As the Los Angeles Times notes, "The study authors said their findings support the conclusions of the Institute of Medicine, which blamed a fragmented health system, poverty, a weak social safety net and other factors for 'poor health outcomes' in the U.S."
The authors reached the following conclusions:
"The care of children is a basic moral responsibility of our society. The U.S. outspends every other nation on health care per capital for children, yet outcomes remain poor."
"All U.S. policy makers, pediatric health professionals, child health advocates, and families should be troubled by these findings."
They also warn that Donald Trump's proposed budget cuts will make the situation even worse. And, as of this writing, Republicans in Congress have not renewed funding for the children's health insurance program known as CHIP. Parents are already being warned that their children's coverage could lapse as soon as next month if Congress doesn't act.
Medical ApartheidThe Health Affairs report is new, but we've known about the systemic injustices in our healthcare system for a long time. African-American infant mortality rates are 2.2 times higher than those of non-Hispanic whites. They were 3.2 times more likely to die from complications due to low birthweight, and experienced more than twice the rate of Sudden Infant Death Syndrome (SIDS).
Racial disparities are even more pronounced when they are combined with geographic differences. The infant mortality rate in Mississippi is the highest in the country. At 9.4 deaths per thousand, that state is closer to Costa Rica, Botswana, and Sri Lanka than it is to the overall United States.
A 2015 study found that infants born [in] Washington D.C.'s poorest neighborhood were 10 times more likely to die than its richest infants. That neighborhood, Ward 8, was 93.5 percent black at the time. It also found that the nation's capital has a higher infant mortality rate than any other capital in the developed world.
Another recent infant mortality report found something else significant: The white, non-Hispanic infant mortality rate ranged from a low of 2.52 deaths per 1,000 in the Washington, DC to a high of 7.04 in Arkansas. That difference is, of itself, an injustice.
The mortality rate for black infants ranged from a low of 8.27 per 1,000 in Massachusetts to a high of 14.28 in Wisconsin. That means a black infant born in Wisconsin faces the same likelihood of death as an infant born in the West Bank of Palestine. She or he is more likely to die than an infant born in Colombia, or Jamaica, or Venezuela, or Tunisia.
Something else is striking about these race-based statistics: The country's worst white infant mortality rate is better than its best black rate. That is apartheid, and it is a moral crime.
Racial and Economic BarriersA 2011 study compared World Health Organization data from the U.S. and 19 countries and found that the U.S. had the worst child mortality rates. Using a UNICEF standard of measurement, it concluded that "the USA health care system appears the least efficient and effective in 'meeting the needs of its children.'"
Meeting the needs of our children: why can't we do it?
Many parents can't afford adequate healthcare for either expectant mothers or children. Many of the same parents also face barriers of entrenched racism. A news brief from the University of California, San Francisco offers the striking anecdote of "an ER physician who had lost a document and was searching frantically for it in the garbage bins behind ... San Francisco General Hospital and Trauma Center. What he found instead in the mountain of rubbish were crumpled prescription slips that patients had tossed in hospital trash cans throughout the week."
They had been tossed, not because parents didn't care, but because they couldn't afford to pay for the medications their children needed.
The brief goes on to describe physicians' efforts to provide care in the face of poverty, including "the nurse trying to help a mom living in a single-room-occupancy hotel find refrigeration for her son's antibiotic before an infection ruptures his second eardrum."
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