http://jamilaakil.blogspot.com/2007/03/we-dont-need-universal-health-
care-pt-i.html
Time and time again I am told that the United States needs a universal
health care plan because of our sky-high infant mortality rate. On it's
face, the statistics appear damning: according to a Save The Children
report funded by the Bill and Melinda Gates Foundation, the US has the
penultimate newborn mortality rate in the developed world--only Latvia
ranks lower. Our current infant mortality rate of 6.4 per 1,000 live
births is high compared with the 3.2 to 3.6 per 1,000 estimated for the
three top-scoring countries in the world-Iceland, Finland, and Japan.
One has to focus a critical eye on the statistics to understand what
they really say about American health care for newborns: the US provides
some of the best care for neonates in the world.
The infant mortality rate (or IMR) is defined as the number of newborns
dying under a year of age divided by the number of live births during
the year. When comparing infant mortality rates between countries, each
country's IMR is reported as the number of live newborns dying under a
year of age per one thousand live births. Since 1950 The World Health
Organization (WHO) defined a live birth as follows:
“The complete expulsion or extraction from its mother of a product
of conception,irrespective of the duration of the pregnancy, which,
after such separation, breathes or shows any other evidence of life,
such as beating of 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.” (WHO, 1992, definition 3.1)
Until the 1990's the former USSR 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
showing signs of life but failed to survive for at least 7 days. The
exclusion of those premature infants from the numbers of live births
would result in a lower infant mortality.
Some countries count frail or premature infants who die before the
normal due date as miscarriages (spontaneous abortions) and those who
die during or immediately after childbirth as stillborn. The demographer
Ansley Coale found 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 and 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.
In Austria and Germany, fetal weight must be at least 500 grams (1
pound) to count as a live birth; 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. When you consider the disparate definitions of
live births it is easy to see why the United States would not compare
favorably--particularly when other countries are using definitions that
lower their infant mortality rate. Due to the wildly varying definitions
of what constitutes a live birth and reporting requirements, the
Organization for Economic Cooperation and Development, which collects
the European numbers, warns of head-to-head comparisons by country.
How to define live birth isn't the only factor inflating the US infant
mortality rate. America is more racially and economically diverse than
many other industrialized countries. African-American babies are twice
as likely as white infants to be premature, to have a low birth weight,
and to die at birth; teen pregnancies and obesity both
disproportionately affect African-American women and also increase risk
for premature births and low birth weights, factors which raise the
infant mortality rate. Thus, African-Americans have higher infant
mortality rates than the country as a whole while various other ethnic
groups, including Chinese Americans, have lower than average rates.
Iceland uses the same standards as we do but has a population under
300,000 that is 94 percent homogeneous, a mixture of Norse and Celts.
Finland has a population of 5.2 million people with foreigners
comprising only 2 percent. Japan's population is estimated at around
one-hundred and twenty-seven million with a small population of foreign
workers; 99% of the nation speaks Japanese as a first language. And on
the other hand we have America with a multi-racial, polyglot population
of 300 million people, home to 31 ethnic groups with more than a million
members. Estimates suggest that we have 12 million undocumented
immigrants, many of whom are women that do not seek prenatal care until
they show up at the hospital to give birth. We have more illegal
immigrants in our country than the entire populations of Finland and
Iceland combined.
Paradoxically, our excellence at treating neonates, abundance of medical
resources, and expanding fertility treatment industry may work against
us in the attempt to lower infant mortality rates. "The United States
has more neonatologists and neonatal intensive care beds per person than
Australia, Canada and the United Kingdom, but its newborn rate is higher
than any of those countries," said the annual State of the World's
Mothers report.
According to an article in Slate:
.....in a startling 2002 New England Journal of Medicine study,
David Goodman and his colleagues showed that the regional supply of
neonatologists and NICUs bore no relation to actual need, implying that
some doctors and hospitals set up shop simply because there was money to
be made. More disturbingly, areas with more beds and doctors don't have
lower infant-mortality rates. The authors ominously suggest that
"infants might be harmed by the availability of higher levels of
resources." They argue that the availability of a NICU may mean that
infants with less-serious illnesses may be admitted to one and then
"subjected to more intensive diagnostic and therapeutic measures, with
the attendant risks."
According to a 2006 Institute of Medicine report, the numbers of women
using assistive reproductive technology doubled from 1996 to 2002. At
least half of their pregnancies culminated in multiple births (twins or
more), which are at high risk of premature delivery, and subsequently a
higher risk of death. In 2005, 12.5 percent of births in the United
States were preterm, at less than 37 weeks gestation.
The problem of high infant mortality is really a problem of reducing
premature birth and as yet, methods for reducing prematurity have been
unsuccessful. If the rising rates of prematurity are driven by the
fertility industry there may not be a way to significantly reduce the
IMR.
Last month I wrote a post about a mother in Miami who gave birth to a 21
week old baby. The medical standard is to not even try to resuscitate a
22 week old infant but the doctors were unaware of just how far along
the mother was. In the comments to that post MizJJ, a Canadian, had this
to say:
If you treat 100 babies at 22 weeks and only 1 survives then that
gives you a good indication of how successful treatment will be. The
chances of a baby staying alive that young are slim. An argument can be
made that they should try, but doctors and hospitals do not have endless
resources. In addition, I think, there are questions of quality of life
of the infant when they are born that young.
Her comments are telling. In the Canadian system, or any nationalized
health care plan, how much money something is going to cost comes first.
When you are paying for your own health care, your satisfaction comes
first. This is why there are countries that won't try to resuscitate a
25 week old baby--it costs the government too much money.
When all of the factors are taken into account--the differing
definitions of live birth, disparate standards for resuscitation of
premature infants, quality of care, biological and environmental
differences between races and ethnic groups, homogeneous populations and
high numbers of illegal immigrants--the US infant mortality rate is not
so bad after all.
The solution to lowering the infant mortality rate is not socialized
medicine, but the targeting of specific groups--namely immigrant women,
racial minorities, and those using assistive reproductive technologies--
with additional resources in the goal of preventing prematurity.
--
Fred Stone
aa# 1369
"The simplest way to explain the behavior of any bureaucratic
organization is to assume that it is controlled by a cabal of its
enemies."
--
Posted via a free Usenet account from http://www.teranews.com
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