Infants, children and adolescents are dying at much lower rates in the United States and other high-income countries than 40 years ago, but many of today’s deaths — perhaps as many as 20 percent — are still preventable, according to a series of articles published late last week in the Lancet.
Of all the factors that influence child death rates in high-income countries, the one with the most persistent association is poverty, the authors of the new research also point out.
Indeed, the five high-income countries with the worst child death rates — the U.S., the United Kingdom, Canada, New Zealand, and Portugal — are also those with the greatest inequalities of income, say the researchers.
“Although some contributing factors are relatively fixed, including a child’s age, sex, and genetics, many environmental, social and health service factors are amenable to interventions that could lessen risks and help prevent future deaths,” stated the series lead researcher, Dr. Peter Sidebotham, a pediatrician and associate professor of child health at the University of Warwick in the U.K., in a press release that accompanies the Lancet articles.
Level of danger varies by age
The papers are packed with information. Here are some of the key findings:
- Throughout childhood, boys are at greater risk of dying than girls in high-income countries. There may be some biological reasons for this difference — girls, for example, appear to have a greater resistance to infections — but by adolescence, the difference is mainly due to higher levels of aggression and risk-taking among boys. In recent years, however, increasing number of girls have adopted some of these risk-taking behaviors, such as misusing alcohol and illegal drugs, which may narrow the gender death-rate gap during the teen years.
- The most dangerous time for children is in infancy, particularly during the first month. Preterm births and low birthweights are key factors associated with these early deaths. They are also major contributors to life-threatening health problems later in childhood. Babies with a low birthweight who survive their first year are two to three times more likely to die before their 15th birthday than babies with a healthy birth weight. But, as the authors of the Lancet papers point out, in most high-income countries, the incidence of preterm birth has actually increased in recent decades. Many more of these babies are surviving into childhood than in the past, but often with significant long-term — and potentially life-threatening — health problems.
- The death rate for children in high-income countries drops during middle childhood (ages 1-14). The leading causes of death among children during these years are complications from a pre-existing or acquired medical conditions, such as epilepsy or asthma. Many of these deaths could be prevented. Delays in diagnosing and treating serious health problems — and a lack of ongoing support services for families with seriously ill children — are contributing factors to these preventable deaths.
- When children from high-income countries enter adolescence, their death rate climbs again, particularly among boys. Risk-taking behaviors involving cars, drugs and alcohol are major reasons for this rise. Guns also play a role, particularly in the U.S., as the report notes:
Every year in the USA, firearms cause at least 80% of all child and adolescent homicides. A 2003 analysis of US homicide rates compared with rates from 22 high-income tountries reported that firearm-related deaths were 42.7% higher in children and adolescents in the USA. Such differences are also present in child and adolescent suicide rates in the USA. When firearm-related deaths are not included in child and adolescent suicide deaths, rates are consistent with other high-income countries. When firearm suicides are included, the rate in the USA doubles. Many suicides by young people are impulsive acts.
In one survey of young people who have attempted suicide, 24% reported that only 5 [minutes] divided the time between when they decied to act and when they attempted to die by suicide. Firearms make suicide particularly lethal because, unlike other methods, they are fast and usually irreversible. About 85-90% of firearm attempts are fatal, as opposed to 1-2% of poisoning and cutting attempts.
The core of the problem: poverty
Most notably, however, the Lancet papers found “a consistent inverse association between socioeconomic status and childhood mortality in high-income countries.” Children from low-income families are more likely to die from a variety of causes, including sudden infant death syndrome, leukemia, injury, poisoning, traffic accidents, homicides and suicides. Part of that increased risk is associated with the behavior of parents (low-income parents are more likely to smoke, for example), part of it is associated with the physical environment of the home (low-income homes are more likely to have physical hazards or to be located in neighborhoods with high levels of pollutants and crime), but lack of access to social and health services is also a major factor.
“Politicians should recognize that child mortality is as much as result of proper socioeconomic planning as it is of changes in health-care systems,” Sidebotham and his colleagues write. They recommend that policymakers in high-income countries focus on improving prenatal and post-natal care for women and their babies, on training physicians to recognize and respond more quickly to severe and acute illnesses in children and on making homes and communities safer.
“Continuing disparities in child mortality between and within countries emphasise not only a reluctance to truly engage with the deep social inequalities inherent in society, but also a failure to look beyond simple descriptions of the problem to understand the complex pathways that ultimately lead to poor outcomes for children,” they write.
You’ll find abstracts of the papers on the Lancet’s website.