When the numbers cease to be abstract, a certain kind of unease sets in. Dr. Ashish Thakrar was sitting somewhere in Baltimore with data covering fifty years of childhood deaths in twenty affluent countries. What he discovered wasn’t just concerning, but alarming, in his own words. Among similar high-income nations, the United States, the world’s richest democracy, has the highest child mortality rate. Not the second worst. The worst.
The study, which was published in Health Affairs, looked at mortality rates for children up to the age of 19 in the US and 19 other OECD countries between 1961 and 2010. What surfaced was not a tale of a single policy failure or a bad decade. It was a protracted, gradual divergence, with other nations dragging their kids to safety while America’s advancement stalled and eventually fell behind.
Between 2001 and 2010, the mortality rate in the United States was approximately 50% higher for children aged 1 to 19 and approximately 75% higher for infants than the average for all countries under study. These numbers do not originate from a partisan think tank or a fringe source. They are sourced from the World Health Organization and the Human Mortality Database. It’s difficult not to feel something when you sit with that—not just worry, but a sort of subdued incredulity.
What’s causing it? It’s made worse in some way by the fact that the solution isn’t all that mysterious. Three focused areas are identified by researchers: firearm violence, auto accidents, and infant deaths associated with SIDS and prematurity. The final one is the most important. Compared to their peers in any other wealthy democratic nation, American teenagers between the ages of 15 and 19 have an 82-fold higher risk of dying from gun violence. Eighty-two times. That gap cannot be explained by a rounding error.
By examining data from 2007 to 2022, a second, more recent study that was published in JAMA brought the picture closer to the present. It discovered that American children between the ages of one and nineteen had a 1.8-fold higher mortality rate than children in similar nations. Beyond death, another change had occurred: chronic illness had subtly become the standard. Dr. Chris Forrest claimed he hardly ever saw a child managing a chronic condition when he first started practicing pediatrics in the 1990s. Nearly half of American children were receiving care for one by the time his study was published. It’s not a blip. That generation is changing.
A framing that breaks through the policy clutter was provided by Lindsay Stark, an associate professor at Columbia University’s Mailman School of Public Health. She pointed out that cardiovascular issues and infectious diseases are not the main causes of the disparity between the US and other countries. It’s injuries and perinatal mortality, especially from firearms. Most of these deaths could have been avoided. The word “preventable” carries more weight than just statistics.
The fact that this is more than just a healthcare issue makes it more difficult to write it off as such. The social environment—weak safety nets, enduring inequality, and gaps in public policy that leave some families, mothers, and children far more vulnerable than others—is emphasized by researchers in both studies. Sweden, which routinely has the lowest child mortality rate among the countries under study, didn’t get there by good fortune. It arrived as a result of conscious decisions about how a society handles its youngest and most vulnerable members.
Beneath the cacophony of other arguments, there’s a feeling that America is aware of this. For decades, the data has been unambiguous. When the knowing will transform into something else is still unknown.
