A new study of worldwide childhood and infant mortality rates contains both good and bad news about a major measure of the quality of the U.S. healthcare system.
On the one hand, mortality rates for children under 5 continue to drop steadily. The rate in the U.S. declined from 8.3 per 1,000 in 2000 to 6.7 in 2010—nearly a 20% drop over the 10-year period. This continues a decades-long trend of consistent improvement. Mortality rates were 25.7 per 1,000 in 1970, 16 per 1,000 in 1980, and 11.6 per 1,000 in 1990.
But the improvement doesn't negate the fact that the United States has fallen further behind other wealthy nations in childhood mortality rate comparisons, and now ranks 42nd globally, behind most of Europe and nations such as the United Arab Emirates, Chile, and Cuba.
In 1990, the U.S. ranked 29th in the world, but other nations have been improving at faster rates. For instance, Serbia and Malaysia were ranked behind the U.S. 20 years ago, but cut their mortality rates by 70% and are now ranked higher, according to the Los Angeles Times.
The study was funded by the Bill and Melinda Gates Foundation and aimed to measure progress being made toward the United Nations' Millennium Development Goal 4, which targets a two-thirds reduction in the under-five mortality rate between 1990 and 2015.
The U.S. has seen a 42% decline since 1990, but is making slower progress than more than 120 other countries. Even nations that were ranked higher than the United States in 1990 have managed to make larger gains during the period. Singapore, which currently has the lowest rates in the world and had fewer deaths per 1,000 in 2000 than the U.S. has now, was able to cut its rate by two-thirds since 1990.
The U.S. healthcare system's struggles with infant and maternal mortality received considerable attention during the healthcare reform debate, because although healthcare is expensive in the United States compared to the rest of the world, the infant mortality rankings suggest Americans are not getting value for their dollar.
In addition to struggling with infant mortality, the U.S. healthcare system falls short when it comes to maternal deaths, too. This January the Joint Commission issued a Sentinel Event Alert for preventing maternal death, highlighting an uptick in recent years.
Although the news was mixed at best for the United States, it was overall positive for global health. The cumulative effective of improvements across the world mean there will only be about 7.7 million deaths in 2010, compared to 11.9 million in 1990. Despite the successes, the pace is currently insufficient to meet the UN's goal by 2015.