Often, activists and pundits alike turn to life expectancy and infant mortality rate data to conclude that there is a direct correlation between better quality of life and a country’s healthcare system. However, utilizing statistics without presenting the proper reasoning behind them can be exceptionally misleading. Blatantly pointing at life expectancy and our infant mortality rate is a deeply flawed way of thinking about the quality of a country’s healthcare system.
Firstly, life expectancy is determined by numerous exogenous factors other than the delivery system of health services that vary from country to country based. These include the prevalence of smoking, environmental factors, physical activity levels, the use of opiates, obesity, the list goes on. That is, in a country where daily habits and social conditions foster more overweight, drug-abusing people, any health care system will be starting with a less healthy population in general — even before any treatment options are even considered. As Samuel Preston and Andrew Stokes conclude in their study “Contribution of Obesity to International Differences in Life Expectancy”: “The high prevalence of obesity in the United States contributes substantially to its poor international ranking in longevity.” Similarly, in a separate study, Preston, Stokes, and Yana Vierboom found that as Americans became heavier from 1988 to 2011, this “has reduced life expectancy at age 40 by 0.9 years in 2011 and accounted for 186,000 excess deaths that year.” They conclude that obesity has become a significant factor in slowing down improvement in U.S. life expectancy compared to other countries. Further, if we follow the common conclusion that life expectancy and quality of healthcare were directly correlated, immigrants from countries with higher life expectancies would be expected to have a lower life expectancy in the U.S. However, let’s take the case of Japanese Americans to illustrate otherwise. At 84.2 years, Japan has the longest life expectancy of all industrialized countries, about six years longer than the United States. One would not expect Japanese-Americans to live as long as their counterparts in Japan, but they do.
As for infant mortality rate, the United States has an infant mortality rate of 5.7 per 1,000 births while other countries like Japan have a rate of only 1.1, Sweden 2.1, and Canada 4.2. Why is this so? Critics of the American healthcare system believe this is irrefutable evidence for the case of socialized medicine. However, like life expectancy, there are several other factors outside of a country’s healthcare system that contributes to the high infant mortality rate. As a multiethnic country, race constitutes a significant factor in the infant mortality rate as different racial groups have different likelihoods of birthing a low-weight baby. For example, African American women deliver small babies at twice the rate of white women controlling the mother’s age, income, prenatal visits, and education. Although these disparities are not fully understood, studies of twins have suggested 40 percent of the variation is due to genetics. Secondly, not all infant mortality rates are measured equally across the world. In the U.S., very-low-birth-weight infants have a much greater chance of being brought to term with the latest medical technologies. Some of those low‐birth‐weight babies die soon after birth, which boosts our infant mortality rate, but in many other Western countries, those high-risk, low‐birth‐weight infants are not included when infant mortality is calculated. These nonviable babies who die quickly after birth are recorded as live births in the U.S., but are more likely to be classified as stillbirths in other countries, especially if they die before birth is legally registered. This substantially inflates the infant mortality rate in our country. If a baby in Hong Kong or Japan is born alive but dies within the first 24 birth, he or she is reported as a “miscarriage” thus not affecting the country’s infant mortality rate. According to the calculation procedures in countries like Canada, Germany, and Austria, a premature baby weighing less than 500 grams is not considered a live birth. In Switzerland and other parts of Europe, a baby born less than 30 centimeters long is not counted as a live birth either. In these cases, the infant mortality rate remains the same.
Critics frequently use comparisons of infant mortality and life expectancy to accuse the United States of providing inadequate health care and to advocate for increased government regulation. However, reported infant mortality and life expectancy data do not accurately demonstrate that the U.S. is inferior in health care provision, because they involve simplistic comparisons of inconsistent measures, which omit many important factors.