If you want to live to be 20, the US is a terrible place to be born

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The US might now be the worst rich country to be born in—at least, if you judge by how likely it is for a child to live to reach legal drinking age.

According to a new study published in the journal Health Affairs, the mortality rate from 2001 to 2010 for US infants (0-1 years old) was 76% higher than the combined rate across 19 other rich countries in the Organization of Economic Cooperation and Development (OECD). Mortality rates in the US are also 57% higher for those ages 1-19. The study is the first of its kind to compare child and adolescent death rates in the US to similarly wealthy countries.

No other country examined in the study had a child mortality rate even close to that of the US. New Zealand has a similar death rate among 1-19 year olds, but their infant mortality rates are less than half that in the US. “Persistently high poverty rates, poor educational outcomes, and a relatively weak social-safety net have made the US the most dangerous of wealthy nations for a child to be born into,” write the researchers.

It wasn’t always this way. In the 1960s, babies in the US were actually less likely to die than in these same countries. While infant mortality rate fell in all countries, starting in the late 1970s, it dropped much more slowly than in the other countries.

Researchers who examined the US’s high infant mortality rate compared to Finland and Austria (pdf) in the early 2000s found that 40% of the difference could be explained by the US’s counting many premature babies as dying that in other countries would not have counted as ever being alive. The rest of the difference can be chalked up to US newborns having poorer health at birth and developing illnesses between their first and 12th months—differences in mortality rates in the first month were very small.

The Health Affairs study researchers blame the disparities on the US’s poorly funded social safety net and jumbled healthcare systems.

The gulf between death rates for 1-19 year olds in the US and those in the 19 other OECD countries emerged in the late 1960s. It’s mostly due to the high number of gun deaths in the US: from 2001 to 2010, 15-19 year olds in the US were 82 times more likely to die from a gun homicide than those in other rich countries.

The US’s relatively high child mortality rate is commensurate with its poor performance on a variety of common measures of economic development. As Quartz reporter Annalisa Merelli has pointed out, the US has unusually high rates of poverty, obesity, and income inequality compared to other wealthy countries.

It doesn’t look like the US will catch any time soon, either. The federal government is doing little to address gun violence, and has not prioritized extending funding for the Children’s Health Insurance Program (CHIP), which covers around 9 million children. Without policies to keep more of its children alive, the US’s shameful mortality gap is only likely to widen.

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