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ABSTRACT The United States has poorer child health outcomes than other wealthy nations despite greater per capita spending on health care for children. To better understand this phenomenon, we examined mortality trends for the US and nineteen comparator nations in the Organization for Economic Cooperation and Development for children ages 0-19 from 1961 to 2010 using publicly available data. While child mortality progressively declined across all countries, mortality in the US has been higher than in peer nations since the 1980s. From 2001 to 2010 the risk of death in the US 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 US. Over the fifty-year study period, the lagging US performance amounted to over 600,000 excess deaths. Policy interventions should focus on infants and on children ages 15-19, the two age groups with the greatest disparities, by addressing perinatal causes of death, automobile accidents, and assaults by firearm.
Across almost every domain, the United States has poorer child health outcomes than other wealthy nations. A UNICEF report from 2013 summarized these findings by ranking the US twenty-fifth of twenty-nine developed countries with respect to overall child health and safety.1 Compared to other highincome nations, mortality rates for US infants are higher and life expectancy at birth is lower.2,3 Children in the US also face a morbidity disadvantage, with higher rates of injury, obesity, HIV infection, and adolescent pregnancy, compared to children from peer countries.4
The care of children is a basic moral responsibility of our society, both because children are inherently vulnerable and because disease can profoundly affect a child's life course.5 The US outspends every other nation on health care per capita for children, yet outcomes remain poor.6 The proposed budget for 2018 of the administration of President Donald Trump includes substantial cuts to the Children's Health Insurance Program, which covers seven million children, and to the Supplemental Nutrition Assistance Program, which directs three-quarters of its benefits to households with children.7-9 In the current political climate, with the government poised to execute these and other dramatic reductions to the social safety net, it is essential to understand how well the...