One of the authors of a recent study of U.S. children’s deaths told an interviewer that, “The U.S. is the most dangerous of wealthy, democratic countries in the world for children… Across all ages and in both sexes, children have been dying more often in the U.S. than in similar countries since the 1980s.” The report was published online January 8 in Health Affairs. Ninety percent of the deaths analyzed there were of infants and older adolescents.
According to the authors, “we examined mortality trends for [20] nations in the Organization for Economic Cooperation and Development (OECD) for children ages 0–19 from 1961 to 2010 using publicly available data.” They discovered that, “Over the fifty-year study period, the lagging U.S. performance amounted to over 600,000 excess deaths.”
“While child mortality progressively declined across all countries, mortality in the U.S. has been higher than in peer nations since the 1980s,” they indicate. “From 2001 to 2010, the risk of death in the U.S. was 76 percent greater for infants and 57 percent greater for children ages 1–19. During this decade, children ages 15–19 were eighty-two times more likely to die from gun homicide in the U.S.”
In 2013, the United Nations Children’s Fund ranked the United States in 25th place among 29 developed countries for success in assuring child health and safety. African-descended infants in the United States are most at risk for preventable deaths. The overall U.S. infant mortality rate (IMR) for all babies in 2015 was 5.9. (The IMR is the number of babies dying during their first year of life for every group of 1000 babies born alive.) The IMR for white babies was 4.8; that for black and Hispanic babies was 11.4 and 5.2, respectively.
U.S. mothers are experiencing similarly dreadful health outcomes. In the United States the maternal mortality rate (MMR) for 1990, 2000, and 2015 was 16.9, 17.5, and 26.4, respectively. (The MMR is the number of women per 100,000 births who die from causes related to childbirth during pregnancy, the birth process, and for 42 days thereafter.) The comparable Canadian figures were 6.0, 7.7, and 7.3, respectively.
Over those 25 years, the MMR decreased globally by an average of 1.5 percent per nation per year. Over the same period in the United States, the MMR increased at an average rate of 1.8 percent per year. The MMR for the United States in 2010 ranked 48 places higher than that of Estonia, whose MMR was the world’s lowest. In Save the Children’s 2015 rankings for overall performance in delivering health care to mothers, the United States ended up in 61st place. The MMR for black mothers in the United States 2012 was almost four times that of white women.
Blame falls upon capitalism. In a recent Monthly Review article, John Bellamy Foster and Brett Clark explain that capitalists arrived at a method for accumulating wealth at the expense of women. Children are losers too.
They get that wealth in the midst of the process that Marx, Engels, and their followers have labeled “social reproduction,” which refers to the reproduction and rearing of the capitalist workforce. Children are the fodder for social reproduction, and women are the agents. Citing the investigations of others, the Monthly Review authors explain how women—and children—become sources of accumulation, a task for which capital would seem, superficially, to be ill-suited. After all, social reproduction differs from the production of commercially valuable commodities through which workers are exploited.
But capitalists are resourceful, and “those areas outside commodity production, including both the reproduction of labor power and what could be expropriated from nature, were considered ‘free gift[s] … to capital’” (Marx’s words). According to the authors, capital demonstrates a “necessary and continuing attempt to transcend or readjust its boundaries with respect to its external conditions of production.” Doing so, it “constantly seeks to expropriate what it can from its natural and social environment.” In both situations, it’s a matter of “actual robbery—usurpation, expropriation, dependence, enslavement.”
Marilyn Waring, whom they cite, thinks that, “the treatment of Mother Earth and the treatment of women and children in the system of national accounts have many fundamental parallels.”
The vulnerability of U.S. children was on display recently. Congress in 1997 enacted legislation creating the Children’s Health Insurance Program (CHIP). Children who benefited were those whose families earned too much to receive Medicaid benefits for them, but not enough to buy private health insurance. By 2015, the rate of uninsured children in the United States had fallen from 13.9 percent to 4.5 percent. CHIP should have been reauthorized in September 2017, but that didn’t happen.
Between then and January 22, 2018, it seemed that health insurance for millions of children might disappear. That day, however, an agreement emerged to renew CHIP, but only as part of a deal for temporarily funding the federal government. The idea that protection of children’s health depends on negotiations on unrelated issues suggests the precariousness of guarantees for children’s survival in the United States.
Clearly, prospects for the well-being of U.S. children, taken as a whole, fall short of expectations for a wealthy nation. Those in charge, it seems, are able to commandeer financial resources that in a just society would be readily available for saving children and mothers from preventable deaths. But how, one asks, did children and mothers living in other OECD nations, all capitalist, escape dangers weighing upon children and mothers in the United States?
Vicente Navarro, a veteran public health investigator and economist, suggests that working-class forces in the United States are weak, too weak to resist plunder. He points out that, “The United States, the only major capitalist country without government-guaranteed universal health care coverage, is also the only nation without a social democratic or labor party that serves as the political instrument of the working class and other popular classes. These two facts are related.” Navarro notes the juxtaposition of strong labor movements in Europe and relatively small, timid unions in the United States.
In general, he observes, “If you establish a spectrum of capitalist countries, listing them from very “corporate friendly” (like the United States) to very “worker friendly” (like Sweden), you will find, where the capitalist class is very strong, very poor health benefits coverage (in the public as well as in the private sectors), highly unequal coverage, and very poor health indicators. This is, indeed, the U.S. case.”
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