2+2=5 — right? ;-)

Despite plenty of reasons to feel blessed and positive about our modern life, Associated Press and mainstream media have been trying hard to convince Americans that our rising life expectancies are “more bad news.” They’re counting on us to not think too much or look at their claims too critically.

They’ve tried tactics like report raw numbers of deaths, hoping we won’t catch on that they haven’t adjusted for growth in the population!

Another angle attempting to give the news a negative spin has been to say that U.S. life expectancy statistics lag behind other developed countries. This tactic is especially popular with those who believe everything about our country is awful, but savvy readers know that accurate comparisons of mortality data among countries is fraught with pitfalls, especially with the minor differences in life expectancies among developed countries, as the World Health Organization has cautioned. Differences are due to more than real distinctions in mortality levels, they said, but to divergent definitions and reporting systems, sources of data, and levels of accuracy and completeness. Countries have different and very inconsistent ways of measuring statistics.

We’ll take one example. Start with "live births" — you have to be considered to have been born alive to be included in the population that later dies. Hence, among nations, there is generally an inverse relationship between reported neonatal (first month of life) and infant (first year of life) mortalities and life expectancies: higher reported infant mortality figures lower the overall life expectancy figures for that country.

Despite attempts of the World Health Organization to standardize definitions for live births around the world (all babies showing any sign of life — “breathing...beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not he umbilical cord has been cut or the placenta is attached” — should be included as a live birth regardless of size or gestational age), not all countries comply as the U.S. strictly does.

“The legal requirements for registration of fetal deaths and live births vary between and even within countries,” said the WHO’s 2006 report “Neonatal and Perinatal mortality: country, regional and global estimates.” WHO’s analysis found that “reliability of data depends on reliable reporting and recording of births and deaths. Underreporting and misclassification are common.... A number of studies in developed countries show that incomplete reporting of vital events varied between 10% and 30%.” Cultural and religious traditions also play a role in how births and deaths are classified.

A number of countries also define many neonatal deaths as stillbirths, deaths that are never counted towards live births, and hence mortality figures. Switzerland, for instance, doesn't count as live births babies who died shorter than 30 cm, according to Nicholas Eberstadt, Ph.D., formerly a Visiting Fellow at the Harvard University Center for Population and Developmental Studies. Tiny babies are more likely to die, but when counted as stillbirths, their deaths don't affect mortality figures. Other countries don’t include as live births all babies who die during the first 24 hours of life, he reported. Over one-third of all infant deaths take place in the first day of life in the U.S. and Canada, but only make up 1/6 of reported deaths in France and 1/25 in Hong Kong.

In many European countries and in Cuba, for example, babies born weighing less than 1000 grams are also considered stillborn and aren’t counted towards mortality statistics. “Differences in birth registration practices for infants weighing <1500 grams are primarily responsible for the poor, deteriorating performance by the U.S. in the International rankings of neonatal mortality rates,”concluded Dr. Samuel Sepkowitz at the University of Oklahoma Health Sciences Center in Oklahoma City, in a review of international vital statistics.

When comparing country data for deaths, one also has to consider rates of reported abortions and early termination of pregnancies and, hence, the numbers of high risk pregnancies permitted to go to term when a problem is recognized.

According to UNICEF, the Soviet definition of not counting as live births babies born less than 28 weeks, weighing less than 1,000 grams, or measuring less than 35 cm if they die within the first week of life, is still predominately used.

It’s important to realize that babies who are born premature or tiny — which are also related to teen pregnancies (U.S. is 8 times as high as Japan and 4 times that of France), assisted fertility methods, multiple births (higher among certain populations), older women having babies, etc. — are at much greater risk of dying but are counted as live births in some countries such as ours, and vigorously attempted to be saved. Rates of multiple pregnancies need to be considered, as the risk of neonatal death in multiple births can be as high as six times higher than single births, noted WHO, and there are significant differences among populations of twins and multiples.

Unfortunately, there are also significant differences in life expectancies and infant mortalities among certain ethnic minorities as compared to whites, and these disparities are evident whether they are living in their country of origin or elsewhere. Yet few take into consideration that the U.S. is the most ethnically diverse of most industrialized countries and it is unavoidably clear that the highest life expectancy ranking countries in Europe are the whitest in the world with the most homogenous populations. For instance, according to the CDC, infant mortality rates are 3 to 4 times higher among blacks compared to whites. The Netherlands, for example, has for many years conducted studies on its falling international ranking for perinatal mortality rates and have concluded that it could be fully explained by increased numbers of blacks and Hindustani ethnic minorities and immigrants, who had more than twice the rates of perinatal mortality compared to indigenous whites.

The take-home message is that developed countries share extremely low mortality rates, and life expectancies are improving. The good news negates the continued hand-wringing about the dire state of affairs. Understanding the reality of accurately comparing different countries' data shows that splitting hairs is a game of agendas and diverts our attention away from helping people in ways that really count. Better access to food (yes, even that supposedly horrible modern diet) and lower rates of hunger and poverty, better access to safe drinking water and immunizations, have meant fewer premature deaths and longer lives, as well as higher average weights. Good news isn’t bad, no matter how much alarmists try to convince us 2+2=5.

© 2007 Sandy Szwarc