"Cuba does have a very low infant mortality rate, but pregnant women are treated with very authoritarian tactics to maintain these favorable statistics," said Tassie Katherine Hirschfeld, the chair of the department of anthropology at the University of Oklahoma who spent nine months living in Cuba to study the nation's health system. "They are pressured to undergo abortions that they may not want if prenatal screening detects fetal abnormalities. If pregnant women develop complications, they are placed in ‘Casas de Maternidad’ for monitoring, even if they would prefer to be at home. Individual doctors are pressured by their superiors to reach certain statistical targets. If there is a spike in infant mortality in a certain district, doctors may be fired. There is pressure to falsify statistics."
Can we base our universal healthcare proposals on countries that have done it without the authoritarianism and human rights violations please? There are a few other examples.
Hospital stays for pregnancy complications is incredibly common in the US (and you have to pay for it!) Acting like this is coersion is disingenuous, especially when pregnant women in the US are forced to go home without monitoring when they can't afford an extended hospital stay.
Edit: I should also add that these complications are things that can cause both maternal and fetal death. No one wants to be further than arms-length from medical care when the risk is that high (note the use of "may" in the quote from the parent comment, as if this is a theoretical discussion because they couldn't actually find anyone who was begging to leave).
I've been to Cuba many times over the last 10 years and have seen how pregnant women are treated up close and personal. The difference between Cuba and the U.S. is that Cuba has a greater sense of urgency when it comes to pregnancy. No one is coerced, but there is a community-driven sense of urgency and importance when it comes to following up with your pregnancy.
>>Can we base our universal healthcare proposals on countries >>that have done it without the authoritarianism and human >>rights violations please?
You're entirely correct there are many other examples of western democracies that can stand as models. However, I believe the reason Cuba was chosen was precisely to elicit a reaction. A story comparing mortality rates in the US to those in Canada, the UK or France would have fallen by the wayside. For one reason or another, the mention of Cuba generates attention and reactions - as attested to by this post itself.
The 'pressure to undergo abortions in case of fetal abnormalities' sounds the only potentially troubling part of that, but I don't exactly get what's 'authoritarian' about insisting women with complications stay and be be monitored in the hospital, or firing people based on poor performance?
The data regarding infant mortality is collected differently in different countries, so this is like comparing apples and oranges. In the US, more events are included in the umbrella of "infant mortality" than in most other countries, which use narrower definitions. Neither way is more "correct" than the other, but the varying definitions mean that it is very difficult to make meaningful cross-country comparisons, as Mr. Kristof is trying to do here.
I at least have the author credit for stating that the statistics should be taken with a grain of salt.
How is this possible? Well, remember that it may not be. The figures should be taken with a dose of skepticism.
The US actually has very generous social services when it comes to medical care for pregnant women and their babies. CHIP and Medicaid cover pregnant women up to 200% (~$30K) or sometimes 300% (~$50K) of the federal poverty level.[1] Waiting lists are non-existent for most states as they have an exemption for pregnant women or newborns..[2]
Lol try having kids and see for yourself how "generous" it is. We've been "fully-covered" for pregnancy and delivery for both kids and still had to go on payment plans to cover the costs.
Very generous compared to what? Don’t most other wealthy nations also offer this kind of care, along with continued free at point of service care for life?
At around 6 per 1000, compared to 4.3 for the UK (or 2.7 for Japan) for example.
I would imagine, infant mortality isn’t just about a function of healthcare available during pregnancy, but also for the parent before pregnancy. There could of course be multiple other confounding factors (such as life style issues)...
Does chip and Medicaid cover absolutely everyone who might need it? Are there people who, despite the coverage, are still left with outstanding costs they can't meet?
My understanding is that in Cuba, there is no applying to services like Chip, or Medicaid. Theres no chance you won't get coverage, as everyone, by default, gets the care they need. Wait times are non existent for the pregnant or disabled across the country, not just in certain regions.
It doesn't seem totally unlikely that the people that """"fall through the cracks"""" in the American systems are enough to swing infant mortality rates.
When we were getting ready for our first child, looking for a hospital, I went deep diving on infant mortality rates in the US in general, and specifically in our area's hospitals.
At least in my area of the country, the higher infant mortality (outside birth defects) rates are almost entirely driven by a tiny percentage of the overall population - extremely young mothers with substance abuse problems. The biggest portion of the effect is not a result of medical care differences. According to the CDC, "Asians" in the US have almost a quarter the infant mortality rate of "Blacks".
The article mentions that the US infant death rate is 5.9, and the Cuban infant death rate is 4.0. However, according to the CDC report, Cuban ancestry, living in the US, has an infant death rate of 3.0!
All this [these prenatal home visits] is possible because Cuba overflows with doctors — it has three times as many per capita as the United States — and pays them very little.
The country has an unusually high rate of late fetal deaths, and skeptics contend that when a baby is born in distress and dies after a few hours, this is sometimes categorized as a stillbirth to avoid recording an infant death.
1. "4 (Cuban) vs 6 (American) deaths per live birth."
Are we sure they're measured the same? Are we sure that the count for deaths starts at the same time? Could easily be that Cuban mothers are more likely to lose a baby at an earlier stage of pregnancy (for example Cubans measure it from 2nd trimester on, Americans measure it from conception so Cubans fail to count early stage deaths).
2. "7500 deaths per year in US".
The author does not seem to have his figures correct. Approximately 3.8 million american babies are born per year. If 0.6% of them die that's 228,000 total deaths and a differential of about 60,000 between US rates and Cuba's. Not to nitpick here but if you can't get these objective facts right how can I take you seriously about other things you're saying?
According to the CDC, in 2013, there were 3,932,181 live births and 23,446 infant deaths (from birth to age one). That checks out with a 6 in 1000 ratio.
A pre-birth death can't be counted among the 'per live birth' deaths, and would have to include estimates of miscarriage rates since those are woefully underreported everywhere. Pretty sure every country starts the clock at birth.
The country has an unusually high rate of late fetal deaths, and skeptics contend that when a baby is born in distress and dies after a few hours, this is sometimes categorized as a stillbirth to avoid recording an infant death. ... I’m not in a position to judge who’s right, but any manipulation seems unlikely to make a huge difference to the reported figures.
What are we to make of that last sentence? The author seems to be saying "I don't know enough to judge" but then immediately follows that with a strong opinion as to who must be wrong. How are we as an audience supposed to gauge whether Kristof (the author) is right that the effects will be inconsequential even if the accusations of manipulation were true? The implication would seem to be that because he's writing his (clearly labeled) opinion in the New York Times, we should trust him as an expert, despite his disavowals.
While we can't easily answer the question as to whether the statistics are manipulated, it turns out that there are at least clear answers to what the effect of the manipulation would be. In a 2015 article entitled "Infant Mortality in Cuba: Myth and Reality", Roberto Gonzalez runs the numbers and shows that the effect of reporting Early Neonatal Deaths as Late Fetal Deaths would be enough to completely change our interpretation of the statistics. Here's a summary of the paper's conclusions: https://thecubaneconomy.com/wp-content/uploads/2014/02/Infan...
What should we make of this? Certainly a problem with a small detail like this doesn't mean the overall question isn't worth asking, and the "human interest" aspects of the story are certainly interesting, but it sure make me wonder how much we should trust the author's intuitions about other details in the story.
This article is extremely misleading. One of the main causes of infant mortality is parental obesity. [1] As America becomes more and more obese we're going to see more and more of these sort of consequences. For instance our declining life expectancy is also related to this. Diseases ranging from cardiovascular to cancer had been steadily retreating, but as our waist lines expanded the frequency and mortality of these sorts of things have once again begun rising. Better healthcare is not a magic pill for unhealthy lifestyles.
In other words, this is about a healthier people - not about a comparable people with better access to healthcare. I'd expect to see these numbers level out in time. Cubans have also been thickening up as the article does mention, but they're still quite far behind us.
"the infant mortality rate in Cuba is only 4.0 deaths per 1,000 live births. In the United States, it’s 5.9. In other words, an American infant is, by official statistics, almost 50 percent more likely to die than a Cuban infant."
Is that right? Or is it 0.19% more likely to die in the USA. This is why I never win on the horses.
So perhaps the answer is that they are both pretty safe? I would think more elective caesarians and traffic accidents could account for much of the differences but it must be getting pretty close to the margin of error?
No, you may consider the statement misleading, but it is correct. 100% of 4/1000 is 4/1000, 50% of 4/1000 is 2/1000, so 50% more likely than 4/1000 = 4/1000 + 2/1000 = 6/1000.
Regardless of reliability it's important to mention that mortality rates isn't the be all end all of healthcare quality. Many people contrasting Cuban mortality and life expectancy statistics against the US have a political axd to grind, and they fail to mention key nuances. Chief among them, the fact that it's drastically easier to curb obesity when the government rations food.
Key quote: “(...) evidence that physicians likely reclassified early neonatal deaths as late fetal deaths, thus deflating the infant mortality statistics and propping up life expectancy.“
> Eschew flamebait. Don't introduce flamewar topics unless you have something genuinely new to say. Avoid unrelated controversies and generic tangents.
It must be compared with other caribean small poor post-colonial countries. Against that, they're obviously better off. One can only wonder what would be of it without the sanctions. This is not to claim their system is good or etc, what really pisses me off is that most examples we use, of people starving, of poverty, of misery, etc, in a "ideological-enemy" is proof that they suck, while we are full of it in our "other side" societies, slums, crime, misery, what this leads us to is that, actually, all those other suffering are irrelevant unless they serve as pretext for some political interest, in other words they're nothing. And let's face it, there's much more post-colonial people in capitalist societies living in hell than else, there's just more people.
US is propping up a war with Venezuela right now because of "humanitarian blablabla" at the same time there's children starving because of the Yemen's war the US is a sponsor.
There's absolutely no morals in geopolitics. If you hear about it, be confident it's bullshit. Sad but true.
If people in a free and open vote want to choose communism as the basis for their economic system, as Europeans had the opportunity to do with various Eurocommunist parties, that's fine. But a system imposed by one party without accountability or the opportunity to push for change is a system that doesn't work. As others have noted, the rafts are heading in just one direction as was the traffic over the wall in Berlin.
"Yet people continue to argue how communism doesn't work."
Perhaps because there's a long parade of examples of it not working, and Cuba is not an unqualified success story -- not now nor for the decades it was propped up by the Soviet Union.
Also, the soviet union got to space faster. Capitalism is good enough until it creates too much waste and uses all resources. The only reason capitalism is still "nice" is that the continuous growth has not been stopped yet. However, we live on a planet with limited resources and capitalism will hit a wall soon enough. I'm not in favor of communism and gulags, but definitely free healthcare, education, true effort by government to solve climate change and wealth redistribution.
Do you have a source of infants dying from vaccine preventable diseases? I was under the impression that some vaccines aren't even administered to infants and the diseases become a problem a little later in life.
They state themselves the figures aren't to be trusted.
This makes me unsure how to feel about the subject. If Cuba's just lying about infant mortality (I don't know how feasible that would be) it invalidates a lot of things.
I find the point about local, conveniently-accessible doctors leading to earlier diagnoses interesting, too. That seems like a fair point: I've heard a lot about the automobilised nature of america, where cities are built for cars rather then people. If you can't just walk over to the local doctor you've known for the last 5 years to ask about the lump on your back because going to the doctor is seen as a big deal- you can imagine this leading to fewer check-ups.
I've heard a point that the US is in a hellish middle-ground between socialised healthcare ala euroland and hypothetical free-er market healthcare: you can't actually shop around for cheaper treatment, because the government's teamed up with big pharma to reduce competition and obscure pricing.
edit: Just read a comment mentioning obesity as a factor. That makes a lot of sense, as well. Of course a country as fat as america's going to be in a worse health state than one like cuba where people are only starting to bloat up after starving a while back.
[+] [-] bhawks|7 years ago|reply
https://www.politifact.com/truth-o-meter/statements/2014/jan...
Can we base our universal healthcare proposals on countries that have done it without the authoritarianism and human rights violations please? There are a few other examples.
[+] [-] rmrfrmrf|7 years ago|reply
Edit: I should also add that these complications are things that can cause both maternal and fetal death. No one wants to be further than arms-length from medical care when the risk is that high (note the use of "may" in the quote from the parent comment, as if this is a theoretical discussion because they couldn't actually find anyone who was begging to leave).
[+] [-] atentaten|7 years ago|reply
[+] [-] pseudolus|7 years ago|reply
You're entirely correct there are many other examples of western democracies that can stand as models. However, I believe the reason Cuba was chosen was precisely to elicit a reaction. A story comparing mortality rates in the US to those in Canada, the UK or France would have fallen by the wayside. For one reason or another, the mention of Cuba generates attention and reactions - as attested to by this post itself.
[+] [-] blindwatchmaker|7 years ago|reply
Am I missing something here?
[+] [-] gnicholas|7 years ago|reply
https://www.forbes.com/sites/physiciansfoundation/2016/04/12...
[+] [-] refurb|7 years ago|reply
[+] [-] refurb|7 years ago|reply
How is this possible? Well, remember that it may not be. The figures should be taken with a dose of skepticism.
The US actually has very generous social services when it comes to medical care for pregnant women and their babies. CHIP and Medicaid cover pregnant women up to 200% (~$30K) or sometimes 300% (~$50K) of the federal poverty level.[1] Waiting lists are non-existent for most states as they have an exemption for pregnant women or newborns..[2]
[1]https://www.medicaid.gov/chip/eligibility-standards/index.ht... [2]https://www.medicaid.gov/chip/eligibility-standards/waiting-...
[+] [-] rmrfrmrf|7 years ago|reply
[+] [-] TaylorAlexander|7 years ago|reply
[+] [-] new299|7 years ago|reply
https://en.m.wikipedia.org/wiki/List_of_countries_by_infant_...
At around 6 per 1000, compared to 4.3 for the UK (or 2.7 for Japan) for example.
I would imagine, infant mortality isn’t just about a function of healthcare available during pregnancy, but also for the parent before pregnancy. There could of course be multiple other confounding factors (such as life style issues)...
[+] [-] cazum|7 years ago|reply
My understanding is that in Cuba, there is no applying to services like Chip, or Medicaid. Theres no chance you won't get coverage, as everyone, by default, gets the care they need. Wait times are non existent for the pregnant or disabled across the country, not just in certain regions.
It doesn't seem totally unlikely that the people that """"fall through the cracks"""" in the American systems are enough to swing infant mortality rates.
[+] [-] minikites|7 years ago|reply
Only if you're white:
https://www.nytimes.com/2018/04/11/magazine/black-mothers-ba...
[+] [-] danielvf|7 years ago|reply
At least in my area of the country, the higher infant mortality (outside birth defects) rates are almost entirely driven by a tiny percentage of the overall population - extremely young mothers with substance abuse problems. The biggest portion of the effect is not a result of medical care differences. According to the CDC, "Asians" in the US have almost a quarter the infant mortality rate of "Blacks".
https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_09.pdf
--
The article mentions that the US infant death rate is 5.9, and the Cuban infant death rate is 4.0. However, according to the CDC report, Cuban ancestry, living in the US, has an infant death rate of 3.0!
[+] [-] unknown|7 years ago|reply
[deleted]
[+] [-] adolph|7 years ago|reply
The country has an unusually high rate of late fetal deaths, and skeptics contend that when a baby is born in distress and dies after a few hours, this is sometimes categorized as a stillbirth to avoid recording an infant death.
[+] [-] corporateVeal27|7 years ago|reply
1. "4 (Cuban) vs 6 (American) deaths per live birth."
Are we sure they're measured the same? Are we sure that the count for deaths starts at the same time? Could easily be that Cuban mothers are more likely to lose a baby at an earlier stage of pregnancy (for example Cubans measure it from 2nd trimester on, Americans measure it from conception so Cubans fail to count early stage deaths).
2. "7500 deaths per year in US".
The author does not seem to have his figures correct. Approximately 3.8 million american babies are born per year. If 0.6% of them die that's 228,000 total deaths and a differential of about 60,000 between US rates and Cuba's. Not to nitpick here but if you can't get these objective facts right how can I take you seriously about other things you're saying?
[+] [-] danielvf|7 years ago|reply
[+] [-] falsedan|7 years ago|reply
A pre-birth death can't be counted among the 'per live birth' deaths, and would have to include estimates of miscarriage rates since those are woefully underreported everywhere. Pretty sure every country starts the clock at birth.
[+] [-] unknown|7 years ago|reply
[deleted]
[+] [-] corporateVeal27|7 years ago|reply
[+] [-] nkurz|7 years ago|reply
What are we to make of that last sentence? The author seems to be saying "I don't know enough to judge" but then immediately follows that with a strong opinion as to who must be wrong. How are we as an audience supposed to gauge whether Kristof (the author) is right that the effects will be inconsequential even if the accusations of manipulation were true? The implication would seem to be that because he's writing his (clearly labeled) opinion in the New York Times, we should trust him as an expert, despite his disavowals.
While we can't easily answer the question as to whether the statistics are manipulated, it turns out that there are at least clear answers to what the effect of the manipulation would be. In a 2015 article entitled "Infant Mortality in Cuba: Myth and Reality", Roberto Gonzalez runs the numbers and shows that the effect of reporting Early Neonatal Deaths as Late Fetal Deaths would be enough to completely change our interpretation of the statistics. Here's a summary of the paper's conclusions: https://thecubaneconomy.com/wp-content/uploads/2014/02/Infan...
What should we make of this? Certainly a problem with a small detail like this doesn't mean the overall question isn't worth asking, and the "human interest" aspects of the story are certainly interesting, but it sure make me wonder how much we should trust the author's intuitions about other details in the story.
[+] [-] rjf72|7 years ago|reply
In other words, this is about a healthier people - not about a comparable people with better access to healthcare. I'd expect to see these numbers level out in time. Cubans have also been thickening up as the article does mention, but they're still quite far behind us.
[1] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2674328/
[+] [-] gandalfian|7 years ago|reply
Is that right? Or is it 0.19% more likely to die in the USA. This is why I never win on the horses.
So perhaps the answer is that they are both pretty safe? I would think more elective caesarians and traffic accidents could account for much of the differences but it must be getting pretty close to the margin of error?
[+] [-] AnIdiotOnTheNet|7 years ago|reply
[+] [-] davidivadavid|7 years ago|reply
[+] [-] manfredo|7 years ago|reply
[+] [-] danlugo92|7 years ago|reply
[+] [-] andrenth|7 years ago|reply
https://academic.oup.com/heapol/article/33/6/755/5035051
Key quote: “(...) evidence that physicians likely reclassified early neonatal deaths as late fetal deaths, thus deflating the infant mortality statistics and propping up life expectancy.“
[+] [-] RodericDay|7 years ago|reply
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[+] [-] zjaffee|7 years ago|reply
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[+] [-] sctb|7 years ago|reply
https://news.ycombinator.com/newsguidelines.html
[+] [-] tdfx|7 years ago|reply
[+] [-] brbrodude|7 years ago|reply
US is propping up a war with Venezuela right now because of "humanitarian blablabla" at the same time there's children starving because of the Yemen's war the US is a sponsor.
There's absolutely no morals in geopolitics. If you hear about it, be confident it's bullshit. Sad but true.
[+] [-] pseudolus|7 years ago|reply
[+] [-] duxup|7 years ago|reply
"Yet people continue to argue how communism doesn't work"
The your scale and what this news story says are just totally on different planets.
[+] [-] MrZongle2|7 years ago|reply
Perhaps because there's a long parade of examples of it not working, and Cuba is not an unqualified success story -- not now nor for the decades it was propped up by the Soviet Union.
[+] [-] unknown|7 years ago|reply
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[+] [-] simplysimple|7 years ago|reply
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[+] [-] simplysimple|7 years ago|reply
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[+] [-] mrits|7 years ago|reply
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[+] [-] antepodius|7 years ago|reply
I find the point about local, conveniently-accessible doctors leading to earlier diagnoses interesting, too. That seems like a fair point: I've heard a lot about the automobilised nature of america, where cities are built for cars rather then people. If you can't just walk over to the local doctor you've known for the last 5 years to ask about the lump on your back because going to the doctor is seen as a big deal- you can imagine this leading to fewer check-ups.
I've heard a point that the US is in a hellish middle-ground between socialised healthcare ala euroland and hypothetical free-er market healthcare: you can't actually shop around for cheaper treatment, because the government's teamed up with big pharma to reduce competition and obscure pricing.
edit: Just read a comment mentioning obesity as a factor. That makes a lot of sense, as well. Of course a country as fat as america's going to be in a worse health state than one like cuba where people are only starting to bloat up after starving a while back.
[+] [-] isolli|7 years ago|reply
https://data.oecd.org/healthstat/infant-mortality-rates.htm