Wednesday, May 13, 2009

Infant Mortality Determinants in the US

I have to apologize for suggesting earlier that giving uninsured women health insurance would improve prenatal care and reduce infant mortality. That seems like an intuitive prediction, but it is questionable. I have been playing with GapMinder, and it is a very helpful tool for identifying probable correlations and tracking them over time. Gapminder shows:

* No discernable relationship between percent of a state's population without insurance and infant mortality. Infant mortality has been steadily decreasing while the proportion of uninsured decreased, then increased.

* Possible relationships between infant mortality and income, education, life-expectancy at birth, and geography.

* Less clear possible relationships between infant mortality and murder, robbery, and divorce.

* Washington DC is a crazy outlier on nearly every measure.

How does this information fit together to explain our infant mortality rates?

The southern states are typically more rural and politically conservative, demanding minimal government intrusion. They have a prevailing culture of deregulation, which has led to the highest pollution rates and the lowest education standards. There is a "brain drain" phenomenon in rural areas that high academic achievers move to cities, perhaps in other states such as California and New York. There is natural colinearity among the variables GapMinder showed may associate with infant mortality. Low education -> low income. Living in the south -> low education and low income.

The Northeast has different attitudes, favoring government involvement, having high standards for education. This region is more progressive, trying new things to see how to make improvements, instead of following traditions.

Some pieces are missing from this puzzle that GapMinder doesn't have.

I would like to see drug addiction data mapped with the rest of this data. I think it is a key link between the health insurance and infant mortality discrepancies between the US and other industrialized nations. Drug addiction increases infant mortality. Across the US, people with drug problems end up in jail at very high rates. Across other industrialized nations, people with drug problems end up in rehabilitation programs more often than in the US. Many US health insurance programs cover some drug rehab, but not all and not very well. Medicaid covers a lot more, but only covers people who qualify for Medicaid.

Does the South have more drug problems than the Northeast? Is it more likely to send addicts to jail than the Northeast? Is it less likely to provide rehabilitation than the Northeast? Using murder and robbery rates as an estimate of drug problems, it looks like the South (plus Nevada) is worse off than other US regions.

A socioneuropsychological unification theory:

Fearful, angry people are more easily overwhelmed by novelty and complexity. Their brains simplify input their whole lives, causing them to miss nuance and detail. Their relationships are poor, their learning is poor, and they are drawn to simple, concrete, black-and-white ideas. They are also drawn to each other in order to feel more secure in a predictable and simple social environment. They also raise fearful, angry kids (though yelling, shaming, rigidity, overcontrol, and abuse), perpetuating these problems generation after generation. With lower education, worse income prospects, less hope, and a baseline physiological disregulation, drug use can be a pleasant liberation. There are also genetic components to all of this, but they are not nearly as important as environmental factors except for predisposition to drug dependence. Let's include cigarettes and alcohol as drugs. Besides drug use, other self-soothing behaviors such as overeating would be common. GapMinder does not show obesity rates, but it does show that the South has the worst life-expectancy in the US. The South has about equivalent uninsured rates to the West, but worse health outcomes because of behavior. Nicotine, alcohol, and other drugs during pregnancy are associated with low birth weight, among other developmental problems. During fetal development, the frontal lobe is the last part of the brain to get blood and oxygen. When there is a problem with getting proper nutrients to the fetus, this part of the brain is generally affected the most. This is the part of the brain involved in behavioral planning and inhibition. Smokers and drug users give birth to kids that are impulsive, and who are then more likely to do things like use drugs, not take care of themselves, and have kids at younger ages. We are observing a cycle over generations that is changing the distributions of neurologically and behaviorally healthy people across geographic regions. They do not care for themselves, their developing fetuses, or their children as well as normal-functioning people.

What is up with Washington DC?

DC has many well-paid government employees and contractors, giving it the highest average income by far. It also has a large population of urban poor, contributing to the highest per-capita murder rate (some competition with Philadelphia) and highest HIV rate. Rampant drug use and unhealthy behavior among the urban poor population of DC increase its infant mortality rate.

What should we do?

Whether its covered by health insurance or not, we need better drug rehabilitation services, comparable to other industrialized nations. We also need uniformly high standards for educating our children, especially in how to raise healthy children themselves. It is going to be a long and difficult task to undo the damage done by generations of poor habits, and the beliefs and impulsivity and poor self-awareness that perpetuate them.

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