Mediocre U.S. rankings in infant mortality and life expectancy have little to do with health-care quality.
Critics of American heath care—and advocates of single-payer insurance or other forms of socialized medicine—point to poor U.S. rankings in infant mortality and life expectancy. It turns out both are grossly flawed calculations that misleadingly make the U.S. rank low.
America’s rate of infant mortality—death within the first year after birth—was 5.9 per 1,000 live births in the latest statistics, 32nd among 35 developed countries, according to the Organization for Economic Cooperation and Development. But these aren’t apples-to-apples comparisons. Unlike many other countries, the U.S. strictly adheres to the World Health Organization’s definition, recording as a live birth any baby, “irrespective of the duration of the pregnancy,” who “breathes or shows any other evidence of life.”
By contrast, WHO noted in a 2008 report, it is “common practice in several western European countries to register as live births only those infants who survived for a specified period.” Infants who don’t survive are “completely ignored for registration purposes.” A British Journal of Obstetrics and Gynaecology study of Western Europe found that terminology alone caused up to 40% variation and 17% false reductions in infant mortality.
Partly because of harmful behaviors during pregnancy and socioeconomic factors, premature births—the main risk factor for infant death—are far more common in the U.S. than in any other developed country. The U.S. prematurity rate is 65% higher than in Britain and more than double that of Ireland and Finland. A Centers for Disease Controlstudy found that standardizing for gestational age eliminated 68% of the difference in infant mortality between Sweden and the U.S. The CDC concluded “the primary reason for the United States’ higher infant mortality rate when compared with Europe is the United States’ much higher percentage of preterm births.”
American physicians consistently make heroic efforts to save extremely premature infants—unlike their European counterparts, who limit necessary technology and then don’t even count such babies when they die. Official data from the U.S. National Center for Health Statistics and the European Perinatal Health Report show that when it comes to newborns who need medical care and have the highest risk of dying, the U.S. has the world’s third-best infant-mortality rate—trailing only Sweden and Norway.