Virtually every national and international agency involved in statistical assessments of health status, health care, and economic development uses the infant-mortality rate — the number of infants per 1,000 live births who die before reaching the age of one — as a fundamental indicator. America’s high infant-mortality rate has been repeatedly put forth as evidence “proving” the substandard performance of the U.S. health-care system. And now a new report focusing specifically on neonatal mortality (mortality rates in the first four weeks of life) from Mikkel Oestergaard and the World Health Organization (WHO) is being cited as an indictment of U.S. health care, with headlines proclaiming that the U.S. ranks 41st in the world on this measure.
Yet it’s not that simple. Infant and neonatal mortality rates are complex, multifactorial end-points that oversimplify heterogeneous inputs, many of which have no relation to health care at all. Moreover, these statistics gleaned from the widely varied countries of the world are plagued by inconsistencies, problematic definitions, and gross inaccuracies, all of which disadvantage the ranking of the U.S., where accuracy is paramount. Even though Oestergaard’s WHO report lists several “challenges and limitations” in comparing neonatal mortality rates, sensationalized headlines continue to rage about the supposedly poor showing of the United States. The following are a few of the difficulties:
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