1. The United States and Child Mortality Progress toward Millennium Development Goal #4

2. Millennium Development Goal #4: Reduce Child Mortality Child mortality is a statistic that describes the number of children that die before they are five years old. Child mortality is a statistic that describes the number of children that die before they are five years old. –Rate per thousand

3. Millennium Development Goal #4: In developing countries, one child in 10 dies before its fifth birthday, compared with 1 in 143 in high- income countries. In developing countries, one child in 10 dies before its fifth birthday, compared with 1 in 143 in high- income countries. Mortality rates for children under five dropped by 15 percent since 1990, but the rates remain high in developing countries. (UN, 2005) Mortality rates for children under five dropped by 15 percent since 1990, but the rates remain high in developing countries. (UN, 2005)

4. MDG #4: Target Reduce the child mortality of children under five by two-thirds by 2015 Reduce the child mortality of children under five by two-thirds by 2015

5. Causes of Child Mortality Poverty Poverty War and civil unrest War and civil unrest Diseases: HIV/AIDS, malnutrition, malaria, diarrhea, and acute respiratory infections Diseases: HIV/AIDS, malnutrition, malaria, diarrhea, and acute respiratory infections Low birth weights Low birth weights Poor health care during pregnancy Poor health care during pregnancy Adolescent pregnancy Adolescent pregnancy Source: The World Health Report, 2005, http://www.who.int/whr/2005/en/index.html

6. Child Mortality and the U.S.: Statistics U.S. Population: 291,038,000 U.S. Population: 291,038,000 GDP per capita: $35,182 GDP per capita: $35,182 Annual number of under-5 deaths per thousand (2003): 34 1 Annual number of under-5 deaths per thousand (2003): 34 1 Child mortality rates (per thousand) 2 : Child mortality rates (per thousand) 2 : –Male: 9 –Female: 7 1. Source: UNICEF, http://www.unicef.org/infobycountry/usa.html http://www.unicef.org/infobycountry/usa.html 2. Source: World Health Organization, http://www.who.int/countries/usa/en, 2004 datahttp://www.who.int/countries/usa/en

7. U.S. Statistics Total health expenditures per capita 1 : $4,887 Total health expenditures per capita 1 : $4,887 Total health expenditures as a percentage of GDP 2 : 13.9% Total health expenditures as a percentage of GDP 2 : 13.9% 1. Source: World Health Organization, http://www.who.int/countries/usa/en/http://www.who.int/countries/usa/en/

8. Is Child Mortality a problem in the United States? Not in comparison with the rest of the world Not in comparison with the rest of the world 50% of all child deaths are concentrated in China, the Democratic Republic of the Congo, Ethiopia, India, Nigeria and Pakistan. 50% of all child deaths are concentrated in China, the Democratic Republic of the Congo, Ethiopia, India, Nigeria and Pakistan. But… But…

9. Child Mortality in the U.S.: A Closer Look The child mortality rate in the U.S. is almost double the rate in Hong Kong (3.1) and Japan (3.4) 1 The child mortality rate in the U.S. is almost double the rate in Hong Kong (3.1) and Japan (3.4) 1 The child mortality rate (also called the Infant Mortality rate) in the United States varies among racial/ethnic groups 2 The child mortality rate (also called the Infant Mortality rate) in the United States varies among racial/ethnic groups 2 1. National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention, 1999 data 2.Source: Gale Encyclopedia of Medicine, Jan 1, 2001. Minority health. M.D. Laith Farid Gulli; M.S. Nicole Mallory. Retrieved from Infotrac.

10. Child Mortality in the U.S.: A Closer Look African Americans: 14.2 per 1,000 live births in 1996 (approximately 2.5 times higher than Caucasians) African Americans: 14.2 per 1,000 live births in 1996 (approximately 2.5 times higher than Caucasians) Hispanics: 7.6 per 1,000 live births Hispanics: 7.6 per 1,000 live births –Puerto Ricans: 8.9 per 1,000 live births Source: Gale Encyclopedia of Medicine, Jan 1, 2001. Minority health. M.D. Laith Farid Gulli; M.S. Nicole Mallory. Retrieved from Infotrac.

11. Child Mortality in the U.S.: A Closer Look Despite higher poverty and lower education rates, Hispanic infants have higher birthweights and their child mortality rates approximate those of white infants. Cultural practices, family support, selective migration, diet, and genetic heritage are possible contributing factors.

12. Child Mortality in the U.S.: A Closer Look Very low birth weight accounts for approximately two thirds of the black- white gap in infant mortality, specifically preterm deliveries.

13. Child Mortality in the U.S.: A Historical Perspective “Follow up question:” To what extent has the status of women advanced throughout the 20th century? “Follow up question:” To what extent has the status of women advanced throughout the 20th century?

14. Child Mortality in the U.S.: A Historical Perspective The U.S. child mortality rates declined by 90% in the 20 th century The highest child mortality rates have always been in U.S. cities

15. Child Mortality in the U.S.: A Historical Perspective Racial differences in child mortality have not been explained fully by differences in socioeconomic status. Black infants born to college-educated parents have higher child mortality rates than white infants born to parents of similar educational background; this difference is attributed to a higher rate of very low birthweight

16. Child Mortality in the U.S.: A Historical Perspective A complex interaction of social, environmental, and biologic factors experienced uniquely by black women might account for the difference in child mortality rates.

17. Comparing Child Mortality Statistics Comparing Child Mortality in the U.S. to other countries in the Americas Comparing Child Mortality in the U.S. to other countries in the Americas (Follow up question: To what extent have economic disparities between developed and developing nations persisted or increased? )

18. Comparing Regions of the World Source: http://millenniumindicators.un.org/unsd/mi/mi_worldregn.asp#Annex

19. What Progress is Being Made? UN Millennium Development Goals Progress Reprot 2004: UN Millennium Development Goals Progress Reprot 2004: –http://www.un.org/millenniumgoals/mdg 2004chart.pdf http://www.un.org/millenniumgoals/mdg 2004chart.pdfhttp://www.un.org/millenniumgoals/mdg 2004chart.pdf

20. What Needs to be Done? Access to reproductive health care needs to be expanded. Access to reproductive health care needs to be expanded. Distribute vitamin supplements in countries without functioning health care systems. Distribute vitamin supplements in countries without functioning health care systems. Access to clean water and sanitation is needed to further reduce occurrences of diarrhea. Access to clean water and sanitation is needed to further reduce occurrences of diarrhea. Source: http:// cyberschoolbus.un.org/mdgs/index.html

21. What Needs to be Done? Distribute insecticide-treated nets to families in area at high risk for malaria and make sure the nets are retreated each year. Distribute insecticide-treated nets to families in area at high risk for malaria and make sure the nets are retreated each year. Increase the number of health care providers in underserved populations, particularly in rural areas. Increase the number of health care providers in underserved populations, particularly in rural areas. Source: http:// cyberschoolbus.un.org/mdgs/index.html

22. References Gale Encyclopedia of Medicine, Jan 1, 2001. Minority health. M.D. Laith Farid Gulli; M.S. Nicole Mallory. Retrieved from Infotrac 5/15/05. National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention, 1999. Retrieved from Harvard Public Health Now, http://www.hsph.harvard.edu/now/dec10/apha_infant.html, 5/16/05. http://www.hsph.harvard.edu/now/dec10/apha_infant.html United Nations United Nations –http://www.un.org/millenniumgoals/ retrieved 5/15/05. http://www.un.org/millenniumgoals/ –http://cyberschoolbus.un.org/mdgs/index.html retrieved 5/15/05. http://cyberschoolbus.un.org/mdgs/index.html retrieved 5/15/05http://cyberschoolbus.un.org/mdgs/index.html retrieved 5/15/05 – –http://millenniumindicators.un.org/unsd/mi/mi_worldregn.asp#Annex retrieved 5/15/05.http://millenniumindicators.un.org/unsd/mi/mi_worldregn.asp#Annex –http://www.unicef.org/ retrieved 5/15/05. http://www.unicef.org/ World Health Organization World Health Organization – –http://www.who.int/countries/usa/en retrieved 5/15/05.http://www.who.int/countries/usa/en