US falls behind other nations in child mortality
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* Tiggi Jalloh

Kids in the U.S. are more likely to die in childhood than their peers in other wealthy countries, a new study shows.

Since the 1980s, U.S. childhood mortality rates have been higher than in other high-income countries. Though there has been improvement across most countries, the U.S has had the slowest progress. According to a study published Jan. 8 in Health Affairs, the leading causes of death for children in the U.S. are premature birth and injuries.

Researchers examined mortality trends for children from birth to 19 years of age in the U.S. and 19 other high-income countries in the Organization for Economic Cooperation and Development. From 2001 to 2010, the risk of death in the U.S. was 57 percent higher for children ages 1 to 19 and 76 percent higher for infants.

Infant deaths were most likely to be caused by sudden infant death syndrome and immaturity, which included preterm delivery and low birthweight. According to the study, infants in the U.S. were more than twice as likely to die from SIDS and three times more likely to die from prematurity at birth than their peers in other countries. Adolescents ages 15 to 19 were most likely to die from assaults by firearm and motor vehicle crashes. U.S. teenagers were 82 times more likely to die from gun homicide compared with teens in the other 19 countries and twice as likely to die from motor vehicle accidents. U.S. children also have higher rates of obesity, HIV infection and adolescent pregnancy than other countries.

The U.S. also had higher rates of racial disparities than its peer countries. Black mothers in the U.S. had higher rates of preterm delivery. Black males were more likely to be killed as a result of gun violence than their peers of other races.

The study showed that in the early 1980s, the U.S. had the highest rates of child poverty among high-income countries. Child poverty increased by almost one-third in the mid-1980s. Along with poverty, U.S children were among the lowest-performing nations in educational outcomes since the 1960s. High rates of poverty and low rates of education in children were linked to worse health outcomes.

Despite the U.S. spending a greater amount on health care for children, spending on social safety net programs has dropped, coinciding with worse health outcomes. Under President Donald Trump’s administration, cuts have been proposed for the Supplemental Nutritional Assistance Program, which offers food assistance to millions of U.S. households, three-quarters of which include children. The Children’s Health Insurance Program, which was reauthorized in February, went for months without funding, putting millions of kids at risk.

The study’s authors called for applying public health solutions to risk factors such as gun violence and car crashes. Doing so, they said, would level the playing field for U.S. kids.

“The findings show that in terms of protecting child health, we’re very far behind where we could be,” said Christopher Forrest, MD, senior author of the study and pediatrician at Children’s Hospital of Philadelphia, in a Jan. 8 news release. “We hope that policymakers can use these findings to make strategic public health decisions for all U.S. children to ensure that we don’t fall further behind peer nations.”

For more information, visit [www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0767](http://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0767).

*   Copyright The Nation’s Health, American Public Health Association