The health of U.S. children is worse in virtually all
categories when compared to children in other
industrialized countries, according to new research from a
Johns Hopkins Bloomberg
School of Public Health researcher.
The United States can improve the health of American
children by changing some of its health care policies,
adopting new Institute of Medicine recommendations
concerning how child health should be viewed and developing
information systems that better reflect the health needs of
children and their distribution in the population,
according to study author Barbara Starfield, University
Distinguished Professor with the
Department of Health Policy and Management. The study,
"U.S. Child Health: What's Amiss, and What Should Be Done
About It?" is published in the September/October issue of
the journal Health Affairs.
According to the study, 24 countries ranked better
than the United States in infant mortality rates in 2000.
Out of 191 countries, the United States ranked 33rd in its
death rate for children under age 5. The United States, out
of 187 countries, ranked 68th in immunizing children
against diphtheria-pertussis-tetanus, 89th for polio and
84th for measles. U.S. teens ranked 18th out of 28
industrialized countries in a self-reported survey of not
Starfield, also director of the Primary Care Policy
Center at the Bloomberg School, said that partial
explanations for the United States' low rankings may be the
country's income inequity and inadequacy of the health
services system. The United States is the most
income-inequitable country among the industrialized
nations. Past studies have shown that geographic areas that
are more income-equitable have better health and that the
ill effects of social disadvantage and income inequality
can be partly reduced by better primary care services.
Starfield also notes in her study that U.S. health
care policies are not conducive to good primary care. U.S.
health professional training and payment mechanisms
encourage the growth of specialties rather than primary
care, making it more profitable for physicians to
specialize and to perform unneeded and potentially harmful
The challenge, Starfield says, is for the United
States not only to improve overall health care but also to
eliminate disparities across population subgroups. She
suggests the following six health care policy strategies to
increase primary care to U.S. children: assure that every
child has a source of good primary care, eliminate
co-payments and other forms of cost sharing for primary
care, establish disincentives for seeking unnecessary
specialist care, include primary care services assessment
in all quality assurance activities, assure federal and
state support for increased training of primary care
practitioners and develop information systems that monitor
health and detect differences across population
"The extent to which a society protects its children
reflects the magnitude of investment in its future. In this
sense, the United States can be judged as less than
successful," Starfield says. "However, strong federal
leadership and a professional strategy will allow the
United States to take a leadership position worldwide and
achieve better health for all."
The study was supported by a grant to the Primary Care
Policy Center for Underserved Populations at The Johns
Hopkins University from the Bureau of Primary Health Care,
Health Resources and Services Administration, U.S.
Department of Health and Human Services.