Introduction
Infant mortality defined as the number of deaths that occur to children, one year old or below per one thousand live births, has been used as an important indicator of a nation’s health status and well-being (DPHP, 2003). Compared to other European nations particularly Sweden, United States’ infant mortality rate has been consistently higher for at least the last three decades. For instance, in 1960 United States was ranked 12th internationally and later 23rd in 1988 (Navarro, 2004, p.31). The recent rankings are not any better, with the latest Center for Disease Control and Prevention’s release placing the country at position 30 out of 31 countries from Europe, ranked with statistical average of 6.0 deaths for every 1000 live births (Newell, 2009). This is in line with other statistical showing that one out of eight births in the United States were preterm, a comparatively higher rate as compared to a number of industrialized nations (Newell, 2009).
In stack contrast to the United States is Sweden. In fact, at the turn of 19th century, Sweden had a consistently lower rate of infant mortality compared to many European counterparts like Germany and Britain, i.e. in 1880s the country experienced 112 per 10000 infant deaths, compared with 228 in Germany and 143 in Great Britain; in the 1920s 60 per 1000 in Sweden, compared with 72 in Britain and 112 in Germany (Navarro, 2004). In 1982, Sweden had the lowest infant mortality rate, considering the fact that both neonatal and postneonatal mortality rates of Sweden were relatively lower (Navarro, 2004). Before in 1960s the neonatal mortality rate of Sweden was substantially reduced and additionally, incidences of low birth weight are significantly lower in Sweden (Newell, 2009). Moreover, the latest rankings (2009) show Sweden as only second to Singapore, with the former having 2.4 deaths in every 1000 births and the latter 2.1 (Newell, 2009). Just to emphasize Sweden’s consistency in their performance, the turn of 19th century produced an overall infant mortality rate of about 100 per 1000 live births; in 1997 it was about 4 per 1000 (Navarro, 2004, p.31). In fact, it is said that none of the U.S states has reached the level of Sweden in terms of low infant mortality. This paper will highlight the reasons behind the Sweden’s success in the consistent lowering of the infant mortality rate in comparison with the United States; what they do better than United States; and what the United States (as a country) and New York State are doing to lower infant mortality rate to be at per with the likes of Sweden.
Why is Sweden’s rate lower than the United States?
The Swedish experience, which has been well studied, provides quite relevant information on declines in infant mortality. In 1986, a study conducted in the country indicated that the social difference gap is narrowed due to the minimal gap between the highly educated vs. the middle level and low level groups, a complete contrast to the United States where education has been found to discriminate between social groups (Pankhurst, 2005). When the Swedish infant mortality was measured in relation to groups’ sources of death, an obvious social pattern, as measured by length of education, was found for sudden infant death syndrome only (Pankhurst, 2005). However, the sudden infant mortality was found to be preventable, as long as quick measures are taken in terms of seeking healthcare services, in this perspective, it is prudent to state that Sweden’s free healthcare for all has boosted even detection and reduction of sudden infant death syndrome than the United States, who’s healthcare services are not a free-for-all service.
Again, during this period and after, social class in Sweden as measured by length of mother’s education played a major role as a risk factor for all causes of infant death (Pankhurst, 2005). This study also revealed a peculiar scenario where the increased risk for sudden infant death syndrome among infants to mother with short education was substantially related to differences in maternal age, parity, and smoking habits (Pankhurst, 2005). From this study, the authors concluded that it is reasonable to assume that the relatively minor instances of maternal education on infant survival was a consequence of a generally high standard of living; of high medical, technical, and economic development; and of the nationwide, free prenatal and child healthcare system (Pankhurst, 2005). Newell (2009) states that the relatively unfavorable international standing of the United States in terms of infant mortality is largely as a result of the substantial racial disparity in infant survival and associated socioeconomic inequality that have existed in the country for a long period. It is significant to note that substantial differences in infant mortality have been well documented, with various literature highlighting certain important socioeconomic variables such as education as and family income as factors that play their independent roles in the infant mortality rate.
Interestingly, the CDC reported that among the preterm infants born less than 37 weeks into gestation, United States scored much better than the European countries including Sweden (Newell, 2009). However, the concern is mainly in the later stages of gestations, where the mortality rate for infants is generally higher than most of other countries in the same category of industrialized (Newell, 2009). This finding is in line with the other findings by Frey & Field (2000), which indicated that the major cause of high infant mortality rate in the United States is as a result of preterm birth since 12% of the infants are born as preterm. It further illustrate that if United States had the similar distribution of gestational age of birth as Sweden, the cases of infant mortality will drastically reduce by an average of 33% (Frey & Field, 2000). As such it would be logical to state that any effort to prevent preterm births will considerably reduce the infant death incidences in the United States as seen in the Sweden model.
What is Sweden doing to keep their rate low?
Sweden as a country developed a national health insurance programs that are under the government watch, i.e. the program is run by the government with the financial support from the general tax (Navarro, 2004). As earlier stated, all the Swedish citizens have access to primary healthcare system and even the specialized treatment for free or at a relatively low cost (Navarro, 2004). In other words, the country has a universal access to healthcare. In contrast, American citizens do not have an entitlement to such services, despite the fact that the healthcare services has gone under significant changes in terms of cost, access and quality (Shi & Singh, 2009). Shrtell at al. 1996, as cited in Shi & Singh (2009) states that one barrier to the universal healthcare coverage is the unnecessary fragmentation of the U.S. delivery system, which is probably its main feature (p.2).
The government of Sweden has had long term initiative in their healthcare programs with the main aim of reducing the overall health of the people. In essence they identified several multiple factors that affect these parameters such as family characteristics (Social differences) social support system that includes healthcare services (Navarro, 2004).
Several empirical studies have revealed that in Sweden, there is a small gap between the low and high social class, which has decreased considerably throughout the last three decades (Navarro, 2004). There are no social differences regarding availability of and access to healthcare for the mother and the child, i.e. the parental and child healthcare system is available for everyone, and specialized hospitals are also available at no or low cost for those who need special care (Navarro, 2004). The housing conditions are described as generally good, the differences in income have become smaller and there is hardly any real poverty (Navarro, 2004).
Theories and the Infant mortality
The modernization theory states that industrialization increases the chances of infant mortality prevention; that “economic growth fosters improvement in education, housing, nutrition, healthcare, sanitation, and various public services that reduce infant mortality” (Frey & Field, 2000, p.215). It is therefore prudent to state that when an economy improves, the people get encouraged with new form of energy and develops much interest to work; this positivism means healthy mothers parents (especially mothers) and subsequently healthy babies. However, the United States scenario does not seem to comply with this line of argument.
However, one would argue that the theory of gender stratification is more relevant to the United States and Sweden scenarios. In this theory, it is stated that where a female gender is empowered, her role as a mother is empowered too (Frey & Field, 2000, p.217). In this case, education is one of the ways of improving the mother’s ability to care for the newly born child. This is because a mother who is educated will most likely seek healthcare services for her child, and more importantly will be bale to communicate effectively to the healthcare (Frey & Field, 2000). Furthermore, it is said that educated mothers do have higher self-esteem as compared to uneducated mothers, hence boosting their health outcomes as well as that of their babies (Frey & Field, 2000). There is also the theory of economic disarticulation, which states that a country’s disorganization is dependent on the disjointed economy and the uneven development, i.e. social services are not distributed in equal measure and that thus causing unequal economic development and strenuous relationship between the rich and the poor (Frey & Field, 2000)
From the above theories, it can be substantially clarified that a country’s low infant mortality does not depend on its wealth, as illustrated by Sweden whose overall national wealth is far much behind the United States’.
What the United States (as a country) does
Being a multifaceted problem, Infant mortality has brought with it numerous challenges for the United States as whole. Basically, about 201.7 million Americans have private health insurance coverage, 40.3 million are beneficiaries of the Medicare, and 38.3 million are recipient of Medicaid (Shi & Singh, 2009). Even though the said health insurance is available in over 1000 health insurance companies and 70 Blue Cross/Blue Shield plans (Shi & Singh, 2009), it is not sufficient as not everyone is able to afford the cost of buying health insurance. In lieu to this, there are numerous organizations under the managed care sector, i.e. with approximately 405 licensed health maintenance organizations and 925 preferred provider organizations (Shi & Singh, 2009). They are supported by a number of government agencies that are responsible for the financing of the various organizations involved in healthcare services, research as well as regulatory aspects of several of the healthcare delivery system (Shi & Singh, 2009, p.3).
After realizing the importance of community in reducing infant mortality, the government established a public health organization, the Disease Prevention and Human Promotion in target of “Healthy people 2010” (Frey & Field, 2000). It was comprised of diverse groups of specialists including scientists to help improve the quality of life to eliminate disparities, focusing on many areas including maternal, infant, and Child Health (Frey & Field, 2000). This was meant to instill the culture of healthy living among the population. However, so far no significant change has occurred since this initiative kicked off more than 5 years ago considering the fact that infant mortality has remained stagnantly high for almost a decade (Newell, 2009).
This kind of failure has posed a lot of concern to most researchers and the general public alike, prompting some experts to believe that the solution purely lies in the policy issues that will address all aspects of healthcare in a multidimensional aspect rather than the current focus on the health sector alone (Newell, 2009).
New York City and New York State Infant Mortality Rate Reduction Initiative
In an effort to reduce the infant mortality in the New York City and New York State as a whole, the state government introduced a program that they described as “cross-cutting” with a numerous programs through partnership initiatives with the local community (BMIRH, 2009). The central aim of the project was to reduce infant mortality and reduce the racial, ethnic, as well as geographical disparities that have existed for decades (DPHP, 2003; BMIRH, 2009).
According to the statement from the Department of Health Planning Council Cross-Cutting Project, infant mortality was identified as the priority among other cross-cutting issues that required multifaceted approach (BMIRH, 2009). Additionally, the impact of psychological, behavioral, and environmental factors, which have influence on the infant mortality provoked the idea of solving infant mortality through such a program that would be long term based by applying the resources that would be got from different departments, hence maximizing the impact (BMIRH, 2009). According to BMIRH (2009) Central Brooklyn was selected as the community district to launch the pilot project after an extensive data analysis, literature review as well as community resource inventory that was carried out by Infant Mortality Task Force. Its plans are to expand the initiative to encompass communities from New York City suffering from the same effect of infant mortality. The highlighted actions were identified as partnership development and intra-department of health cross-cutting participation (BMIRH, 2009).
Conclusion
The contrast between United States and Sweden in terms of healthcare services and in particular infant mortality has a long historical background. While Sweden’s infant mortality reduction has been above average and improving almost annually since 19th century, the United States’ case has been a complete contrast, with the rate either increasing or stagnating throughout. This may be attributed to the difference in health and social policies and particularly those touching on the general healthcare and social issues such as poverty and education. That is to say Sweden realized the importance of reducing the gap between the poor and the rich, increasing opportunities to empower its citizens through education and making healthcare services a free-for-all. This is in stack contrast to the United States which has basically faltered in its policy issues coupled with the historically wide gap between the rich and the poor.
Reference List
Disease Prevention and Health Promotion (DPHP). (2003). Healthy People. Web.
Frey, S. R. & Field C. (2000). The Determinants of Infant Mortality in the Less Developed Countries: A Cross-National Test of Five Theories. Social Indicators Research 52: 215-234. Netherlands: Kluwer Academic Publishers.
Navarro, V. (2004). The Political and Social Context of Health. New York: Sage Publishers.
Newell, J. (2009). Infant Mortality Rates: U.S. Ranks Poorly Among Industrialized Nations. Web.
New York City Department of Health and Mental Hygiene (BMIRH). (2009). Infant Mortality Reduction Initiative. Web.
Pankhurst, C. (2005). Infant Mortality: Public Health Management and Policy. Cleveland: Bolton School of Nursing.
Shi, L. & Singh D. (2009). Essentials of the U.S. Health Care System, 2nd edition. Sudbury, MA: Jones and Bartlett Publishes.