Infants May Be More Likely to Die in America Than Cuba
nytimes.com
nytimes.com
https://www.politifact.com/truth-o-meter/statements/2014/jan...
Can we base our universal healthcare proposals on countries that have done it without the authoritarianism and human rights violations please? There are a few other examples.
Edit: I should also add that these complications are things that can cause both maternal and fetal death. No one wants to be further than arms-length from medical care when the risk is that high (note the use of "may" in the quote from the parent comment, as if this is a theoretical discussion because they couldn't actually find anyone who was begging to leave).
I think the article definitely gave the impression that the abortions were "forced". But to be fair, the article never actually said that. I think the word they used most often was "pressure".
It's been a while since I was last in Cuba, but when I was last there abortion was given on a list of the various options that could be taken in such cases. And just like everywhere, the option that the doctor would recommend would depend on the doctor and his/her motivations. For instance, some might recommend abortion, another might recommend an experimental treatment that he came up with etc. Again, in fairness, you see this in the US as well. Let's say you go in and they find a tumor. Doctors conversant with radio-therapy will likely recommend radiotherapy. A surgeon, nine times out of ten, will recommend surgery. Etc etc etc.
So yeah, not much difference between the two systems in this regard. At least, when I was last there the doctors in the US and Cuba behaved similarly in this regard.
I will say though, that abortion seems like the only option if, say, 9 out of 10 doctors are all advising the same thing. Or if 9 out of 10 doctors are all saying your child will need 24/7 care for the rest of her life, and her life will be short. So how you're presenting the option, even though it is only an option, can make the whole thing feel forced.
The only other source I can find from a brief Google is from a predominantly pro-life org.
I dont really get this style of steering a discussion: the idea that every reply needs to include a disclaimer about every differences and some insight into how the poster agrees or disagrees with those things as if checking a box. “Oh darn we cant villify the messenger now what are we going to do... well we can discredit them by highlighting why we cant question their stance on anything”
You're entirely correct there are many other examples of western democracies that can stand as models. However, I believe the reason Cuba was chosen was precisely to elicit a reaction. A story comparing mortality rates in the US to those in Canada, the UK or France would have fallen by the wayside. For one reason or another, the mention of Cuba generates attention and reactions - as attested to by this post itself.
Am I missing something here?
(I have no idea what actually happens in Cuba).
https://www.forbes.com/sites/physiciansfoundation/2016/04/12...
How is this possible? Well, remember that it may not be. The figures should be taken with a dose of skepticism.
The US actually has very generous social services when it comes to medical care for pregnant women and their babies. CHIP and Medicaid cover pregnant women up to 200% (~$30K) or sometimes 300% (~$50K) of the federal poverty level.[1] Waiting lists are non-existent for most states as they have an exemption for pregnant women or newborns..[2]
[1]https://www.medicaid.gov/chip/eligibility-standards/index.ht... [2]https://www.medicaid.gov/chip/eligibility-standards/waiting-...
https://en.m.wikipedia.org/wiki/List_of_countries_by_infant_...
At around 6 per 1000, compared to 4.3 for the UK (or 2.7 for Japan) for example.
I would imagine, infant mortality isn’t just about a function of healthcare available during pregnancy, but also for the parent before pregnancy. There could of course be multiple other confounding factors (such as life style issues)...
My understanding is that in Cuba, there is no applying to services like Chip, or Medicaid. Theres no chance you won't get coverage, as everyone, by default, gets the care they need. Wait times are non existent for the pregnant or disabled across the country, not just in certain regions.
It doesn't seem totally unlikely that the people that """"fall through the cracks"""" in the American systems are enough to swing infant mortality rates.
Only if you're white:
https://www.nytimes.com/2018/04/11/magazine/black-mothers-ba...
At least in my area of the country, the higher infant mortality (outside birth defects) rates are almost entirely driven by a tiny percentage of the overall population - extremely young mothers with substance abuse problems. The biggest portion of the effect is not a result of medical care differences. According to the CDC, "Asians" in the US have almost a quarter the infant mortality rate of "Blacks".
https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_09.pdf
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The article mentions that the US infant death rate is 5.9, and the Cuban infant death rate is 4.0. However, according to the CDC report, Cuban ancestry, living in the US, has an infant death rate of 3.0!
The country has an unusually high rate of late fetal deaths, and skeptics contend that when a baby is born in distress and dies after a few hours, this is sometimes categorized as a stillbirth to avoid recording an infant death.
1. "4 (Cuban) vs 6 (American) deaths per live birth."
Are we sure they're measured the same? Are we sure that the count for deaths starts at the same time? Could easily be that Cuban mothers are more likely to lose a baby at an earlier stage of pregnancy (for example Cubans measure it from 2nd trimester on, Americans measure it from conception so Cubans fail to count early stage deaths).
2. "7500 deaths per year in US".
The author does not seem to have his figures correct. Approximately 3.8 million american babies are born per year. If 0.6% of them die that's 228,000 total deaths and a differential of about 60,000 between US rates and Cuba's. Not to nitpick here but if you can't get these objective facts right how can I take you seriously about other things you're saying?
A pre-birth death can't be counted among the 'per live birth' deaths, and would have to include estimates of miscarriage rates since those are woefully underreported everywhere. Pretty sure every country starts the clock at birth.
Agree on the point about underreporting everywher
What are we to make of that last sentence? The author seems to be saying "I don't know enough to judge" but then immediately follows that with a strong opinion as to who must be wrong. How are we as an audience supposed to gauge whether Kristof (the author) is right that the effects will be inconsequential even if the accusations of manipulation were true? The implication would seem to be that because he's writing his (clearly labeled) opinion in the New York Times, we should trust him as an expert, despite his disavowals.
While we can't easily answer the question as to whether the statistics are manipulated, it turns out that there are at least clear answers to what the effect of the manipulation would be. In a 2015 article entitled "Infant Mortality in Cuba: Myth and Reality", Roberto Gonzalez runs the numbers and shows that the effect of reporting Early Neonatal Deaths as Late Fetal Deaths would be enough to completely change our interpretation of the statistics. Here's a summary of the paper's conclusions: https://thecubaneconomy.com/wp-content/uploads/2014/02/Infan...
What should we make of this? Certainly a problem with a small detail like this doesn't mean the overall question isn't worth asking, and the "human interest" aspects of the story are certainly interesting, but it sure make me wonder how much we should trust the author's intuitions about other details in the story.
In other words, this is about a healthier people - not about a comparable people with better access to healthcare. I'd expect to see these numbers level out in time. Cubans have also been thickening up as the article does mention, but they're still quite far behind us.
The article you cite does not say that it is a main cause. It says it is a cause, and that it doubles the chance of infant mortality in obese mothers, but it makes no comparisons with other causes.
> In other words, this is about a healthier people - not about a comparable people with better access to healthcare.
We can test your hypothesis. Let's compare two countries that happen to have female populations with the same average BMI, with similar cultures and dominant ethnicity (both former colonies of the British Empire):
* USA -> Female mean BMI: 28.8; Under-five mortality rate: 6.5
* Australia -> Female mean BMI: 28.8; Under-five mortality rate: 3.7
For Feamle Mean BMI I used World Health Organization data from 2015: https://en.wikipedia.org/wiki/List_of_countries_by_body_mass...
For Under-five mortality rate (deaths/1,000 live births) I used World Bank data from 2016: https://en.wikipedia.org/wiki/List_of_countries_by_infant_an...
While obesity clearly plays a role in increasing infant mortality, it fails to account for the big discrepancy in infant mortality rates between the USA and the other western nations. One compelling explanation remains: the USA is the only one of these countries without some form of universal healthcare.
Something that might help clarify matters most is this [1] paper. It not only gives specific figures but is over an extremely large and comprehensive sample, most of the data is from a ethnically homogeneous sample, and is in a region with nationalized healthcare (Sweden). So it helps remove confounding variables. And there too we find that infant mortality for normal weight women was 2.4/1000 while it was 5.8/1000 for those with obesity grade 3. There was a linear scaling of risks and mortality that mapped directly against obesity. Interestingly enough even being just overweight also corresponded to a slightly increased rate of infant mortality.
Crucially, what obesity tended to lead to was preterm deliveries, congenital birth defects, pregnancy complications, and sudden infant death syndrome. The reason I say crucially is that these [2] are the leading causes of infant death from the CDC. Those issues that arise from obesity are literally the top 4/4 causes of infant death.
[1] - https://www.bmj.com/content/349/bmj.g6572.full.pdf+html
[2] - https://www.cdc.gov/reproductivehealth/maternalinfanthealth/...
Is that right? Or is it 0.19% more likely to die in the USA. This is why I never win on the horses.
So perhaps the answer is that they are both pretty safe? I would think more elective caesarians and traffic accidents could account for much of the differences but it must be getting pretty close to the margin of error?
I'm not saying food in Cuba was available in the same kind of quantities and choices as in the states, but portions were almost on par (which is to say, enough to floor a European for several hours after a meal!)
The article even states that the primary weight problem faced in Cuba is over, not underweight people.
I come from a family of Cuban immigrants, and have some distant relatives still in Cuba. Some of my family has visited over the last few years. It's a tacit understanding that the visiting relatives will bring money or valuables to sell on the black market to help pay for the feast that Cubans will inevitably throw for visiting relatives, because otherwise several months worth of income will be spent on food (which would only cost maybe a few days wages for the person coming from abroad).
https://academic.oup.com/heapol/article/33/6/755/5035051
Key quote: “(...) evidence that physicians likely reclassified early neonatal deaths as late fetal deaths, thus deflating the infant mortality statistics and propping up life expectancy.“
However they do get protected by what’s called “herd immunity” If a sufficient fraction of all other people are vaccinated, diseases cannot spread. So basically the toddler in the family gets protected because the older kids/parents cannot be disease carrying. So yes, anti-vaxxers are a problem for toddlers (and other people that cannot be vaccinated due to other reasons)
I find the point about local, conveniently-accessible doctors leading to earlier diagnoses interesting, too. That seems like a fair point: I've heard a lot about the automobilised nature of america, where cities are built for cars rather then people. If you can't just walk over to the local doctor you've known for the last 5 years to ask about the lump on your back because going to the doctor is seen as a big deal- you can imagine this leading to fewer check-ups.
I've heard a point that the US is in a hellish middle-ground between socialised healthcare ala euroland and hypothetical free-er market healthcare: you can't actually shop around for cheaper treatment, because the government's teamed up with big pharma to reduce competition and obscure pricing.
edit: Just read a comment mentioning obesity as a factor. That makes a lot of sense, as well. Of course a country as fat as america's going to be in a worse health state than one like cuba where people are only starting to bloat up after starving a while back.