Myth: Poor people and minorities are committing the most crime.



Fact: The rich commit far more crime than the poor.







Summary



The upper class commits far more crime than the lower class. Street criminals stole $15.3 billion in 1993, but white collar-criminals embezzled $200 billion. Street criminals murdered 23,271 people that year, but the decisions of profit-driven corporations murdered at least 318,368 (through pollution, consumer and worker safety violations, etc.) Corporations deserve blame for these deaths because they lobby for and enact policies which drive up these death rates. Virtually all other rich countries have higher safeguards and lower death rates.







Arguments



Say the word "criminal," and the image that comes to the mind of most people is a street criminal usually poor, usually black, usually armed with a gun.



In terms of sheer damage, however, the crimes of the poor do not even begin to compare with the rich. In 1993, the property loss to theft and robbery amounted to $15.3 billion. (1) But white-collar embezzlement costs about $200 billion a year! (2) So conditioned are we to ignore the crimes of the middle and upper classes that the FBI does not even list this statistic in its authoritative annual report, Crime in the United States. The very way we think of crime is racist and classist to its core.



The same is true of murder. Officially, the FBI counted 23,271 murders in 1993. (3) But a truer figure would run at least 318,368, even by the incomplete and conservative count listed below. Society has simply conditioned us not to think of the deaths caused by corporations as murder. For example, when a criminal breaks into someone's home and shoots a family of six, we have no trouble identifying that as mass murder. But what about the mine disaster that kills 26 miners -- after the owners had committed 1,250 safety violations in the last 13 years? (4) If the mine owner callously and knowingly risks human lives in his pursuit of profits, shouldn't he then be guilty of murder?



Murder is defined as "unlawful killing with malice aforethought." Clearly, a mine owner who has been lawfully warned that his mines are unsafe has the requisite foreknowledge of likely death. And the mine owner who would then choose to ignore those warnings in his quest for profits clearly displays the requisite malice towards his fellow human beings. An analogy best describes this similarity. Suppose someone puts out a $100,000 contract on your life, causing a gangster to show up at your door one day and kill you. He may not have known you, or held a personal grudge against you. He did it for the money -- that is, with cold-blooded malice aforethought. The same is true of a businessman who desires to earn an extra $100,000 in profits when scientists have already warned him that this action will drive up the percentage of worker or consumer deaths.



Three objections are commonly raised to the above argument. Some object that a street crime is different because it is terrifying, direct and real in a way that work is not. But this only begs the question: which would you rather be killed by, a street criminal or an unsafe job?



Others object that job deaths are accidental, even negligent, but not criminal. But our society has a long tradition of finding people guilty for criminal negligence (such as drunk drivers who kill, or restaurants that fail to put out the "wet floor" sign). Even so, it cannot be negligence if scientists, experts or regulators have repeatedly warned the perpetrator.



Others object that if workers do not want to work at dangerous jobs, they should simply find another. Unfortunately, the job market is ruled by the mathematics of displacement. If you quit a dangerous job to take a safe one, you have removed a safe job opening from the job market and replaced it with a dangerous one. Since people must either work or starve, they must take whatever jobs are available. And with an unemployment rate of 5-6 percent, job seekers actually find themselves competing for these jobs. To put it another way, suppose that 30 percent of the jobs in the economy were dangerous. The solution is not to rotate the workforce in and out of those jobs. Nor is the solution to let workers compete for the safer jobs, leaving the bottom 30 percent of workers stranded in dangerous ones. The only real solution is to lower the percentage of dangerous jobs to zero. And that is something only managers and owners can do.



Corporations not only expose workers to danger, but consumers as well. Scientists have long warned corporations that air and water pollution kills a certain percentage of the population (mostly through higher cancer rates). So do cigarettes, cars without safety features like air-bags, defective silicon breast implants, unsafe nuclear waste disposal, chemical food additives and pesticides, inadequate health care, inadequate disaster and emergency services, poverty, poor education and training the list goes on and on.



So how do corporations get away with it? In 1992, corporations formed 67 percent of all Political Action Committees (the lobbyist organizations that bribe our Congress) and contributed 79 percent of all "soft money" to national political parties. (5) These corporate lobbyists have persuaded Congress to scuttle pro-consumer, pro-labor and pro-environmental safeguards, even though this results in a higher percentage of disease and death. Indeed, the statistics below reveal that the U.S. has some of the highest death rates and pollution rates in the industrialized world.



This returns us to the definition of murder: "illegal killing with malice aforethought." If Congress rules that these fatal practices are not illegal, then corporations may claim that they are not guilty of murder. But let's revisit the hypothetical $100,000 contract put out on your life. Suppose that the gangster accepting the contract first visits his local member of Congress, and bribes him to make contract murder legal before going ahead with terminating you. Should society let this gangster off the hook for murder because of this technical loophole?



The following is a closer look at the statistics of how Americans are really murdered. This is obviously an incomplete list, but the tally below easily dwarfs the FBI's official murder count of 23,271.



THE REAL MURDER STATISTICS



In 1992, nearly 70,000 Americans were killed from job-related accidents or work-related illness and desease. Another 13.2 million suffered non-fatal injuries or illness, at a cost of $170 billion to the economy. (6) Although some accidents are obviously inevitable "acts of God," a large portion are surely preventable. When industry pushes the pace of production to the limit, cuts safety corners, lobbies Congress for budget cuts in OSHA (Occupational Safety and Health Administration) and urges extensive safety deregulation, then a certain percentage of these deaths are attributable to profit-driven managers and owners. Throughout this analysis, we will be conservative, counting only 10 to 25 percent of the total deaths as industry-responsible. In this case, that amounts to 17,500 work-related deaths.



Pollution is another way that industry kills. Since 70 percent of all Americans consider themselves pro-environmentalist, environmental legislation tends to pass by wide margins in Congress. But corporations know how to resist these laws. For example, the original Clean Air Act (1970) called for the Environmental Protection Agency to regulate hundreds of known air pollutants. But by 1990, after twenty years of corporate stalling, dodging and fighting in the courts, the EPA had managed to issue regulatory standards for only seven pollutants. (7) Furthermore, corporations are quite successful in lobbying exemptions into environmental laws. In 1990, the Clean Air Act was revised by Congress; environmentalists wanted a clause to reduce industrial cancer risks to one-in-a-million. "The Senate bill still has the requirement," said environmental lobbyist Richard Ayres at the time. "But there are forty pages of extensions and exceptions and qualifications and loopholes that largely render the health standard a nullity." (8) And when the Republicans took over Congress in 1994, Newt Gingrich invited corporate lobbyists themselves to write the texts of environmental legislation.



But pollution kills. The National Cancer Institute has conducted a massive, county-by-county study of cancer in the U.S., in an effort to locate the nation's "cancer hotspots". Dr. Glenn Paulson summed up the results this way: "If you know where the chemical industry is, you know where the cancer hotspots are." (9)



Another study has linked high local cancer rates to hazardous waste sites. A team of researchers identified 593 such hazardous waste sites from the Environmental Protection Agency's National Priority List for cleanup under the Superfund. They found that hazardous waste site counties had significantly higher death rates for six types of cancers for white men, and another six types of cancers for white women (including breast cancer), than non-hazardous waste site counties. (10)



The same correlation exists between breast cancer rates and the nuclear industry. In 1990, the National Cancer Institute conducted a study of cancer mortality rates near nuclear facilities. Using data from that study, Drs. Ernest Sternglass, Jay Gould and Joseph Mangano found that 18 percent of the U.S. female population lives in or adjacent to counties that have nuclear reactors. This 18 percent of the population accounts for 55 percent of all breast cancer deaths. Nationally, breast cancer declined 4 percent over the period of the NCI's study, but for these women, the breast cancer rate rose 9 percent. Prior to start up of nuclear operations in the 107 "nuclear counties" of the NCI's analysis, cancer mortality in these mainly rural counties was 1% below the rate experienced by the U.S. as a whole. After start-up, cancer mortality in these counties increased to 2% above the national rate.



According to a sophisticated study by the Natural Resources Defense Council, some 64,000 people may die prematurely every year from particulate air pollution. It reports that tens of thousands of these deaths could be averted if the Environmental Protection Agency set stringent health standards for fine-particulate pollution. (11)



Many Americans are unaware that the U.S. is the most polluting society in the First World. In some areas, like the emission of greenhouse gases, it even outdoes the environmentally ravaged former communist countries. Click here to see the full statistics.



Unsafe consumer products are another way that industry kills. Each year there are about 21,700 consumer product deaths and 28.6 million injuries, at a total cost of $200 billion. Yet corporate lobbyists effectively blocked the creation of a Consumer Protection Agency under President Carter, and have continually pushed for safety deregulation and defunding of the Consumer Product Safety Commission, which inspects 15,000 products a year. (12)



Perhaps the biggest consumer killer is cigarettes. The American Cancer Society reports that "smoking is related to about 419,000 U.S. deaths each year." (13) Some might argue that this is a personal choice, more appropriately labeled "slow suicide" than "murder." However, the tobacco industry spikes its cigarettes with added nicotine to make them more addictive. And it aggressively advertises to teenagers, using cartoon characters like "Joe Camel," or enviable adult images like the "Marlboro Man." Teenagers are targeted to replace the older customers the industry kills off. According to a 1994 Gallup poll, 75 percent of all smokers admit they are addicted, and 81 percent say they would not start smoking again if they had to do it over. This no longer sounds like a personal choice.



Furthermore, second-hand smoke also kills about 3,000 nonsmokers a year. (14) The cancer risk of smoking cigarettes has been known for decades, but it wasn't until 1992 that the Environmental Protection Agency classified Environmental Tobacco Smoke (or ETS) as a Class-A carcinogen. The Centers for Disease Control report that 88 percent of all Americans have cotinine -- a by-product of ETS -- in their blood. Their survey shows that 43 percent of U.S. children (aged 2 months through 11 years) live in a home with at least one smoker, and that 37 percent of adult non-tobacco users live in a home with a smoker or are exposed to ETS at work. (15)



One example especially clarifies how Americans are really murdered each year: unnecessary surgery. Health care experts have long known that many doctors have a financial incentive to recommend surgery; in 1975, this resulted in 3.2 million unnecessary operations. Obviously, surgery is a radical procedure, and a certain percentage of these patients die as a matter of course. Dr. Sidney Wolf estimates that about 16,000 people died unnecessarily that year, at a cost of $5 billion. (16) (Even the most conservative estimates for that year were 12,000 deaths.) Since 1975, things have only gotten worse. One notorious example is the C-section. In 1970, Caesarean births comprised 5.5 percent of all births; by 1988, they had soared to 24.7 percent. The optimal rate is 12 percent, according to a scale devised by Dr. Edward Quillan, dean of the School of Medicine at the University of California. (17)



Unnecessary prescriptions are also an excellent way for health care providers to turn a profit. Dr. George Silver, a professor at the Yale University School of Medicine, estimates that 22 percent of the nation's 6 billion doses of antibiotic medicines are unnecessary, resulting in 2,000 to 10,000 deaths a year. Silver's estimates are extremely conservative; other authorities put the deaths somewhere between 30,000 and 160,000. (18)



Poverty also kills. The American Journal of Epidemiology reports that "a vast body of evidence has shown consistently that those in the lower classes have higher mortality, morbidity, and disability rates." (19) This is because the poor suffer more polluted, stressful and unsafe work and living environments; they have less preventative health care, less post-health care, less education about safety and health issues, less nutritious meals, less creature comforts like heating or air-conditioning, less recreational opportunities, less tools to ease their standard of living, less isolation from sick and infected people, and less contact with people who could direct them to solutions. Although affluent blacks enjoy the same good health as affluent whites, there are more blacks in poverty than whites (33.1 percent compared to 12.2 percent). (20) And for this reason, the average black life span is about seven years shorter than the average white life span (a statistic that doesn't change even when factoring in the murder rate). (21)



Some might object that America's poor are significantly richer than the poor of other countries. However, researchers have discovered that it is not only absolute poverty that kills, but relative poverty as well! Drs. Bruce Kennedy, Ichiro Kawachi and Deborah Prothrow-Stith conducted a study at the Harvard School of Public Health that found that the gap between the rich and the poor matters. "We found that mortality was strongly related to inequality in the distribution of income, but not to the median income or per capita income of a state," says Kennedy. (22) States with the most income inequality had higher death rates of heart disease, cancer, homicide, tuberculosis, pneumonia and high blood pressure. The Harvard team concluded that if U.S. inequality were reduced from 30% to 25% on the Robin Hood index (about where it is in England), deaths from coronary heart disease would be reduced by 25%. (23) In 1993, the U.S. suffered 489,970 deaths from coronary heart disease; a quarter of that would represent 122,493 lives saved. (24)



A separate study by the California Department of Health Services made the same findings. They found high levels of income inequality and high death rates in Louisiana, Mississippi, Alabama, Kentucky and New York. Conversely, they found comparatively low levels of income inequality and low death rates in New Hampshire, Utah, Wisconsin, Iowa and Hawaii. By both measures, New Jersey and Connecticut were in the middle. Interestingly, the principal researcher in the California group, Dr. George A. Kaplan, says: "The evidence in these two studies suggests that the increased death rates in those states are not due simply to their having more poor people. Income inequality seems to be increasing mortality rates among nonpoor people as well, and we are investigating that possibility." (25)



That said, we can now show that the U.S. has the highest level of income inequality in the industrialized world:

Inequality of income, 1991 (100 = most inequality, 0 = least inequality) (26) United States 99 Canada 83 Netherlands 82 Switzerland 79 United Kingdom 78 Germany 66 Norway 60 Sweden 60

The U.S. also has the greatest poverty rate in the industrialized world:

Poverty level, 1991 (27) United States 17.1% Canada 12.6 United Kingdom 9.7 Switzerland 8.5 Germany 5.6 Sweden 5.3 Norway 5.2 Children under the poverty level, 1991 (28) United States 22.4% Canada 15.5 United Kingdom 9.3 Switzerland 7.8 Sweden 5.0 Germany 4.9 Norway 4.8

Not surprisingly, we also have some of the very worst death rates in the industrialized world. Let's start with infant mortality:



Column 1 - Infant Mortality: Number of deaths of infants under 1 year per 1,000 live births.

Column 2 - Feto-infant Mortality: Number of late fetal deaths plus infant deaths under 1 year per 1,000 live births plus late fetal deaths.

Column 3 - Postneonatal Mortality: Number of postneonatal deaths per 1,000 live births.

Mortality rates (per 1,000), 1990 (29) Infant Feto-infant Postneonatal Japan 4.60 8.38 1.99 Finland 5.64 8.76 1.91 Sweden 5.96 9.50 2.46 Hong Kong 6.13 10.23 2.33 Singapore 6.67 10.65 2.01 Canada 6.82 10.72 2.21 Switzerland 6.83 11.42 3.05 West Germany 6.98 10.37 3.44 Norway 7.02 11.55 3.10 Netherlands 7.06 12.74 2.42 France 7.33 13.66 3.79 East Germany 7.33 12.73 2.84 Denmark 7.39 12.03 2.84 Northern Ireland 7.47 11.45 3.48 Scotland 7.73 12.92 3.35 Austria 7.84 11.39 3.41 England and Wales 7.88 12.44 3.32 Belgium 7.94 15.58 4.05 Spain 8.07 13.30 2.95 Australia 8.17 12.06 3.31 Ireland 8.20 14.25 3.57 New Zealand 8.31 12.37 4.24 Italy 8.53 13.96 2.08 United States 9.22 13.21 3.38 Greece 9.32 16.39 2.81 Israel 9.84 13.96 3.46 Cuba 10.74 22.67 3.91

According to a study by the federal Centers for Disease Control, infant mortality rates were 60 percent higher for women living below the poverty line compared with women living above the poverty line. The study found that poverty was "as large" a factor as a pregnant mother's cigarette smoking or inadequate medical care. (30) In 1992, there were 34,628 cases of infant mortality. (31) If the U.S. were to reduce this rate from 9.22 to 7 per 100,000, then it could save the lives of 5,600 infants a year.



Another study by the CDC found that black women died from complications of pregnancy, childbirth and puerperium three and a half times more often than whites (18.1 to 5.0 per 1,000, age-adjusted). (32) If the black rate were lowered to the white rate, the lives of 17,600 women a year would be saved. (33)

Death rate of 1-to-4 year olds (per community of 200,000 per year) (34) United States 101.5 Japan 92.2 Norway 90.2 Denmark 85.1 France 84.9 United Kingdom 82.2 Canada 82.1 Netherlands 80.3 Germany 77.6 Switzerland 72.5 Sweden 64.7 Finland 53.3 Death rate of 15-to-24 year olds (per community of 200,000 per year) (35) United States 203 Switzerland 175 Canada 161 France 156 Finland 154 Norway 128 Germany 122 Denmark 120 United Kingdom 114 Sweden 109 Japan 96 Netherlands 90 Note: the murder rate for the above age group is 48.8 per 200,000. Even subtracting this entirely still puts the U.S. near the top of the list. Premature Death (years of life lost before the age of 64 per 100 people) (36) United States 5.8 years Denmark 4.9 Finland 4.8 Canada 4.5 Germany 4.5 United Kingdom 4.4 Norway 4.3 Switzerland 4.1 Netherlands 4.0 Sweden 3.8 Japan 3.3 Life Expectancy (years) (37) Men Women Japan 76.2 82.5 France 72.9 81.3 Switzerland 74.1 81.3 Netherlands 73.7 80.5 Sweden 74.2 80.4 Canada 73.4 80.3 Norway 73.1 79.7 Germany 72.6 79.2 Finland 70.7 78.8 United States 71.6 78.6 United Kingdom 72.7 78.2 Denmark 72.2 77.9

And this is to mention nothing of the 40,015 who died from AIDS in 1993. (38) True, AIDS is incurable at the moment, but that could very well be the result of opposition by Congressional conservatives against increasing AIDS research. Furthermore, the AIDS rate can be significantly reduced by education about prevention. However, conservatives have opposed funding such education as well, with the result that large portions of America remain ignorant about the basics of this modern plague.



THE GRAND TOTAL



The above list of how Americans are really murdered is far from complete, but it gives us a start in comparing the official murder rate to the real one. Once again, this is how the FBI counted murders for 1993:

FBI Murder Count, 1993 (FBI) Guns 16,200 Cutting or stabbing 2,960 Blunt objects 1,020 Personal 1,160 Strangulations, Asphyxiations 442 Fire 209 All others 1,280 --------------------------- Total 23,271

Now let's calculate the real rate. To be certain, not even the most aggressive programs can completely eliminate job accidents, pollution and infant mortality. Therefore, we can list only a percentage of the total fatalities, on the grounds that these abnormally high rates can be reduced with properly funded programs. For most cases I will use only 25 percent of the total fatality rate. Keep in mind that the total fatality rates used here are extremely conservative ones, and the list itself is very incomplete.

Partial and conservative list of actual murder counts (early 1990's): Cause Deaths Portion of total ------------------------------------------------------- Job-related deaths 17,500 (25 percent of total) Particulate air pollution 20,000 (of 64,000) Consumer products 5,425 (25 percent of total) Cigarettes 104,750 (25 percent of total) Second-hand smoke 3,000 (100 percent of total) Unnecessary surgery 16,000 (100 percent of total) Unnecessary prescriptions 2,000 (lowest estimate) Infant Mortality 5,600 (Rate reduction from 9.22 to 7 percent) Coronary Heart Disease 122,493 (25 percent of total) Black pregnancy deaths 17,600 (Rate reduction from 18.1 to 5.0 per 1,000.) AIDS 4,000 (10 percent of total) --------------------------------------------------------- Total 318,368

The real murder rate is at least 13 times the official one. It should be noted that this list does not count all the general deaths attributable to poverty, which would add hundreds of thousands more to the final count.



In closing, the middle and upper class are guilty of hypocrisy when they single out lower class crime for especial criticism. The tools that the upper class uses -- lobbyists, deregulation, safety shortcuts, heightened production quotas -- do not seem as terrifying as the tools that a stereotypical criminal uses -- guns, knives, fists, etc. But the results are just as deadly, and far more widespread.



Return to Overview



Endnotes:



1. U.S. Federal Bureau of Investigation, Population-at-Risk Rates and Selected Crime Indicators, 1993. Does not include figures for vandalism; white collar equivalent of vandalism would be pollution.



2. Steve Albrecht, "Fraud in Governmental Entities: The Perpetrators and the Types of Fraud," Government Finance Review 7 (6), 1991, pp. 27-30.

3. U.S. Federal Bureau of Investigations, Crime in the United States, 1993.

4. "Mine is Closed 26 Deaths Late," Washington Star, March 14, 1976, p. A1.

5. Center for Responsive Politics. Josh Goldstein, Soft Money, Real Dollars: Soft Money in the 1992 Elections. Larry Makinson, The Price of Admission: Campaign Spending in the 1992 Elections.

6.Reuters News, "Study: Thousands Die of Job Injuries, Diseases," July 27, 1997. The article cites Paul Leigh et al., of San Jose State University and Stanford University Medical Center, who published these results in Archives of Internal Medicine.

7. William Greider, "Whitewash: Is Congress Conning Us on Clean Air?" Rolling Stone (June 14, 1990), p. 40.

8. Ibid.

9. Quoted in Stuart Auerbach's "N.J.'s Chemical Belt Takes Its Toll: $4 Billion Industry Tied to Nation's Highest Cancer Death Rate," Washington Post, February 8, 1976, p. A1.

10. Jack Griffith, R.C. Duncan, W.B. Riggan, A.C. Pellom, "Cancer Mortality in U.S. Counties with Hazardous Waste Sites and Ground Water Pollution," Archives of Environmental Health, Vol. 44, No. 2, 69-74, Mar-Apr 1989. The cancers were of the lung, bladder, esophagus, stomach, large intestine and rectum for white males and of the lung, breast, bladder, stomach, large intestine, and rectum for white females.

11. Natural Resources Defense Council, 1995.

12. Data from Consumer Product Safety Commission, as reported by The People Helper, "Cutbacks to CPSC Threaten Us All," Times-Picayune (New Orleans), April 28, 1995.

13. American Cancer Society, Cancer Prevention Study II.

14. Ibid.

15. U.S. Centers for Disease Control, National Center for Health Statistics, Third National Health and Nutrition Examination Survey (NHANES III) from 1988-1991.

16. Testimony before the House Commerce Oversight and Investigations Subcommittee by Dr. Sidney Wolfe, of Ralph Nader's Public Interest Research Group, as reported in the Washington Post, July 16, 1975, p. A3. See also the supporting article in Newsweek, March 29, 1976, p. 67.

17. Public Citizen's Health Research Group (founded by Ralph Nader).

18. George Silver, "The Medical Insurance Disease," The Nation, 222, no. 12 (March 27, 1976), p. 369. For greater estimates, see Boyce Rensberger, "Thousands a Year Killed by Faulty Prescriptions," New York Times, January 28, 1976, pp. 1,17.

19. S. Leonard Syme and Lisa Berkman, "Social Class, Susceptibility and Sickness," American Journal of Epidemiology 104, no. 1 (July 1976), pp. 1,4.

20. U.S. Bureau of the Census, Current Population Reports, P60-188.

21. U.S. National Center for Health Statistics, Vital Statistics of the United States, annual.

22. "Income Inequality, Higher Mortality Rates Linked," New York Times, April 18, 1996.

23. Bruce P. Kennedy and others, "Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States," British Medical Journal, Vol. 312 (April 20, 1996), pgs. 1004-1007.)

24. American Heart Association, "Heart and Stroke Facts, 1996 Statistical Supplement.")

25. "Income Inequality, Higher Mortality Rates Linked," New York Times, April 18, 1996, citing study later published in George A. Kaplan and others, "Inequality in income and mortality in the United States: analysis of mortality and potential pathways," British Medical Journal, Vol. 312 (April 20, 1996), pgs. 999-1003.

26. Where We Stand, by Michael Wolff, Peter Rutten, Albert Bayers III, eds., and the World Rank Research Team (New York: Bantam Books, 1992), p. 23.

27. Ibid. Poverty figures are calculated as those making less than half the national median income. Although different nations have different medians, the medians of the richest nations are comparable, and America's higher median is hardly enough to overcome the enormity of these poverty figures.

28. Ibid. 29. SOURCES: World Health Organization: World Health Statistics Annuals. Vols. 1986-1991. Geneva. United Nations: Demographic Yearbook 1986-1991. New York. Centers for Disease Control and Prevention, National Center for Health Statistics: Vital Statistics of the United States, 1985, Vol. II, Mortality, Part A. DHHS Pub. No. (PHS) 89-1101. Public Health Service. Washington. U.S. Government Printing Office, 1990; Vital Statistics of the United States, 1990, Vol. II, Mortality, Part A. DHHS Pub. No. (PHS) 93-1101. Public Health Service. Washington. U.S. Government Printing Office, 1993.

NOTES: Rankings are from lowest to highest infant mortality rates based on the latest data available for countries or geographic areas with at least 1 million population and with "complete" counts of live births and infant deaths as indicated in the United Nations Demographic Yearbook, 1991. Some of the international variation in infant mortality rates (IMR) is due to differences among countries in distinguishing between fetal and infant deaths. The feto infant mortality rate (FIMR) is an alternative measure of pregnancy outcome that substantially reduces the effect of international differences in distinguishing between fetal and infant deaths. The United States ranks 24th on the IMR and 19th on the FIMR and 20th on the postneonatal mortality rate.

30. Survey of 21,583 mothers by Dr. John Kiley, chief of the Infant and Child Health Studies Branch of the National Center for Health Statistics, U.S. Centers for Disease Control.

31. U.S. National Center for Health Statistics, Vital Statistics of the United States, 1992.

32. U.S. Centers for Disease Control and Prevention, National Center for Health Statistics: Vital Statistics of the United States, Vol. II, Mortality, Part A, for data years 1950-91. Public Health Service. Washington. U.S. Government Printing Office; Vital Statistics of the United States, Vol. I, Natality, for data years 1950-91. Public Health Service. Washington. U.S. Government Printing Office; Data computed by the Division of Analysis from data compiled by the Division of Vital Statistics.

33. Based on 1,344,000 black pregnancies reported for 1991 by the U.S. National Center for Health Statistics, Monthly Vital Statistics Report, vol. 43, no. 12.

34. Where We Stand, p. 115.

35. Ibid., p. 116.

36. Ibid., p. 113.

37. Ibid., p. 112.

38. U.S. Centers for Disease Control, Surveillance Report, 1993.

