Health Care? Ask Cuba

By NICHOLAS D. KRISTOF

There's a wrenching fact: If the U.S. had an infant mortality rate as good as Cuba's, we would save an additional 2,212 American babies a year.

Yes, Cuba's. Babies are less likely to survive in America, with a health care system that we think is the best in the world, than in impoverished and autocratic Cuba. According to the latest C.I.A. World Factbook, Cuba is one of 41 countries that have better infant mortality rates than the U.S.

Even more troubling, the rate in the U.S. has worsened recently.

In every year since 1958, America's infant mortality rate improved, or at least held steady. But in 2002, it got worse: 7 babies died for each thousand live births, while that rate was 6.8 deaths the year before.

Those numbers, buried in a recent report from the Centers for Disease Control and Prevention, didn't get much attention. But they are part of a pattern of recent statistics dribbling out of the federal government suggesting that for those on the bottom in America, life in our new Gilded Age is getting crueler.

"America's children are at greater risk than they've been in for at least a decade," said Dr. Irwin Redlener, associate dean at the Mailman School of Public Health at Columbia University and president of the Children's Health Fund. "The rising rate of infant mortality is an early warning that we're headed in the wrong direction, with no relief in sight."

It's too early to know just what to make of the increase in infant mortality in 2002 for American babies. Reliable data for 2003 and 2004 are not out yet. Sandy Smith of the Centers for Disease Control says that the statisticians are pretty sure there was not a further deterioration in 2003, but that it's too soon to know whether there was an improvement or just a leveling off at the higher rate.

Singapore has the best infant mortality rate in the world: 2.3 babies die before the age of 1 for every 1,000 live births. Sweden, Japan and Iceland all have a rate that is less than half of ours.

If we had a rate as good as Singapore's, we would save 18,900 babies each year. Or to put it another way, our policy failures in Iraq may be killing Americans at a rate of about 800 a year, but our health care failures at home are resulting in incomparably more deaths - of infants. And their mothers, because women are 70 percent more likely to die in childbirth in America than in Europe.

Of course, deaths in maternity wards occur one by one, and don't generate the national attention, grief and alarm of an explosion in Falluja or a tsunami in Sri Lanka. But they are far more frequent: every day, on average, 77 babies die in the U.S. and one woman dies in childbirth.

Bolstering public health isn't as dramatic as spending $300 million for a single F/A-22 Raptor fighter jet, but it can be a far more efficient way of protecting Americans.

For example, during World War II, the employment boom meant that many poor Americans enjoyed regular health care for the first time. So even though 405,000 Americans died in the war, life expectancy in the U.S. actually increased between 1940 and 1945, rising three years for whites and five years for blacks.

True, infant mortality and many other American health problems are largely intertwined with poverty, and experience suggests that neither the left nor the right has easy solutions for intractable poverty. But some of the steps the government is now taking or talking about - like cutting back further on entitlements, particularly those giving children access to health care - would aggravate the situation. Last year, a study by the Institute of Medicine, a branch of the National Academy of Sciences, estimated that the lack of health insurance coverage causes 18,000 unnecessary deaths a year.

As readers know, I complain regularly about the Chinese government's brutality in imprisoning dissidents, Christians and, lately, Zhao Yan, a New York Times colleague in Beijing. Yet for all their ruthlessness, China's dictators have managed to drive down the infant mortality rate in Beijing to 4.6 per thousand; in contrast, New York City's rate is 6.5.

We should celebrate this freedom that we enjoy in America - by complaining about and working to address pockets of poverty and failures in our health care system. It's simply unacceptable that the average baby is less likely to survive in the U.S. than in Beijing or Havana.

(C) The New York Times 2005