Structural Inequality and Infant Mortality

I can’t recommend this Stephen Bezruchka essay on structural inequality and infant mortality strongly enough. Just a quick excerpt:

Everyone in a society gains when children grow up to be healthy adults. The rest of the world seems to understand this simple fact, and only three countries in the world don’t have a policy, at least on the books, for paid maternal leave—Liberia, Papua New Guinea, and the United States. What does that say about our understanding, or concern, about the health of our youth?

Infant death rates, those occurring in the first year of life, are a particularly sensitive measure of health in a population. According to a U.S. Centers for Disease Control and Prevention report released in 2013, our infant mortality rate is about 6.1 deaths for every thousand live births. Sweden has an infant mortality rate less than half of ours, 2.1 deaths per thousand births. If we had Sweden’s rate of infant deaths, the United States would have around forty-seven fewer infants dying every day in the United States. That is what is achievable: every day forty-seven babies wouldn’t die if we had Sweden’s rate of infant deaths.

Differences in mortality rates are not just a statistical concern— they reflect suffering and pain for very real individuals and families. The higher mortality in the United States is an example of what Paul Farmer, the noted physician and anthropologist, calls structural violence. The forty-seven infant deaths occur every day because of the way society in the United States is structured, resulting in our health status being that of a middle-income country, not a rich country.

There is growing evidence that the factor most responsible for the relatively poor health in the United States is the vast and rising inequality in wealth and income that we not only tolerate, but resist changing. Inequality is the central element, the upstream cause of the social disadvantage described in the IOM report. A political system that fosters inequality limits the attainment of health.

Resist changing? For Republicans, rising inequality is the stated goal, with an underlying racial tone that gets poor whites to buy in against their own economic interests.

The only thing I’d add that Bezruchka leaves out is how the decline of labor unions has played into this problem. He suggests worker-owned businesses as part of the strategy to overcome this structural inequality, but that he mentions this and not unionized workplaces says a lot about just how desperate organized labor’s situation has become. In all of American history, only labor unions have allowed workers to have a real voice on the job and provided a powerful and long-term voice for the American working class. Without that voice and the potential of delivering (or withholding) votes and money, politicians have little reason to care very much about structural inequality.

But otherwise, an outstanding essay.