Editor's Note: Steve Chapman is on vacation. The following column was originally published in August 2009.
The American medical system has the latest technology, the greatest variety of new drugs and unparalleled resources. But anyone who thinks we're getting something great for our dollars inevitably encounters a two-word rebuke: infant mortality.
The United States is the richest nation on Earth, but it comes in 29th in the world in survival rates among babies. This mediocre ranking is supposed to make an irrefutable case for health care reform. If we cared enough to insure everyone, we are told, we would soon rise to the health standards of other modern nations. It's just a matter of getting over our weird resistance to a bigger government role in medical care.
But not every health issue is a health care issue. The reason boxers are unusually prone to concussions is not that they lack medical insurance. Doctors may treat head injuries, but it's a lot easier to prevent them. Absent prevention, we shouldn't blame the medical industry for punch-drunk fighters.
Like life expectancy (the subject of a previous column), infant mortality is a function of many factors. The more you look at the problem the less it seems to be correctable by a big new federal role in medical insurance -- and, in fact, the less it seems to be mainly a medical issue at all.
No one denies the problem. Our infant mortality rate is double that of Japan or Sweden. But we live different lives, on average, than people in those places. We suffer more obesity (about 10 times as much as the Japanese), and we have more births to teenagers (seven times more than the Swedes). Nearly 40 percent of American babies are born to unwed mothers.
Factors like these are linked to low birth weight in babies, which is a dangerous thing. In a 2007 study for the National Bureau of Economic Research, economists June O'Neill and Dave O'Neill noted that "a multitude of behaviors unrelated to the health care system such as substance abuse, smoking and obesity" are connected "to the low birth weight and preterm births that underlie the infant death syndrome."
Nicholas Eberstadt, a scholar at the American Enterprise Institute in Washington, also attributes the gap largely to conduct.
Comparing white Americans to Norwegians in his 1995 book, "The Tyranny of Numbers," Eberstadt concluded that "white America's higher rates of infant mortality are explained not by poverty (as conventionally construed) or by medical care but rather by the habits, actions and indeed lifestyles of a critical portion of its parents." Whites are not unique in those types of behavior.