Continuing Conversation... Emily Oster on Infant Mortality

EconTalk Extra
by Amy Willis
Emily Oster on Infant Mortalit... Nick Bostrom on Superintellige...

EconTalk host Russ Roberts welcomes back University of Chicago's Emily Oster in this week's episode, in which they discuss the differences in infant mortality rates across nations, as well as the challenges and opportunities afforded by health data.

Share your thoughts on this week's conversation by responding to any or all of the questions below in the comments. We love to hear from you!

Check Your Knowledge:

1. How are infant mortality rates calculated, and what difficulties arise in comparing these rates across countries?

2. What do higher rates of infant mortality generally suggest about a nation's economy? What reasons does Oster posit for the higher rates of infant mortality in the United States as compared to other countries, such as Finland? To what extent do you find her suggestions plausible?

Going Deeper:

3. Oster notes that higher standards of living correlate with lower levels of infant mortality. What can the history of industrialization tell us about the difference we see in infant mortality rates today? Are you optimistic or pessimistic about infant mortality rates in the United States relative to other developed countries moving forward?

Extra Credit:

4. Oster says that the higher rates of infant mortality in the US are relatively concentrated. In what ways are they concentrated, and what are some of the suggestions Oster offers to reduce these relatively higher rates? What would you suggest? Is this an economic or political problem (or neither)? Explain.

Comments and Sharing

CATEGORIES: Extras (194) , Health (63)

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COMMENTS (7 to date)
Steve H writes:

Initial comment, without having read the paper, which I will today (Thanksgiving Day):

I suspected early on in the podcast that this would come down to correlation with race, which really means socio-economic status, which really means inhumane government-led policies that continue to marginalize black Americans. Higher IM rates is just one more metric that should convince the black community that they are no better off now then when Democrats swooped in during the 1960's to sell them the snake oil of the welfare state. Look at abortion and out of wedlock rates for blacks now compared to 1965. Look at employment and graduation rates.

Having destroyed one race's social fabric, I suppose it's time for them to move on to the next indentured constituency: newly minted Hispanic Americans.

...same as the old boss.

SaveyourSelf writes:

4a. Oster says that the higher rates of infant mortality in the US are relatively concentrated. In what ways are they concentrated?

Oster states that the higher infant mortality is concentrated in groups with lower education. She also added that Cook county, IL, has an especially high infant mortality rate. Floccina, in the other comments section, posted a link that indicates the increased infant mortality is also concentrated in the African American population. Floccina’s Link
4b. What are some of the suggestions Oster offers to reduce these relatively higher rates?
She thinks home visits after discharge from the hospital following delivery might help. She thinks reducing poverty would definitely help.
4c. What would you suggest?
Eliminate government welfare programs. Eliminate subsidies for formula. Encrouage breast feeding programs. Eliminate the minimum wage.
4d. Is this an economic or political problem (or neither)? Explain.
It is an artificially induced economic problem created by government aid programs. The problem does not exist for segments of the population that are not exposed to government welfare. The problem is NOT poverty. Being poor in America does not cause kids to have a higher risk of death. Being poor in America means the parents of those kids have less access to information, especially market price information, than everyone else in the country. The paucity of information in prices is ENTIRELY artificial. Absent government intervention, the problem would not exist. Additionally, absent government interference, there would be far less poverty.

SaveyourSelf writes:

Addendum 4d:

I feel confident about my statements regarding the paucity of price information for poor American’s and its negative impact on their earnings. I am not nearly as confident about the lack of an association between infant death rates and poverty. My statement, “The problem is NOT poverty,” is extreme and probably incorrect given the study results discussed in this podcast.

Michael Wara writes:

Listening to the Oster podcast, one thought occurs: how much would it cost to test whether or not changing the SES of mothers (via a big tax credit or something like that) in the first year of life would reduce infant mortality?

Maybe this is an example where just giving people money (to use as they see fit) could actually make a big difference.

Some simple calculations bear out that this might be worth doing.

Approx 4 million live births per year * $30k per child = $120B total cost (actual cost would be smaller because you would only want to give the credit to mothers of infants that were below some income threshold).

Approx 12,000 potentially avoidable deaths (difference between 3/1000 and 6/1000 infant mortality) * $9.6M (current value of a statistical life) = $220B. Of course, the benefits would likely be smaller because you probably wouldn't get 100% efficacy. But if you could even get something like 50% efficacy, it would be close to break-even for CBA purposes - and this assumes the high cost from above.

Now this is big money for any kind of a program. One would want to measure its efficacy. So my question is really, how big a study would you have to do? If you randomly selected mother/infant pairs to award $$$ to and followed a cohort of awardees and nonawardees, how big to have sufficient power to measure the treatment effect? How much would it cost to run the trial?

Seems like an experiment worth trying, at least to this father of young children.

David writes:

Twenty plus years ago we had a daughter who from my laymen's perspective, it was arguable that she was stillborn.

However what I recall is that income taxes came into play that day. The doctors implied they had the leeway to have the records show that she had been born and died the same day. A death certificate would be issued, and I could claim her as an exemption for that tax year.

I have no idea, but I wonder to what extent taxes bias situations similar to mine from being recorded as stillborn to infant mortality?

jbdmd writes:

From the perspective of a neonatologist:
At least in California, anything with a heartbeat and over 499 grams is counted as a live birth even if the infant is in the process of dying at the time of birth. In other countries this is not counted as a live birth.
In terms of race and social class birth interval time seems to determine the risk of prematurity which is the single biggest determinant of neonatal death risk (besides congenital anomalies). see the following: Prevalence of Low Birth Weight and Preterm Delivery in Relation to the Interval between Pregnancies among White and Black Women
James S. Rawlings, M.D., Virginia B. Rawlings, R.D., M.S.P.H., and John A. Read, M.D.

N Engl J Med 1995; 332:69-74January 12, 1995DOI: 10.1056/NEJM199501123320201

In terms of deaths after the first year: were motor vehicle deaths accounted for? These should be eliminated in any analysis or at least adjusted for miles driven per year per person across countries.

Regarding sids: I freqently see mothers who do NOT place the infant on the back to sleep and continue to smoke in the home (all factors that increase the risk of sids).

jbdmd writes:

One should also see the article below that deconstructs the WHO report from 2000 that rates the U.S. healthcare system poorly. Having read the introduction of the actual WHO report, I found it obvious that it was structured to give the results it gave. Yet, such biased reports are used to demagogue the healthcare issue and call for collectivistic programs that further expand federal power and control.

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