In Pittsburgh, where the unemployment rate is well below the national average, the infant mortality rate for black residents of Allegheny County was 20.7 in 2009, a slight decrease from 21 in 2000 but still worse than the rates in China or Mexico. In the same period the rate among whites in the county decreased to 4 from 5.6 — well below the national average, according to state statistics. Figures for the past two years, which are not yet available, have most likely increased the gap significantly, county health officials said.

While Pittsburgh’s struggles are illustrative of problems in other cities, it also faces its own particular issues, including the county’s privatization of many of its health care services over the years.

With the county taking a reduced role, Healthy Start, a federally financed national nonprofit group, is now responsible for Pittsburgh’s most vulnerable pregnant women. None of its $2.35 million budget, much of which is used for 6,000 annual home visits, comes from the county. The group’s budget has not increased since 1997.

Even with its high-risk clients, Healthy Start has had success: in 2007 there were no child deaths among its participants countywide. The numbers though, have begun to creep up, and in 2010 the mortality rate among participants was 13.9.

“As a city you want to be known for your football and baseball teams, but you don’t want to be known as a place where babies die,” said Cheryl Squire Flint, who leads the group’s Pittsburgh branch.