Infants May Be More Likely to Die in America Than Cuba

https://www.nytimes.com/2019/01/18/opinion/sunday/cuba-healthcare-medicare.html

by pseudolus • 8 years ago

59 53 8 years ago

nytimes.com

maccio92• 8 years ago

thanks anti-vaxxers

spamizbad• 8 years ago

Actually it's likely our broken healthcare system and poverty. But they certainly aren't helping.

antepodius2• 8 years ago

Don't forget obesity.

mrits• 8 years ago

Do you have a source of infants dying from vaccine preventable diseases? I was under the impression that some vaccines aren't even administered to infants and the diseases become a problem a little later in life.

Xylakant• 8 years ago

Infants are generally not vaccinated in the first few month but would have most common shots by the age of 1, with refreshers up to the age of 2.

However they do get protected by what’s called “herd immunity” If a sufficient fraction of all other people are vaccinated, diseases cannot spread. So basically the toddler in the family gets protected because the older kids/parents cannot be disease carrying. So yes, anti-vaxxers are a problem for toddlers (and other people that cannot be vaccinated due to other reasons)

refurb4• 8 years ago

I at least have the author credit for stating that the statistics should be taken with a grain of salt.

How is this possible? Well, remember that it may not be. The figures should be taken with a dose of skepticism.

The US actually has very generous social services when it comes to medical care for pregnant women and their babies. CHIP and Medicaid cover pregnant women up to 200% (~$30K) or sometimes 300% (~$50K) of the federal poverty level.[1] Waiting lists are non-existent for most states as they have an exemption for pregnant women or newborns..[2]

[1]https://www.medicaid.gov/chip/eligibility-standards/index.ht... [2]https://www.medicaid.gov/chip/eligibility-standards/waiting-...

TaylorAlexander• 8 years ago

Very generous compared to what? Don’t most other wealthy nations also offer this kind of care, along with continued free at point of service care for life?

refurb4• 8 years ago

Generous compared to what the author is suggesting - pregnant women being left out in the cold.

pseudolus2• 8 years ago

In the US there's a patchwork of programs that vary according to the state and even the city you live in. The tragedy of the situation is that prenatal care is literally a case of spending pennies and recouping many, many dollars down the line in health costs for both the mother and the child. When you ponder the situation, it's truly a WTF moment.

cazum• 8 years ago

Does chip and Medicaid cover absolutely everyone who might need it? Are there people who, despite the coverage, are still left with outstanding costs they can't meet?

My understanding is that in Cuba, there is no applying to services like Chip, or Medicaid. Theres no chance you won't get coverage, as everyone, by default, gets the care they need. Wait times are non existent for the pregnant or disabled across the country, not just in certain regions.

It doesn't seem totally unlikely that the people that """"fall through the cracks"""" in the American systems are enough to swing infant mortality rates.

new299• 8 years ago

Infant mortality in the USA is high relative to other developed countries:

https://en.m.wikipedia.org/wiki/List_of_countries_by_infant_...

At around 6 per 1000, compared to 4.3 for the UK (or 2.7 for Japan) for example.

I would imagine, infant mortality isn’t just about a function of healthcare available during pregnancy, but also for the parent before pregnancy. There could of course be multiple other confounding factors (such as life style issues)...

lallysingh• 8 years ago

Would life style issues be a major difference between here and the UK or Japan?

dantheman• 8 years ago

How countries count infant mortality is not the same. So it's very hard to compare numbers.

minikites• 8 years ago

The US actually has very generous social services when it comes to medical care for pregnant women and their babies.

Only if you're white:

https://www.nytimes.com/2018/04/11/magazine/black-mothers-ba...

rmrfrmrf4• 8 years ago

Lol try having kids and see for yourself how "generous" it is. We've been "fully-covered" for pregnancy and delivery for both kids and still had to go on payment plans to cover the costs.

refurb4• 8 years ago

Are you on Medicaid or CHIP? Because that's what I was referring to.

isolli• 8 years ago

Infants are definitely more likely to die in the USA than in any almost any other OECD country (the exceptions being Chile, Turkey, and Mexico).

https://data.oecd.org/healthstat/infant-mortality-rates.htm

pitaj• 8 years ago

Are these statistics standardized in methodology? Many countries don't count certain types of infant mortality that the US does.

davidivadavid• 8 years ago

How reliable are the Cuban statistics?

danlugo92• 8 years ago

Not reliable at all.

manfredo2• 8 years ago

Regardless of reliability it's important to mention that mortality rates isn't the be all end all of healthcare quality. Many people contrasting Cuban mortality and life expectancy statistics against the US have a political axd to grind, and they fail to mention key nuances. Chief among them, the fact that it's drastically easier to curb obesity when the government rations food.

mdpye• 8 years ago

The government provides a ration, you can buy more food.

I'm not saying food in Cuba was available in the same kind of quantities and choices as in the states, but portions were almost on par (which is to say, enough to floor a European for several hours after a meal!)

The article even states that the primary weight problem faced in Cuba is over, not underweight people.

rjf722• 8 years ago

This article is extremely misleading. One of the main causes of infant mortality is parental obesity. [1] As America becomes more and more obese we're going to see more and more of these sort of consequences. For instance our declining life expectancy is also related to this. Diseases ranging from cardiovascular to cancer had been steadily retreating, but as our waist lines expanded the frequency and mortality of these sorts of things have once again begun rising. Better healthcare is not a magic pill for unhealthy lifestyles.

In other words, this is about a healthier people - not about a comparable people with better access to healthcare. I'd expect to see these numbers level out in time. Cubans have also been thickening up as the article does mention, but they're still quite far behind us.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2674328/

TelmoMenezes• 8 years ago

One of the main causes of infant mortality is parental obesity. [1]

The article you cite does not say that it is a main cause. It says it is a cause, and that it doubles the chance of infant mortality in obese mothers, but it makes no comparisons with other causes.

In other words, this is about a healthier people - not about a comparable people with better access to healthcare.

We can test your hypothesis. Let's compare two countries that happen to have female populations with the same average BMI, with similar cultures and dominant ethnicity (both former colonies of the British Empire):

* USA -> Female mean BMI: 28.8; Under-five mortality rate: 6.5

* Australia -> Female mean BMI: 28.8; Under-five mortality rate: 3.7

For Feamle Mean BMI I used World Health Organization data from 2015: https://en.wikipedia.org/wiki/List_of_countries_by_body_mass...

For Under-five mortality rate (deaths/1,000 live births) I used World Bank data from 2016: https://en.wikipedia.org/wiki/List_of_countries_by_infant_an...

While obesity clearly plays a role in increasing infant mortality, it fails to account for the big discrepancy in infant mortality rates between the USA and the other western nations. One compelling explanation remains: the USA is the only one of these countries without some form of universal healthcare.

rjf722• 8 years ago

You need to compare maternal obesity rates, not mean BMI. The two are not correlated because there are major biases in maternal demographics. For instance in the US most children born are now non-white and there is a strong inverse correlation between income and fertility rates. Both those characteristics (non-white, low income) in turn correlate strongly with increased obesity rates. There are an immense number of studies on this topic. Without link bombing an easy way to find more data is to check out google scholar: https://scholar.google.com/scholar?q=US+infant+mortality+obe...

Something that might help clarify matters most is this [1] paper. It not only gives specific figures but is over an extremely large and comprehensive sample, most of the data is from a ethnically homogeneous sample, and is in a region with nationalized healthcare (Sweden). So it helps remove confounding variables. And there too we find that infant mortality for normal weight women was 2.4/1000 while it was 5.8/1000 for those with obesity grade 3. There was a linear scaling of risks and mortality that mapped directly against obesity. Interestingly enough even being just overweight also corresponded to a slightly increased rate of infant mortality.

Crucially, what obesity tended to lead to was preterm deliveries, congenital birth defects, pregnancy complications, and sudden infant death syndrome. The reason I say crucially is that these [2] are the leading causes of infant death from the CDC. Those issues that arise from obesity are literally the top 4/4 causes of infant death.

[1] https://www.bmj.com/content/349/bmj.g6572.full.pdf+html

[2] https://www.cdc.gov/reproductivehealth/maternalinfanthealth/...

antepodius2• 8 years ago

They state themselves the figures aren't to be trusted. This makes me unsure how to feel about the subject. If Cuba's just lying about infant mortality (I don't know how feasible that would be) it invalidates a lot of things.

I find the point about local, conveniently-accessible doctors leading to earlier diagnoses interesting, too. That seems like a fair point: I've heard a lot about the automobilised nature of america, where cities are built for cars rather then people. If you can't just walk over to the local doctor you've known for the last 5 years to ask about the lump on your back because going to the doctor is seen as a big deal- you can imagine this leading to fewer check-ups.

I've heard a point that the US is in a hellish middle-ground between socialised healthcare ala euroland and hypothetical free-er market healthcare: you can't actually shop around for cheaper treatment, because the government's teamed up with big pharma to reduce competition and obscure pricing.

edit: Just read a comment mentioning obesity as a factor. That makes a lot of sense, as well. Of course a country as fat as america's going to be in a worse health state than one like cuba where people are only starting to bloat up after starving a while back.

bhawks• 8 years ago

"Cuba does have a very low infant mortality rate, but pregnant women are treated with very authoritarian tactics to maintain these favorable statistics," said Tassie Katherine Hirschfeld, the chair of the department of anthropology at the University of Oklahoma who spent nine months living in Cuba to study the nation's health system. "They are pressured to undergo abortions that they may not want if prenatal screening detects fetal abnormalities. If pregnant women develop complications, they are placed in ‘Casas de Maternidad’ for monitoring, even if they would prefer to be at home. Individual doctors are pressured by their superiors to reach certain statistical targets. If there is a spike in infant mortality in a certain district, doctors may be fired. There is pressure to falsify statistics."

https://www.politifact.com/truth-o-meter/statements/2014/jan...

Can we base our universal healthcare proposals on countries that have done it without the authoritarianism and human rights violations please? There are a few other examples.

rmrfrmrf4• 8 years ago

Hospital stays for pregnancy complications is incredibly common in the US (and you have to pay for it!) Acting like this is coersion is disingenuous, especially when pregnant women in the US are forced to go home without monitoring when they can't afford an extended hospital stay.

Edit: I should also add that these complications are things that can cause both maternal and fetal death. No one wants to be further than arms-length from medical care when the risk is that high (note the use of "may" in the quote from the parent comment, as if this is a theoretical discussion because they couldn't actually find anyone who was begging to leave).

friedman232• 8 years ago

Why did you choose to gloss over the forced abortions?

blindwatchmaker• 8 years ago

The 'pressure to undergo abortions in case of fetal abnormalities' sounds the only potentially troubling part of that, but I don't exactly get what's 'authoritarian' about insisting women with complications stay and be be monitored in the hospital, or firing people based on poor performance?

Am I missing something here?

DanBC• 8 years ago

Patients have the rights to chose their treatment, and this includes the right to make unwise choices about their treatment.

(I have no idea what actually happens in Cuba).

rmrfrmrf4• 8 years ago

The only group of women who would feel oppressed would be the CEOs that can afford fully-staffed private hospitals in their own homes and wouldn't be caught dead resting alongside the unwashed masses.

atentaten• 8 years ago

I've been to Cuba many times over the last 10 years and have seen how pregnant women are treated up close and personal. The difference between Cuba and the U.S. is that Cuba has a greater sense of urgency when it comes to pregnancy. No one is coerced, but there is a community-driven sense of urgency and importance when it comes to following up with your pregnancy.

pseudolus2• 8 years ago

>Can we base our universal healthcare proposals on countries >>that have done it without the authoritarianism and human >>rights violations please?

You're entirely correct there are many other examples of western democracies that can stand as models. However, I believe the reason Cuba was chosen was precisely to elicit a reaction. A story comparing mortality rates in the US to those in Canada, the UK or France would have fallen by the wayside. For one reason or another, the mention of Cuba generates attention and reactions - as attested to by this post itself.

adolph• 8 years ago

All this [these prenatal home visits] is possible because Cuba overflows with doctors — it has three times as many per capita as the United States — and pays them very little.

corporateVeal273• 8 years ago

Skeptical of these numbers:

1. "4 (Cuban) vs 6 (American) deaths per live birth."

Are we sure they're measured the same? Are we sure that the count for deaths starts at the same time? Could easily be that Cuban mothers are more likely to lose a baby at an earlier stage of pregnancy (for example Cubans measure it from 2nd trimester on, Americans measure it from conception so Cubans fail to count early stage deaths).

2. "7500 deaths per year in US".

The author does not seem to have his figures correct. Approximately 3.8 million american babies are born per year. If 0.6% of them die that's 228,000 total deaths and a differential of about 60,000 between US rates and Cuba's. Not to nitpick here but if you can't get these objective facts right how can I take you seriously about other things you're saying?

danielvf2• 8 years ago

According to the CDC, in 2013, there were 3,932,181 live births and 23,446 infant deaths (from birth to age one). That checks out with a 6 in 1000 ratio.

falsedan• 8 years ago

Americans measure it from conception

A pre-birth death can't be counted among the 'per live birth' deaths, and would have to include estimates of miscarriage rates since those are woefully underreported everywhere. Pretty sure every country starts the clock at birth.

corporateVeal273• 8 years ago

I wasn't implying they DO measure it from conception I'm just an example that could explain a discrepancy that is not indicative of better results

Agree on the point about underreporting everywher

corporateVeal273• 8 years ago

Edit: I meant 22.8k not 228k. Type on my part. Good thing I don't publish articles :)

danielvf2• 8 years ago

When we were getting ready for our first child, looking for a hospital, I went deep diving on infant mortality rates in the US in general, and specifically in our area's hospitals.

At least in my area of the country, the higher infant mortality (outside birth defects) rates are almost entirely driven by a tiny percentage of the overall population - extremely young mothers with substance abuse problems. The biggest portion of the effect is not a result of medical care differences. According to the CDC, "Asians" in the US have almost a quarter the infant mortality rate of "Blacks".

https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_09.pdf

The article mentions that the US infant death rate is 5.9, and the Cuban infant death rate is 4.0. However, according to the CDC report, Cuban ancestry, living in the US, has an infant death rate of 3.0!

gnicholas• 8 years ago

The data regarding infant mortality is collected differently in different countries, so this is like comparing apples and oranges. In the US, more events are included in the umbrella of "infant mortality" than in most other countries, which use narrower definitions. Neither way is more "correct" than the other, but the varying definitions mean that it is very difficult to make meaningful cross-country comparisons, as Mr. Kristof is trying to do here.

https://www.forbes.com/sites/physiciansfoundation/2016/04/12...

refurb4• 8 years ago

Similar issues comparing crime statistics across countries. What falls under "assault" can vary quite a lot.

gandalfian• 8 years ago

"the infant mortality rate in Cuba is only 4.0 deaths per 1,000 live births. In the United States, it’s 5.9. In other words, an American infant is, by official statistics, almost 50 percent more likely to die than a Cuban infant."

Is that right? Or is it 0.19% more likely to die in the USA. This is why I never win on the horses.

So perhaps the answer is that they are both pretty safe? I would think more elective caesarians and traffic accidents could account for much of the differences but it must be getting pretty close to the margin of error?

AnIdiotOnTheNet• 8 years ago

No, you may consider the statement misleading, but it is correct. 100% of 4/1000 is 4/1000, 50% of 4/1000 is 2/1000, so 50% more likely than 4/1000 = 4/1000 + 2/1000 = 6/1000.

nkurz• 8 years ago

The country has an unusually high rate of late fetal deaths, and skeptics contend that when a baby is born in distress and dies after a few hours, this is sometimes categorized as a stillbirth to avoid recording an infant death. ... I’m not in a position to judge who’s right, but any manipulation seems unlikely to make a huge difference to the reported figures.

What are we to make of that last sentence? The author seems to be saying "I don't know enough to judge" but then immediately follows that with a strong opinion as to who must be wrong. How are we as an audience supposed to gauge whether Kristof (the author) is right that the effects will be inconsequential even if the accusations of manipulation were true? The implication would seem to be that because he's writing his (clearly labeled) opinion in the New York Times, we should trust him as an expert, despite his disavowals.

While we can't easily answer the question as to whether the statistics are manipulated, it turns out that there are at least clear answers to what the effect of the manipulation would be. In a 2015 article entitled "Infant Mortality in Cuba: Myth and Reality", Roberto Gonzalez runs the numbers and shows that the effect of reporting Early Neonatal Deaths as Late Fetal Deaths would be enough to completely change our interpretation of the statistics. Here's a summary of the paper's conclusions: https://thecubaneconomy.com/wp-content/uploads/2014/02/Infan...

What should we make of this? Certainly a problem with a small detail like this doesn't mean the overall question isn't worth asking, and the "human interest" aspects of the story are certainly interesting, but it sure make me wonder how much we should trust the author's intuitions about other details in the story.

andrenth• 8 years ago

Cuban statistics cannot be trusted.

https://academic.oup.com/heapol/article/33/6/755/5035051

Key quote: “(...) evidence that physicians likely reclassified early neonatal deaths as late fetal deaths, thus deflating the infant mortality statistics and propping up life expectancy.“

Infants May Be More Likely to Die in America Than Cuba

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