US child health worse than other industrialized countries

September 16, 2004

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 our health care policies and adopting new Institute of Medicine (IOM) 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, MD, MPH, university distinguished professor with the Bloomberg School of Public Health 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 2004 issue of the journal Health Affairs.

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.

For the latest public health news or to receive news releases from the Johns Hopkins Bloomberg School of Public Health via email, visit

Johns Hopkins University Bloomberg School of Public Health

Related Public Health Articles from Brightsurf:

COVID-19 and the decolonization of Indigenous public health
Indigenous self-determination, leadership and knowledge have helped protect Indigenous communities in Canada during the coronavirus disease 2019 (COVID-19) pandemic, and these principles should be incorporated into public health in future, argue the authors of a commentary in CMAJ (Canadian Medical Association Journal)

Public health consequences of policing homelessness
In a new study examining homelessness, researchers find that policy such a lifestyle has massive public health implications, making sleeping on the street even MORE unhealthy.

Electronic health information exchange improves public health disease reporting
Disease tracking is an important area of focus for health departments in the midst of the COVID-19 pandemic.

Pandemic likely to cause long-term health problems, Yale School of Public Health finds
The coronavirus pandemic's life-altering effects are likely to result in lasting physical and mental health consequences for many people--particularly those from vulnerable populations--a new study led by the Yale School of Public Health finds.

The Lancet Public Health: US modelling study estimates impact of school closures for COVID-19 on US health-care workforce and associated mortality
US policymakers considering physical distancing measures to slow the spread of COVID-19 face a difficult trade-off between closing schools to reduce transmission and new cases, and potential health-care worker absenteeism due to additional childcare needs that could ultimately increase mortality from COVID-19, according to new modelling research published in The Lancet Public Health journal.

The Lancet Public Health: Access to identification documents reflecting gender identity may improve trans mental health
Results from a survey of over 20,000 American trans adults suggest that having access to identification documents which reflect their identified gender helps to improve their mental health and may reduce suicidal thoughts, according to a study published in The Lancet Public Health journal.

The Lancet Public Health: Study estimates mental health impact of welfare reform, Universal Credit, in Great Britain
The 2013 Universal Credit welfare reform appears to have led to an increase in the prevalence of psychological distress among unemployed recipients, according to a nationally representative study following more than 52,000 working-age individuals from England, Wales, and Scotland over nine years between 2009-2018, published as part of an issue of The Lancet Public Health journal on income and health.

BU researchers: Pornography is not a 'public health crisis'
Researchers from the Boston University School of Public Health (BUSPH) have written an editorial in the American Journal of Public Health special February issue arguing against the claim that pornography is a public health crisis, and explaining why such a claim actually endangers the health of the public.

The Lancet Public Health: Ageism linked to poorer health in older people in England
Ageism may be linked with poorer health in older people in England, according to an observational study of over 7,500 people aged over 50 published in The Lancet Public Health journal.

Study: Public transportation use linked to better public health
Promoting robust public transportation systems may come with a bonus for public health -- lower obesity rates.

Read More: Public Health News and Public Health Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to