According to the study, twenty-four countries ranked better than the United States in infant mortality rates in 2000. Out of 191 countries, the United States ranked thirty-third in its death rate for children under age five. The United States, out of 187 countries, ranked sixty-eighth in immunizing children against diphtheria-pertussis-tetanus; eighty-ninth for polio; and eighty-fourth for measles. U.S. teens ranked eighteenth out of 28 industrialized countries in a self-reported survey of not feeling healthy.
Dr. Starfield, also director of the Primary Care Policy Center at the Bloomberg School of Public Health, 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.
Dr. 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 physicians, making it more profitable for doctors to specialize and to perform unneeded and potentially harmful services.
The challenge, Dr. Starfield says, is for the United States not only to improve overall health care, but to also 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 subgroups.
"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 judges as less than successful," said Dr. Starfield, "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 from the Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services, to the Primary Care Policy Center for Underserved Populations at the Johns Hopkins University.
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