WASHINGTON – Underscoring historic recent gains in global health, the number of children younger than 5 who die this year will fall to 7.7 million, down from 11.9 million two decades ago, according to new estimates by population health experts.
But as much of the world makes strides in reducing child mortality, the United States is increasingly lagging and now ranks 42nd globally, behind much of Europe as well as the United Arab Emirates, Cuba and Chile.
Twenty years ago, the United States ranked 29th in the child mortality rate, according to data analyzed by the Institute for Health Metrics and Evaluation at the University of Washington.
The estimates, derived from modeling based on international birth records and other sources, are being published today in the British medical journal the Lancet.
Singapore, the country with the lowest child mortality rate in the world at 2.5 deaths per 1,000 children, cut its rate by two-thirds between 1990 and 2010. Serbia and Malaysia, which were ranked behind the United States in 1990, cut their rates by nearly 70 percent and now are ranked higher.
The U.S., which is projected to have 6.7 deaths per 1,000 children this year, saw a 42 percent decline in child mortality, a pace that is on par with Kazakhstan, Sierra Leone and Angola.
“There are an awful lot of people who think we have the best medical system in the world,” said Dr. Christopher Murray, who directs the institute and is an author of the study. “The data is so contrary to that.”
Even many countries that already had low child mortality rates, such as Sweden and France, were able to cut their rates more rapidly than the United States over the last two decades.
“It’s really just hard to fathom,” said Laura Beavers, national Kids Count coordinator for the Annie E. Casey Foundation, one of the nation’s leading advocates for children’s health.
The U.S. mortality rates defy traditional explanations, such as a nation’s diversity, high number of immigrants and persistent pockets of poverty, Murray said.
Australia, another diverse country with a large immigrant population, cut its child mortality rate over the last two decades more than the United States, for example. Australia now ranks 26th in the world.
And Murray said high child mortality rates are not limited to black and Latino populations in the United States. In fact, researchers have found high rates among higher-income whites, a group that traditionally has better access to medical care.
The data instead suggest broader problems with the nation’s fragmented, poorly planned health care system, Murray and other health care experts say.
Although the United States spends nearly twice as much per capita on health care as most other industrialized countries, researchers are finding substantially higher levels of preventable deaths from diseases such as diabetes and pneumonia.
Another recent study by the Institute for Health Metrics and Evaluation found that the rate of deaths among women giving birth has actually increased in the United States over the last two decades.
“We certainly have outstanding medical science and centers of excellence that rival the best in the world,” said Cathy Schoen, an expert on global health systems at the nonpartisan Commonwealth Fund. “But many other countries have been putting many more resources into thinking about how they can improve. … They have been far more strategic.”