We usually use three factors to judge a nation’s health: how long people live; how well infants and their mothers do in the first year of life; and whether people have adequate health insurance.
On all three fronts, the U.S. is moving backward.
An American baby born in 2017 will live on average 78.6 years, down a tenth of a year from 2016. It’s the third consecutive year of falling longevity. The U.S. is now ranked 26th out of 35 countries in the Organisation for Economic Co-operation and Development for life expectancy, with every other Western nation doing better and only the former members of the Soviet bloc, Mexico, Turkey and South Korea doing worse.
On infant mortality, the U.S. rate has fallen gradually over many decades and now stands at 5.8 deaths per 100,000 live births. Good for us! But our improvements lag well behind other countries with the U.S. rate three times higher than Japan’s, higher than every other Western nation (including Russia!) and only better than countries like Mexico and Turkey.
On the other hand, new mothers here are in deep trouble and losing ground, according to a recent report from the Centers for Disease Control and Prevention. In the first year after giving birth, mothers in the U.S. died at a rate of 17.2 per 100,000 births from 2011 to 2015.
Though this latest report drew no comparisons, I looked up prior reports. During the 1990s, the maternal death rate was 11.8 deaths per 100,000 births. In other words, this basic measure of maternal care has deteriorated by a shocking 46% over the past two decades. Today, mothers in other advanced industrial countries are at far less risk of dying from the complications of childbirth than American mothers.
The Census Bureau just reported that 27.5 million people, or 8.5% of Americans, lacked health insurance during 2018, up from 7.9% the year before. More people are working and fewer are in poverty, but the number of people without insurance and therefore access to routine healthcare services shot up. Government officials attributed most of the decline to reduced Medicaid coverage. Nearly half the babies born in the U.S. are covered by Medicaid.
As disturbing as these numbers are, they mask a far more troubling reality. Part of the U.S. actually does as well as other advanced industrial nations. It’s the part that’s well-to-do and has seen steadily rising wealth and income over the past four decades. It’s the part that’s well-educated and has access through their employers to good health insurance.
A new report from the Government Accountability Office showed that “differences in income, wealth and demographic characteristics were associated with disparities in longevity.” How much? Only half the people in their 50s in the lowest fifth of the income distribution will be alive 22 years later compared with three-quarters of people in the highest fifth. Increased income is directly correlated with increased longevity across every quintile.
In America, race is often a proxy for income. African American maternal mortality rates are three times higher than rates for whites, almost exactly the same as black-to-white poverty rates, which are 2½ times higher.
Ditto for infant mortality. Break down the rate by ethnicity and what you see is that the infant mortality rate for whites was 4.9 per 100,000 live births in 2016, not much different from an average European country. But the black infant mortality rate was 11.4 per 100,000 live births.
We often use the combined statistics to castigate healthcare providers for poor performance. They can do better, of course. Too many providers remain insensitive to the special needs of our less fortunate citizens that are driving the overall rates.
But these trends ultimately reflect a society bitterly divided by class and race that grows more so every day. Too many people here are suffering from deteriorating social conditions that the healthcare system is ill-equipped to address.