On Infant Mortality

May 31, 2010

Over at Spencer Ackerman’s spot (lots of folks are doing the guest-blog thing), Megan Carpentier has a post lamenting the fact that infant mortality rates in the United States are higher than almost all other countries of comparable wealth.  She has compiled a nice chart for the post, but I think the conclusion she reaches is a little contrived:

A new study published in The Lancet from the Institute for Health Metrics and Evaluation at the University of Washington, first highlighted by The Economist this week, puts this into even starker relief. Women in the United States face higher infant mortality rates than women from countries with similar levels of wealth, and the rate remains stubbornly resistant to what little efforts are made to combat it.

In part, the infant mortality rate is strongly correlated to the high infant mortality rate among African-American women, which (despite all stereotypes to the contrary) isn’t correlated to income or educational levels, pregnancy care or the behavior of mothers. Yet every day, African-American children die in numbers higher than even those born to recent immigrants from Africa.

Okay, so our infant mortality rate is higher than almost all other countries with comparable affluence, and all efforts to combat that rate in this country have basically been fruitless even though we spend more money per person than any other country in the world.  The principal driver of this statistic is the high infant mortality rate among black women, and that number has no association with anything socioeconomic whatsoever.  So what’s the problem?  I’ll let you guess what Carpentier thinks, and the first two don’t count:

What it comes down to, however, is one conclusion: we are failing mothers, and we are failing the children that they choose to have. And all our vaunted health care spending — which, even after reform, will mostly line the pockets of insurance companies and continue the existing disparities between rich and poor within that system — does little or nothing to help these children. There is, however, one thing that all the countries with low child mortality rates have in common: comprehensive, government-led universal health coverage, which ensures that women have care before they contemplate pregnancy, before they attempt pregnancy, while they are pregnant and after their children are born. Huh.

Yeah… DUH.  It’s obviously a product of universal health care since that’s the only thing it could be.  What’s that phrase that Steven Levitt and Stephen Dubner made a fortune off?  “Correlation is not causation”?  Let’s just try a little experiment here—try to find something else that the countries on Carpentier’s chart have in common besides universal health care.  I’ve got one, and I bet you’ve already guessed what it is: none of those countries have any black people.

The United States has 37.6 million black people, or 12.4% of the total (without counting those of mixed ethnicity).  By comparison, the only two other countries on Carpentier’s list with any significant black population a’tall are France, which is 3% black, and Cuba which apparently is 65% white, 25% black, and 10% mulatto (?).  The absurdity of the 2002 Cuba census aside, the point is that the United States has an exponentially larger black population than any other country with which it has a comparable affluence

Carpentier even acknowledges that much of our infant mortality rate is driven by the high infant mortality rate among black women, and she is also quick to note that this has nothing to do with “income or educational levels, pregnancy care or the behavior of mothers.”  So, logically, our infant mortality rate is high because… we don’t have universal health care.  Seem like a logical leap to you?  Yeah, it seems much more likely that our high mortality rates among infants—which, I repeat are largely affected by high infant mortality rates among black women—are due to our large population of black people.

So, to recap, for whatever reason (and it’s not socioeconomic), infant mortality is much more common in black people than among people of other ethnicities, and the United States, which has more black people than any other country with similar prosperity, has a higher infant mortality rate than those countries.  It’s much more logical to conclude that our rates are adversely affected by our demographics than to conclude that a lack of universal health insurance is our problem.  I’d bet the farm that this is really a genetic issue more than anything else.  But that’s just me talking.

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