As the charts above show, in the 1960s the United States had significantly lower child mortality rates than the other rich countries included in the study. But starting in the 1970s, that changed.
Among infants, that shift was driven primarily by changes in our premature birthrate (babies born before full gestational age), which is the highest in the developed world. Our rate of “extreme” prematurity — babies born before 25 weeks — is three times higher than the OECD average.
Among older children, the United Stands stands out on our rate of deaths by injury. In particular, Americans teens age 15 to 19 are 82 times more likely than teens in other rich countries to die of a gun homicide. Among black American adolescents, gun homicides are the leading cause of death in the United States.
The root cause of all these problems is well understood: “Persistently high poverty rates, poor educational outcomes, and a relatively weak social safety net have made the U.S. the most dangerous of wealthy nations for a child to be born into,” the study, led by Ashish Thakrar, an internal medicine resident at the Johns Hopkins Hospital, concludes.
Starting in the 1980s, the U.S. childhood poverty rate exploded relative to other wealthy nations. Roughly 21 percent of American children live in poverty, one of the highest rates in the developed world.
American children are also falling behind on education relative to their peers. “Both poverty and education have repeatedly been shown to track along a gradient of health in children, with lower incomes and lower education correlated with worse health outcomes,” according to the report.
These two factors are compounded by a weak American social safety net. “During the period we analyzed, the U.S. spent significantly less of its gross domestic product per capita on child health and welfare programs, compared to other wealthy nations,” the authors write.
Those 600,000 deaths, in other words, are largely the result of deliberate policy choices made by American voters and their elected representatives.
A 2010 study found governing decisions about welfare policies explained up to 47 percent of the observed differences in life expectancy between countries. An earlier study found about 20 percent of country-level differences in infant mortality rates could be explained by a nation's governing style.
“The care of children is a basic moral responsibility of our society,” the report's authors write. “All U.S. policymakers, pediatric health professionals, child health advocates, and families should be troubled by these findings.”