Please respond to Stephen Bezruchka <[log in to unmask]>

Apologies for tooting my horn, but what was front page news in the UK just
didn't make it in the US.  Stephen

Give U.S. children our best
Poor report card on child health should be our call to action
Sunday, April 29, 2007
By STEPHEN BEZRUCHKA GUEST COLUMNIST

SEATTLE POST-INTELLIGENCER
http://seattlepi.nwsource.com/opinion/313449_focus29.html

Why are we leaving the children of the USA behind?

Sputnik's launch in 1957 during my youth was an obvious "F" on our nation's
report card, a failure that propelled us belatedly into space. We were
shamed
to find our guidance system to be lacking as the Russians beat us and we as
a
nation determined to catch up.

The UNICEF Report Card No. 7, released in February, showed that the U.S.
and
the United Kingdom have the worst child outcomes, including those for
education, among rich countries. This, like the launch of Sputnik 1, should
have been our call to action.

But the media response in these two countries couldn't have been more
different. Although the Seattle P-I carried the AP report the next day, it
received only a tiny bit of attention on public radio. In England, however,
stark headlines made the front pages, the news was all over TV and radio.
Discussion of the report continues.

Will "No Child Left Behind," the legislation that requires every child to
perform at grade level for reading and mathematics on test scores by 2014,
bring us up to speed so we no longer lag behind in the world? Let's explore
our
nation's report cards to discover how we should strive for something that
will
be even more challenging than the moon landing: to achieve acceptable
outcomes
for our children, which will benefit all of us.

There was little interest in exploring space after World War II. The first
satellite into space shamed us into faulting our educational system for not
focusing on science. We played catch-up. The media challenged us and
vaunted
our every step forward in the race. The cost was huge, the effort
incredible,
and we were successful: The moon landing helped establish the U.S. as the
key
world power. But the incredible price of continued human presence in space
was
too high to continue.

Most of us have been schooled to rate how well we are doing by comparing
ourselves with others. The February UNICEF report put us at the bottom of
all
rich nations in children's outcomes. It summarized children's material,
educational and subjective well-being as well as health and safety, family
and
peer relationships, and behaviors and risks. While we are the richest
country,
we rank highest in child poverty rates among rich nations. Our children's
death
rates are the worst as well. There is only one indicator in which we do
well:
the amount of money we spend on health care, amounting to half of the
world's
health care bill. In terms of real health outcomes, there is not a single
measure of our health status as a nation in which we rank among the top 20
in
the world. Why are our children being left behind those of other rich
countries? What do the top-ranked countries do that we don't?

I studied medicine at Stanford Medical School in the early 1970s. Even then
I
had highlighted similar points about our child well-being slipping. Our
infant
and child mortality rates, for example, had been some of the best among
nations
in the late 1940s and early 1950s, but by the time I entered medical
school, we
were being left behind by many other nations. Now we are doing much worse:
The
Centers for Disease Control and Prevention's "Health USA 2006" report
presents
our infant morality rate (the proportion of newborns who die in their first
year of life) rankings for selected nations, comparing 1960 with 2003.
Forty-seven years ago we stood in 12th place for infant mortality, and now
are
28th in that most sensitive indicator. If the CDC were to include more
nations
to the comparison, as the CIA does on its Web site, our ranking would fall
to
42nd. The CIA has a practical reason for tracking countries where infant
mortality rates rise, as that measure portends future instability.
Forebodingly, ours rose from 2001 to 2002 for the first time since the
'50s.
Why are even our infants being left behind?

I became interested in comparing our welfare with that of other countries
in
1993 after learning of Sylvia Ann Hewlett's report for UNICEF, "Child
neglect
in rich nations." It received no attention in the media in the U.S. I was
unsuccessful in even finding the report in university libraries in the
Pacific
Northwest, and only located a copy through UNICEF in New York. The
publication
demonstrated the U.S. had the highest child poverty rates. Hewlett pointed
out
we spend much more time earning a living and less time devoted to raising
our
children than a generation ago. Our children spent 25 percent fewer hours
in
school than their European counterparts. Family breakdown and absentee
fatherhood contributed to educational underperformance and failure. TV was
a
surrogate parent. Housing policies and health care presented ways that
public
funding could make a difference in child well-being.

English-speaking countries had fallen behind those on the European
mainland. In
France, motherhood was regarded as a social function and heavily supported.
Scandinavian countries had generous paid leave policies to allow parents to
spend time with their infants and to encourage fathers to be more involved
in
child rearing. Divorce was shown to affect children and mothers adversely;
in
response some European countries managed to protect the economic interests
of
women and children after divorce, in contrast to the U.S.

Hewlett's report spawned a range of report cards by UNICEF's Innocenti
Research
Center that compared child health outcomes among rich nations. The first,
in
2000, analyzed child poverty looking at rich countries belonging to the
Organization of Economic Cooperation and Development. Only Mexico had more
child poverty than the U.S. They estimated that to close our gap would cost
less than one percent of our economy. Reports followed annually, presenting
tables of child deaths by injury, maltreatment, as well as teenage births
and
educational disadvantage.

Despite our abysmal series of "Fs," these findings received little
attention in
our country -- in stark contrast to Sputnik's launch and the Russians
beating
us into space with manned rockets. Surely the consistent finding that we
are
far behind on all early life indicators deserves at least as much attention
as
propelling a human body into space!

Behind the UNICEF reports is that reality that the bulk of our health as
adults
is determined by conditions in the womb and during the first two to five
years
of life, as our CDC and the Institute of Medicine point out. But this
critical
fact doesn't get public attention. Socioeconomic status, especially the
record
gap between the rich and the poor, is the critical condition impacting our
health and well-being. As we go from the womb to the tomb, it is in early
life
that relative poverty matters most. Students in my UW courses find this
difficult to believe. We have all been taught that we control our health as
adults -- that we can amend past transgressions with the right diet,
exercise
and regular medical check ups. But there is clear evidence that these
factors
don't matter all that much. Instead the social and economic conditions of
our
early life have the strongest influence on later health -- that's why we
must
focus on improving conditions for U.S. children now.

The No Child Left Behind act requires all students tested in reading and
mathematics to be at grade level by 2014. We could take this goal as the
equivalent of the moon landing, and see what must be done to achieve it,
and
whether the time required is adequate. The importance of early life
impacting
educational achievement guarantees that we will fail in this goal by 2014.
Generational efforts are required to get an "A" on our report card. It is
much
tougher than a moon landing. But what better goal to strive for than
improving
our children's health! The standard should be comparing ourselves with that
of
other rich nations.

What are the first steps, the equivalent of launching the Vanguard Rocket?
Just
as we learned from the Russians, we as a nation must learn from other
countries
that do things better than we do. Good baby steps might be to grant paid
maternity and paternity leave for everyone, as many European countries do,
to
ensure that newborns have the best chance for healthy development during
the
most important period of their lives. The United States, Papua New Guinea,
Lesotho and Swaziland are the only countries in the world without a paid
maternity leave policy.

We get what we pay for and we get what we measure. If we measure our
standing
in our children's health and well-being compared with other nations, and
pay
for what will improve it, future generations will be healthier and will
thank
us. Other nations will look to us with more admiration than was achieved by
the
moon landing. It is a worthy prize.

________________________________________

Stephen Bezruchka is a professor in the Department of Health Services in
the
University of Washington School of Public Health and Community Medicine.

SoundOff comments can be reached from the website at the bottom or at
http://seattlepi.nwsource.com/soundoff/comment.asp?articleID=313449

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