More Babies Die in Cleveland than in North Korea, Sri Lanka, Albania and Guatemala

Behind America’s Infant Mortality Crisis

Al Jazeera (2013)

Film Review

Since the mid-1990s, when Bill Clinton eliminated Aid For Dependent Children (AFDC), the US has enjoyed infant mortality rates among the highest in the world. Rust belt Midwestern cities lead the US in infant mortality. The loss of steel, auto and other manufacturing to third world sweatshops has virtually crushed many of these cities, leaving massive unemployment – particularly among African Americans.

Cleveland is the US city with the highest percentage of babies dying during the first year of life – with an infant mortality greater than third world countries like North Korea, Albania, Sri Lanka and Guatemala.

Trying to identify the cause of Cleveland’s skyrocketing infant mortality, filmmakers interview African American mothers and expectant mothers and neonatal specialists. The neonatologists identify prematurity as the number one cause of infant deaths. Factors that contribute to mothers delivering prematurely include homelessness and lack of access to healthy food (or money to pay for it) and prenatal care. Ohio is one of the states where Republican legislators declined federal funds to expand Medicaid (which pays for prenatal care) to the working poor.

The neonatologists also point out the false economy of this ideological stinginess. Ohio’s Medicaid program spends hundreds of millions of dollars trying to keep premature babies alive in state-of-the-art neonatal ICUs – it would cost taxpayers far less to prevent prematurity by ensuring expectant mothers have warm housing, healthy food and prenatal care.

How Cuba is Revolutionizing Global Health Care

Salud! : What Puts Cuba on the Map in the Quest for Global Health

Connie Field (2009)

Film Review

Salud! Is about the global struggle to overcome health inequality and the vital role Cuba plays in this effort. Filmmaker Connie Field is totally open about her perspective that that health car is a basic right and not a commodity, as it’s viewed in the US.

In pre-revolutionary Cuba, only a small wealthy elite had access to health care. The poor, who comprised 90-90% of the population, died in droves of treatable conditions, such as malaria, respiratory infection, parasites and infantile diarrheal infections.

The Castro regime responded to this health crisis by training tens of thousands of doctors. At present, Cuba has 60,000 doctors for a population of 11 million, making their health system one of the best resourced in the world.

Ending Diseases of Poverty Worldwide

Cuba has been extremely generous in sharing this resource with other poor countries, especially in Africa and Latin America. Since 1963, over 100,000 Cuban health professionals have worked overseas. As well as performing direct patient care, they also train foreign health care professionals.

The film profiles their work in South Africa, Gambia, Honduras and Venezuela. In all four countries, the Cuban doctors have helped local health professionals establish community-based health delivery systems that focus on health promotion and disease prevention. This contrasts to health care in the industrialized north, which waits for patients to get sick and fights one illness at a time.

Cubans Healthier than Americans

Thanks to their phenomenal workforce and this common sense approach, Cuba is one of the few developing countries that has virtually eradicated malaria. Moreover Cubans experience better overall all health status than Americans. On average, Cubans live longer: 79.07 years compared to 78.74 years for Americans. Cuba also has a lower infant mortality (4.70 per 1,000 live births) than the US (6.2 per 1,000 live births).

In Honduras and Venezuela, Cuban doctors have played an essential role in setting up clinics in barrios and rural areas that are poorly served by Honduran and Venezuelan doctors – both for financial (their barrio patients can’t afford to pay them) and “lifestyle” reasons. Despite their refusal to serve these communities, local doctors responded to the presence of Cuban doctors with mass protests claiming the Cuban medics were threatening their livelihood.

Free Medical Education for International Students

In 1999, Cuba set up the Latin American Medical School, which offers free medical training to low income students from all over the world. In collaboration with the Congressional Black Caucus, they have also opened this medical school to African and Hispanic students from low income US communities.

Income Inequality: The Real Cause of Poor Health

Contrary to popular belief, the primary determinant of your lifelong health status and life expectancy has nothing to do with your weight, fitness level and whether you smoke. According UW epidemiologist Dr Stephen Bezruchka, the most important determinant of your adult health status is your mother’s income level when you were born. Lifestyle factors (including smoking) only account for 10% of illness.

More than fifty years of epidemiological research bear this out. Yet it’s only in the last decade scientists have learned why this is – thanks to the new science of epigenetics. The term refers to changes in gene expression caused by external influences.

The stress of poverty causes an increase in maternal stress hormones, which causes variations in the way genetic code is transcripted into proteins and enzymes. These, in turn, can predispose the fetus to insulin resistance, obesity and immune problems, as well as emotional instability and mental illnesses.

The Link Between Income Inequality and Poor Health

The most important research finding, according to Bezruchka, is a more pronounced effect in societies plagued by income inequality. Study after study bears this out. In other words, a poor person’s health will be worse in a society with a wide gap between its rich and poor residents.

The US, which has the most extreme inequality, is near the bottom of the charts for indicators that measure a nation’s overall health. In life expectancy (according to the CIA), the US ranks 50^th, just behind Guam. In infant mortality, it ranks 174^th, between Croatia and the Faroe Islands.

A Mindset Driven By Social Service Cuts

In Sick and Sicker, Dr Susan Rosenthal notes a 30 year trend for policy makers – both conservative and liberal – to make sick people “take responsibility” for their illnesses. Epidemiological studies – as long as scientists have been doing them – have always shown a correlation between poverty and poor health. Even in Dicken’s time, it was taken for granted that the undernourished poor people living in cold, damp, overcrowded tenements were far more prone to illness than their middle class counterparts.

Rosenthal believes this shift to a “blame the victim” mentality has been deliberate – to justify aggressive social service cutbacks (by both Republicans and neoliberal Democrats like Clinton and Obama) that came into fashion with Ronald Reagan’s election in 1980.

The Role of Oppression and Exploitation in Illness

Although the link between poverty and inequality is unequivocal, epidemiologists have yet to explain why the effect is poor pronounced with extreme income inequality. Bezruchka puts it down to people in egalitarian societies looking after one another. I like Rosenthal’s explanation better. She relates it to high levels of oppression and exploitation in societies with extreme income disparity.

She points out that minimum wage workers aren’t just poor. They also work in exploitive, arbitrary and often punitive job settings which they feel powerless to change. Enduring this massive stress on a daily basis takes an enormous toll on the human body and psyche.

photo credit: AJC1 via photopin cc