Infant Mortality, Obesity Increasing in U.S.

November 10, 2004

Nov. 10, 2004 (Washington) -- After years of steady progress toward improved health in the U.S., there are signs of a downturn that may soon translate into movement in the wrong direction, according to a new report released here at the 132nd annual meeting of the American Public Health Association (APHA).

The report, "America's Health State: State Health Rankings," uncovers three key troubling trends: the first rise in infant mortality rates in four decades, the rapidly increasing prevalence of obesity in all age groups, and the number of uninsured individuals, which increased in 38 states between 2003 and 2004.

Most disturbing perhaps is the big-picture finding that the health improvements of the 1990s, during which overall health improved at an annual rate of 1.5% for a total gain of 17.5%, is headed for reversal. Since the start of the millennium, health improvement has been a negligible 0.2%, a finding that should set off alarms, APHA Executive Director Georges Benjamin, MD, told Medscape.

"Despite the significant improvement in our nation's health over the last 15 years..., the trends we're seeing now -- especially this dramatic slowdown in the rate of improvement -- are not encouraging," Dr. Benjamin said.

In particular, he cited the increase in infant mortality from 6.9 to 7.0 births per 1,000, a statistic that puts the U.S. 28th internationally in infant mortality, as well as the finding that 14 states have preterm birth rates that exceed 13%. That alarming statistic is likely associated with the fact that 12.6 million American women of child-bearing age are uninsured.

"Clearly, there is a connection there that cannot be ignored, and this is something we must address as a nation," Dr. Benjamin said. "Prematurity has many factors, from poverty to inadequate prenatal care and infections, but for the clinicians who treat these women, this [increasing prevalence of preterm births] is clear evidence of a healthcare system in crisis," he said.

Dr. Benjamin urged physicians to get involved in organized medicine activities directed toward increasing policy-makers' awareness of both the current problems and the consequences that high infant mortality and poor preterm birth statistics herald -- economically and in health status -- for the decade ahead.

"It really doesn't take long to get to know your elected officials, and it doesn't take a lot of time to get involved -- and we know that physician involvement can make a difference" in how policy is shaped, Dr. Benjamin said.

Another alarming finding of the report, jointly produced by the APHA, United Health Foundation, and Partnership for Prevention, was the meteoric rise in obesity, which increased by 97% between 1990 and 2003.

"To successfully combat this [obesity] epidemic, we must mobilize our community resources and develop effective public policies," said Reed Tuckson, MD, vice president for United Health Foundation, adding that an estimated 22.8% of the U.S. population is obese and that the obesity rate rose 3.2% in the last year alone.

However, the report highlights several positive developments in the last year that have the potential to yield overall health improvement. These include the 17% increase in per-capita spending on public health activities, a 4% decrease in smoking prevalence, and a 2% decrease in deaths from cardiovascular disease. Incidence of infectious disease also declined in most states.

There was also a slight upward tick in high school graduation rates, from 67.3% to 68.3%, a finding that Dr. Benjamin called "somewhat encouraging," given the known association between education and health issues awareness.

The annual report measures 18 indicators of overall health, including smoking prevalence, premature death, high school graduation rates, and per-capita public health spending, to develop a composite picture of each state's health. In state rankings, Louisiana retained its longstanding position as the least healthy state, closely followed by Tennessee and Mississippi. Topping the healthiest list were Minnesota, New Hampshire, and Vermont.

The great disparities in overall health among the states, which correlates closely with poverty levels and the number of uninsured patients, combines to present a persistent challenge for public health workers and physician providers, Dr. Benjamin said. In Oregon, for example, the percentage of children in poverty increased from 12.4% to 20.1% during the past decade compared with a 13% decrease in child poverty in Mississippi.

APHA 132nd Annual Meeting: News conference. Presented Nov. 9, 2004.

Reviewed by Gary D. Vogin, MD

Bonnie Darves is a freelance writer for Medscape.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.