American babies are 76 per cent more likely to die before they turn a year old than babies in other rich countries, and American children who survive infancy are 57 per cent more likely to die before adulthood, according to a sobering new study published in the journal Health Affairs.

Comparing the United States to 19 other wealthy democracies in the OECD, the study found that if the U.S. had simply kept pace with average childhood mortality rates in those countries, 600,000 young lives could have been saved since 1961. That amounts to roughly 20,000 dead children and teens each year.

In the 1960s the U.S. had significantly lower child mortality rates than the other rich countries included in the study. But starting in the 1970s, that changed.

Among infants, that shift was driven primarily by changes in the premature birth rate (babies born before full gestational age), which is the highest in the developed world. The U.S. rate of “extreme” prematurity — babies born before 25 weeks — is three times higher than the OECD average.

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Among older children, the United Stands stands out in its rate of deaths by injury. In particular, American teens aged 15 to 19 are 82 times more likely than teens in other rich countries to die of a gun homicide. Among black American adolescents, gun homicides are the leading cause of death in the United States.

The root cause of all these problems is well understood: “persistently high poverty rates, poor educational outcomes and a relatively weak social safety net have made the U.S. the most dangerous of wealthy nations for a child to be born into,” the study, led by Ashish Thakrar, an internal medicine resident at the Johns Hopkins Hospital, concludes.

Starting in the 1980s the U.S. childhood poverty rate exploded relative to other wealthy nations. Roughly 21 per cent of American children now live in poverty, one of the highest rates in the developed world.

American children are also falling behind on education relative to their peers. “Both poverty and education have repeatedly been shown to track along a gradient of health in children, with lower incomes and lower education correlated with worse health outcomes,” according to the report.

These two factors are compounded by a weak American social safety net. “During the period we analyzed, the U.S. spent significantly less of its gross domestic product per capita on child health and welfare programs, compared to other wealthy nations,” the authors write.

Those 600,000 deaths, in other words, are in large part the result of deliberate policy choices made by American voters and their elected representatives.

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A 2010 study found that governing decisions about welfare policies explained up to 47 per cent of the observed differences in life expectancy between countries. An earlier study found that about 20 per cent of country-level differences in infant mortality rates could be explained by a nation’s governing style.

“The care of children is a basic moral responsibility of our society,” the report’s authors write. “All U.S. policymakers, pediatric health professionals, child health advocates and families should be troubled by these findings.”