Summer 2007, Volume 11 Number 3

Table of Contents

WHY ARE WE LEAVING THE CHILDREN OF THE USA BEHIND?...By Stephen Bzruchka

Sputnik's launch in 1957 during my youth was an obvious F on our nation's report card, a failure that propelled us belatedly into space.  We were shamed to find our guidance system to be lacking as the Russians beat us and we as a nation determined to catch up.

The UNICEF Report Card Number 7, released in February, showed that the US and the United Kingdom have the worst child outcomes, including those for education, among rich countries. This, like the launch of Sputnik 1, should have been our call to action.  But the media response in these two Anglo countries couldn't have been more different.  Although the Seattle Post-Intelligencer and the Washington Post carried the AP report the next day, and the Los Angeles Times did its own story, it received only a tiny bit of attention on public radio.  In England, however, stark headlines made the front pages, the news was all over the tele and radio.  Discussion of the report continues today. Will “No Child Left Behind,” the legislation that requires every child to perform at grade level for reading and mathematics on test scores by 2014, bring us up to speed so we no longer lag behind in the world?  Let's explore our nation’s report cards to discover how we should strive for something that will be even more challenging than the moon landing: to achieve acceptable outcomes for our children - that will benefit all of us.

There was little interest in exploring space after the Second World War. The first satellite into space shamed us into faulting our educational system for not focusing on science.  We played catch up.  The media challenged us and vaunted our every step forward in the race.  The cost was huge, the effort incredible, and we were successful: the moon landing helped establish the US as the key world power.  Afterwards the incredible price of continued human presence in space was too high to continue.

Most of us have been schooled to rate how well we are doing by comparing ourselves with others. The February UNICEF Report put us at the bottom of all rich nations in children's outcomes. It summarized children's material, educational, and subjective well-being as well as health and safety, family and peer relationships, and behaviors and risks.  While we are the richest country in the world, we rank highest in child poverty rates among rich nations. Our children's death rates are the worst as well. There is only one indicator in which we do well: the amount of money we spend on health care amounting to half of the world's health care bill. In terms of real health outcomes, there is not a single measure of our health status as a nation in which we rank among the top twenty in the world.  Shame!   Why are our children being left behind those of other rich countries? What do the top ranked countries do that we don’t?

I studied medicine at Stanford Medical School in the early 1970s. I discovered that even back then I had highlighted similar points about our child well-being slipping.  Our infant and child mortality rates, for example, had been some of the best among nations in the late 1940s and early 1950s, but by the time I entered medical school, we were being left behind by many other nations.  Now we are doing much worse: The Centers for Disease Control and Prevention’s “Health USA 2006” report presents our infant mortality rate (the proportion of newborns that die in their first year of life) rankings for selected nations, comparing 1960 with 2003.  Forty-seven years ago we stood in 12^th place for infant mortality, and now are 28th in that most sensitive indicator.  If the CDC were to include more nations to the comparison, as the CIA does on its website, our ranking falls to 42nd.   The CIA has a practical reason for tracking countries where infant mortality rates rise as that measure portends future instability.  Forebodingly, ours rose from 2001 to 2002 for the first time since the 1950s.  Why are even our infants being left behind?

I became interested in comparing our welfare with that of other countries in 1993 after learning of Sylvia Ann Hewlett's report for UNICEF "Child neglect in rich nations".  It received no attention in the media in the US.  I was unsuccessful in even finding the report in university libraries in the Pacific Northwest, and only located a copy through UNICEF in New York.  The publication demonstrated that the US had the highest child poverty rates.  Hewlett pointed out that we spend much more time earning a living and less time devoted to raising our children than we did a generation ago.  Our children spent 25% fewer hours in school than their European counterparts.  Family breakdown and absentee fatherhood contributed to educational underperformance and failure. TV was a surrogate parent.  Housing policies and health care presented ways that public funding could make a difference in child well-being. English speaking countries had fallen behind those on the European mainland.  In France, motherhood was regarded as a social function and heavily supported.  Scandinavian countries had generous paid leave policies to allow parents to spend time with their infants and to encourage fathers to be more involved in child-rearing. Divorce was shown to affect children and mothers adversely; in response some European countries managed to protect the economic interests of women and children after divorce, in contrast to what occurred in the US. 

Hewlett's report spawned a range of report cards by UNICEF's Innocenti Research Center that compared child health outcomes among rich nations.  The first, in 2000, analyzed child poverty looking at rich countries belonging to the Organization of Economic Cooperation and Development.  Only Mexico had more child poverty than the US.  They estimated that to close our gap would cost less than one percent of our economy.  Reports followed annually, presenting League Tables of child deaths by injury, maltreatment, as well as teenage births, and educational disadvantage. Despite our abysmal series of "Fs," these findings received little attention in our country - in stark contrast to Sputnik's launch and the Russian's beating us into space with manned rockets.  Surely the consistent finding that we are far behind on all early-life indicators deserves at least as much attention as propelling a human body into space!

Behind the UNICEF reports is that reality that the bulk of our health as adults is determined by conditions in the womb and during the first two to five years of life, as our Centers for Disease Control and Prevention and the Institute of Medicine point out.  But this critical fact doesn't get public attention.   Socioeconomic status, especially the record gap between the rich and the poor, is the critical condition impacting our health and well-being.  As we go from the womb to the tomb, it is in early life that relative poverty matters most.  Students in my courses at the University of Washington find this difficult to believe.  We have all been taught that we control our health as adults - that we can amend past transgressions with the right diet, exercise, or regular medical check ups.  But there is clear evidence that these factors don't matter all that much.  Instead the social and economic conditions of our early life have the strongest influence on later health, which is why we must focus on improving conditions for kids in the US now.

The No Child Left Behind act requires all students tested in reading and mathematics to be at grade level by 2014.  We could take this goal, as the equivalent of the moon landing, and see what must be done to achieve it, and whether the time required is adequate.  The importance of early life impacting educational achievement guarantees that we will fail in this goal by 2014.  Generational efforts are required to get an A on our report card.  It is much tougher than a moon landing.  But what better goal to strive for than improving our children's health!  The standard should be comparing ourselves with that of other rich nations.

What are first steps, the equivalent of launching the Vanguard Rocket?  Just as we learned from the Russians, we as a nation must learn from other countries that do things better than we do.  Good baby steps might be to grant paid maternity and paternity leave for everyone, as many European countries do, to ensure that newborns have the best chance for healthy development during the most important period of their lives.  The United States, Papua New Guinea, Lesotho and Swaziland are the only countries in the world without a paid maternity leave policy.

We get what we pay for and we get what we measure.  If we measure our standing in our children's health and well-being compared to other nations, and pay for what will improve it, then future generations will be healthier and will thank us.  Other nations will look to us with more admiration than was achieved by the moon landing.  It is a worthy prize.

Stephen Bezruchka, MD, MPH is Senior Lecturer in the Department of Health Services at the School of Public Health and Community Medicine, as well as a board-certified Emergency Physician. He may be reached at                              sabez@u.washington.edu.

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