The United States The United States and Child Mortalityand Child Mortality

Progress toward Millennium Progress toward Millennium Development Goal #4Development Goal #4

Millennium Development Millennium Development Goal #4: Reduce Child Goal #4: Reduce Child MortalityMortality Child mortality is a statistic that Child mortality is a statistic that

describes the number of children describes the number of children that die before they are five years that die before they are five years old. old. – Rate per thousand Rate per thousand

Millennium Millennium Development Goal #4: Development Goal #4: In developing countries, one child In developing countries, one child

in 10 dies before its fifth birthday, in 10 dies before its fifth birthday, compared with 1 in 143 in high-compared with 1 in 143 in high-income countries.income countries.

Mortality rates for children under Mortality rates for children under five dropped by 15 percent since five dropped by 15 percent since 1990, but the rates remain high in 1990, but the rates remain high in developing countries. (UN, 2005)developing countries. (UN, 2005)

MDG #4: TargetMDG #4: Target

Reduce the child mortality of Reduce the child mortality of children under five by two-thirds children under five by two-thirds by 2015by 2015

Causes of Child Causes of Child MortalityMortality PovertyPoverty War and civil unrestWar and civil unrest Diseases: HIV/AIDS, malnutrition, Diseases: HIV/AIDS, malnutrition,

malaria, diarrhea, and acute malaria, diarrhea, and acute respiratory infections respiratory infections

Low birth weightsLow birth weights Poor health care during pregnancyPoor health care during pregnancy Adolescent pregnancyAdolescent pregnancy

Source: The World Health Report, 2005, Source: The World Health Report, 2005, http://www.who.int/whr/2005/en/index.htmlhttp://www.who.int/whr/2005/en/index.html

Child Mortality and the Child Mortality and the U.S.: StatisticsU.S.: Statistics U.S. Population: 291,038,000U.S. Population: 291,038,000 GDP per capita: $35,182GDP per capita: $35,182 Annual number of under-5 deaths Annual number of under-5 deaths

per thousand (2003): 34per thousand (2003): 3411

Child mortality rates (per Child mortality rates (per thousand) thousand) 22

::– Male: 9Male: 9– Female: 7Female: 71. Source: UNICEF, 1. Source: UNICEF, http://www.unicef.org/infobycountry/usa.html

2. Source: World Health Organization, http://www.who.int/countries/usa/en, 2004 data

U.S. StatisticsU.S. Statistics

Total health expenditures per Total health expenditures per capitacapita11

: $4,887 : $4,887 Total health expenditures as a Total health expenditures as a

percentage of GDPpercentage of GDP22

: 13.9%: 13.9%

1. Source: World Health Organization, http://www.who.int/countries/usa/en/

Is Child Mortality a Is Child Mortality a problem in the United problem in the United States?States? Not in comparison with the rest of Not in comparison with the rest of

the worldthe world 50% of all child deaths are 50% of all child deaths are

concentrated in China, the concentrated in China, the Democratic Republic of the Democratic Republic of the Congo, Ethiopia, India, Nigeria Congo, Ethiopia, India, Nigeria and Pakistan.and Pakistan.

But…But…

Child Mortality in the Child Mortality in the U.S.: A Closer LookU.S.: A Closer Look The child mortality rate in the The child mortality rate in the

U.S. is almost double the rate in U.S. is almost double the rate in Hong Kong (3.1) and Japan (3.4)Hong Kong (3.1) and Japan (3.4)

11

The child mortality rate (also The child mortality rate (also called the Infant Mortality rate) in called the Infant Mortality rate) in the United States varies among the United States varies among racial/ethnic groupsracial/ethnic groups22

1. National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention, 1999 data 2.Source: Gale Encyclopedia of Medicine, Jan 1, 2001. Minority health. M.D. Laith Farid Gulli; M.S. Nicole Mallory. Retrieved from Infotrac.

Child Mortality in the Child Mortality in the U.S.: A Closer LookU.S.: A Closer Look African Americans: 14.2 per 1,000 African Americans: 14.2 per 1,000

live births in 1996 (approximately live births in 1996 (approximately 2.5 times higher than Caucasians)2.5 times higher than Caucasians)

Hispanics: 7.6 per 1,000 live Hispanics: 7.6 per 1,000 live birthsbirths– Puerto Ricans: 8.9 per 1,000 live Puerto Ricans: 8.9 per 1,000 live

birthsbirths

Source: Gale Encyclopedia of Medicine, Jan 1, 2001. Minority health. M.D. Laith Farid Gulli; M.S. Nicole Mallory. Retrieved from Infotrac.

Child Mortality in the Child Mortality in the U.S.: A Closer LookU.S.: A Closer Look Despite higher poverty and lower

education rates, Hispanic infants have higher birthweights and their child mortality rates approximate those of white infants.

Cultural practices, family support, selective migration, diet, and genetic heritage are possible contributing factors.

Child Mortality in the Child Mortality in the U.S.: A Closer LookU.S.: A Closer Look Very low birth weight accounts for

approximately two thirds of the black-white gap in infant mortality, specifically preterm deliveries.

Child Mortality in the Child Mortality in the U.S.: A Historical U.S.: A Historical PerspectivePerspective ““Follow up question:” To what Follow up question:” To what

extent has the status of women extent has the status of women advanced throughout the 20th advanced throughout the 20th century?century?

Child Mortality in the Child Mortality in the U.S.: A Historical U.S.: A Historical PerspectivePerspective The U.S. child mortality rates

declined by 90% in the 20th century

The highest child mortality rates have always been in U.S. cities

Child Mortality in the Child Mortality in the U.S.: A Historical U.S.: A Historical PerspectivePerspective Racial differences in child mortality

have not been explained fully by differences in socioeconomic status.

Black infants born to college-educated parents have higher child mortality rates than white infants born to parents of similar educational background; this difference is attributed to a higher rate of very low birthweight

Child Mortality in the Child Mortality in the U.S.: A Historical U.S.: A Historical PerspectivePerspective A complex interaction of social,

environmental, and biologic factors experienced uniquely by black women might account for the difference in child mortality rates.

Comparing Child Comparing Child Mortality StatisticsMortality Statistics

Comparing Child Mortality in Comparing Child Mortality in the U.S. to other countries in the U.S. to other countries in the Americas the Americas

(Follow up question: (Follow up question: To what extent To what extent have economic disparities between have economic disparities between developed and developing nations persisted developed and developing nations persisted or increased? )or increased? )

Comparing Regions of Comparing Regions of the Worldthe World

020406080

100120140160180200

1990 2002

Northern AfricaSub-Saharan AfricaSouthern AsiaCISDeveloped regions

Source: http://millenniumindicators.un.org/unsd/mi/mi_worldregn.asp#Annex

What Progress is Being What Progress is Being Made?Made? UN Millennium Development UN Millennium Development

Goals Progress Reprot 2004:Goals Progress Reprot 2004:– http://www.un.org/http://www.un.org/

millenniumgoals/mdg2004chart.pdfmillenniumgoals/mdg2004chart.pdf

What Needs to be What Needs to be Done?Done? Access to reproductive health care needs Access to reproductive health care needs

to be expanded.to be expanded.

Distribute vitamin supplements in Distribute vitamin supplements in countries without functioning health care countries without functioning health care systems.systems.

Access to clean water and sanitation is Access to clean water and sanitation is needed to further reduce occurrences of needed to further reduce occurrences of diarrhea.diarrhea.

Source: http://cyberschoolbus.un.org/mdgs/index.html

What Needs to be What Needs to be Done?Done? Distribute insecticide-treated nets to Distribute insecticide-treated nets to

families in area at high risk for families in area at high risk for malaria and make sure the nets are malaria and make sure the nets are retreated each year.retreated each year.

Increase the number of health care Increase the number of health care providers in underserved providers in underserved populations, particularly in rural populations, particularly in rural areas. areas.

Source: http://cyberschoolbus.un.org/mdgs/index.html

ReferencesReferences

Gale Encyclopedia of Medicine, Jan 1, 2001. Minority health. M.D. Laith Farid Gulli; M.S. Nicole Mallory. Retrieved from Infotrac 5/15/05.

National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention, 1999. Retrieved from Harvard Public Health Now, http://www.hsph.harvard.edu/now/dec10/apha_infant.html, 5/16/05.

United NationsUnited Nations– http://www.un.org/millenniumgoals/ retrieved 5/15/05.http://www.un.org/millenniumgoals/ retrieved 5/15/05.– http://cyberschoolbus.un.org/mdgs/index.html retrieved 5/15/05.http://cyberschoolbus.un.org/mdgs/index.html retrieved 5/15/05.– http://millenniumindicators.un.org/unsd/mi/

mi_worldregn.asp#Annex retrieved 5/15/05.– http://www.unicef.org/ retrieved 5/15/05.http://www.unicef.org/ retrieved 5/15/05.

World Health OrganizationWorld Health Organization– http://www.who.int/countries/usa/en retrieved 5/15/05.