A magazine for friends of the Warren Alpert Medical School of Brown University.

Ask the Expert: Deadly Poverty


Why is infant mortality so high in the US?

About twice as many babies die before their first birthday in the United States as in many comparably developed countries: 6.1 infant deaths per 1,000 live births, versus 2 or 3 in most of Europe, Japan, New Zealand, and Australia. That disparity caught the attention of Emily Oster, PhD, a professor of economics at Brown who studies health and development economics. When she and two co-authors delved into the data, in a paper published in the American Economic Journal: Economic Policy last May, they found some encouraging news—and potential solutions. Oster explains.

In the first month of life, US survival rates are actually higher than some of the comparable countries we looked at. There’s been a lot of focus here on infant survival in this very early period, and we spend a lot of money on better neonatal intensive care units, and those do seem to pay off.

Where the US does really badly is in postneonatal mortality—between the first month and 12 months of life. During that period death rates are much higher, and they’re higher in lower socioeconomic status groups in the US, relative to poor populations in the other countries.

These results suggest we’re sending some people home with their babies who could use more help. We shouldn’t assume that once the baby’s left the hospital, there’s nothing left for policy to do. There are a lot of social services that people don’t take advantage of: for example, the Rhode Island Department of Health offers home visiting programs that send professionals to new parents’ houses to help with all aspects of raising a baby. If doctors knew about that, they could encourage their patients to take advantage of it.


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