U.S. Child Health Worse Than Other Industrialized Countries

[ According
to the new Johns Hopkins study

twenty-four countries ranked better than the United
States in infant mortality rates in 2000. Out of 191 countries, the
United States ranked 33rd in its death rate for children under age
5. The United States, out of 187 countries, ranked 68th in immunizing
children against diphtheria-pertussis-tetanus; 89th for polio; and 84th
for measles. U.S. teens ranked 18th out of 28 industrialized
countries in a self-reported survey of not feeling healthy.

[P]artial explanations for
the United States? low rankings may be the country’s income inequity
and inadequacy of the health services system. The United States is the
most income-inequitable country among the industrialized nations.

Thanks to H.R. Nollert for passing this piece along. –BL ]

September 16, 2004 | Johns Hopkins Bloomberg School of Public Health News Center

by Barbara Starfield, MD, MPH

The health of U.S. children is worse in virtually all categories when
compared to children in other industrialized countries, according to
new research from a Johns Hopkins Bloomberg School of Public Health
researcher. The United States can improve the health of American
children by changing some of our health care policies and adopting new
Institute of Medicine (IOM) recommendations concerning how child health
should be viewed and developing information systems that better reflect
the health needs of children and their distribution in the population,
according to study author Barbara Starfield, MD, MPH, university distinguished professor with the Bloomberg School of Public Health Department of Health Policy and Management.
The study, ?U.S. Child Health: What?s Amiss, And What Should Be Done
About It?? is published in the September/October 2004 issue of the
journal Health Affairs.

According
to the study, twenty-four countries ranked better than the United
States in infant mortality rates in 2000. Out of 191 countries, the
United States ranked 33rd in its death rate for children under age
5. The United States, out of 187 countries, ranked 68th in immunizing
children against diphtheria-pertussis-tetanus; 89th for polio; and 84th
for measles. U.S. teens ranked 18th out of 28 industrialized
countries in a self-reported survey of not feeling healthy.

Dr.
Starfield, also director of the Primary Care Policy Center at the
Bloomberg School of Public Health, said that partial explanations for
the United States? low rankings may be the country’s income inequity
and inadequacy of the health services system. The United States is the
most income-inequitable country among the industrialized nations. Past
studies have shown that geographic areas that are more income-equitable
have better health and that the ill effects of social disadvantage and
income inequality can be partly reduced by better primary care
services.

Dr. Starfield also notes
in her study that U.S. health care policies are not conducive to good
primary care. U.S. health professional training and payment mechanisms
encourage the growth of specialties rather than primary care
physicians, making it more profitable for doctors to specialize and to
perform unneeded and potentially harmful services.

The
challenge, Dr. Starfield says, is for the United States not only to
improve overall health care, but to also eliminate disparities across
population subgroups. She suggests the following six health care policy
strategies to increase primary care to U.S. children: assure that every
child has a source of good primary care, eliminate co-payments and
other forms of cost-sharing for primary care, establish disincentives
for seeking unnecessary specialist care, include primary care services
assessment in all quality assurance activities, assure federal and
state support for increased training of primary care practitioners and
develop information systems that monitor health and detect differences
across population subgroups.

?The
extent to which a society protects its children reflects the magnitude
of investment in its future. In this sense, the United States can be
judged as less than successful,? said Dr. Starfield, ?However, strong
federal leadership and a professional strategy will allow the United
States to take a leadership position worldwide and achieve better
health for all.?

The study was supported by a grant from the Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services, to the Primary Care Policy Center for Underserved Populations at the Johns Hopkins University.

Public
Affairs media contacts for the Johns Hopkins Bloomberg School of Public
Health: Kenna Lowe or Tim Parsons at 410-955-6878 or paffairs@jhsph.edu. Photographs of Barbara Starfield are available upon request.