Universal Health Rankings

It's interesting how headlines and comparisons of national outcomes can mislead, if, as it happens, all things are not equal. A report from Save the Children assessing infant mortality data from 176 countries worldwide, placing Canada with the second-highest rate of first-day infant mortality in the industrialized world. It's rather mind-boggling to think of an advanced country like Canada with a high likelihood of babies dying on the very day of their birth.

But there it is; Canada is right behind the United States, which posted a greater number of babies dying within 24 hours of birth, at 2.6 per 1,000 births. For Canada that damning number is 2.4 deaths of babies within the first 24 hours of life. Switzerland represented third in the top three on the roster, with 2.2 first-day deaths per 1,000 births.

This is perception and proportion.  Cyprus, Estonia, Iceland, Luxembourg, Singapore and Sweden all have an enviable first-day of birth death rate of 0.5 per 1,000 births.

And then there are some ameliorating answers to the statistics. Scientific advancements in health and reproduction. Gynaecologists and obstetricians have access, in North America to an entire range of advanced new technology aimed at bringing babies into the world before full term has been reached. Statistics embrace all live births, including premature ones, induced or not, and this has an end-impact on figures for developed nations.

"Some of the technologies in advanced maternity care, particularly when you're speaking of multiples (births), you might actually have 230 or 22-weekers born alive, but their mortality rate is very high", explained Dr. Janet Smylie, at the department of family and community medicine, Toronto's St. Michael's Hospital. Advances in fertility treatments result in greater numbers of high-risk multiple births, as well.

And then there is the reality of Canada's huge geography, of isolated areas where many aboriginal peoples live on First Nations reserves. "At the root of it is a distribution problem", advises Dr. Smylie. "Some First Nations register mortality rates of up to four times the national average. We're an affluent country, but at a systems level we're still not distributing all of our health and social resources equally to all groups."

An aspiration that has wide need and wide support, but remains nonetheless difficult to achieve for a multitude of reasons, not least of which is the isolation and the difficulty in serving the needs of populations living in what may be in many instances geographic wildernesses.