The most sophisticated medical technologies are available in the United States. The luxury afforded elite health care consumers is best captured by “executive health care” and “personalized” medicines. Given the tailored health care afforded top-tier health care consumers, consciously or unconsciously those at the other end of the spectrum might be overlooked.
For example, the Centers for Disease Control and Prevention issued a report this year that places some US states in the range of Third World countries for health outcomes with mothers and babies. The report, Infant Mortality Statistics From the 2008 Period Linked Birth/Infant Death Data Set, exposes a sad reality; race disparities persist in medicine. The neonatal mortality rate of African Americans is about 2.5 times that of whites. What’s more—class matters. But here’s the interesting part. Class matters at both ends of the scale.
The report exposes how Mississippi, the nation’s poorest state, leads the nation in babies that will die before reaching their first birthday. According data collected by CNN, “for every 1,000 Mississippi babies born in 2011, 9.4 died before their first birthday.” One reporter found that such data “makes Mississippi’s infant mortality rate more comparable to countries such as Costa Rica (9.2), Sri Lanka (9.5) and Botswana (10.5) than the United States (6.0).” The common answer to the challenges of infant mortality looks toward poverty—and in part such analysis is right. However, wealth matters too and sophisticated reproductive choices can lead to dangerous outcomes. One of the leading causes of infant mortality is womb-crowding caused by multiple gestations, which has dramatically increased as a byproduct of assisted reproductive technologies. Those who can afford these sophisticated technologies are usually upper-income individuals, who can afford the multiple rounds of treatments, which are usually required before a pregnancy results. In fact, ART related births are associated with the 100-fold increase in higher order births in the United States. Low birth-weight, one of the leading causes of infant distress, is a common feature of multiple births—as are pre-term deliveries. As we think about solutions to these challenge public health concerns, it will be important to look at both ends of the socio-economic scale.