WASHINGTON — Underscoring historic recent gains in global health, the number of children younger than 5 who die this year will fall to 7.7 million, down from 11.9 million two decades ago, according to new estimates by population health experts.
But while a good part of the world makes strides in reducing child mortality, the United States increasingly lags and now ranks 42nd globally, behind much of Europe as well as the United Arab Emirates, Cuba and Chile.
Twenty years ago, the United States ranked 29th in the child mortality rate, according to data analyzed by the Institute for Health Metrics and Evaluation at the University of Washington.
The estimates, derived from modeling based on international birth records and other sources, are being published Monday in the British medical journal the Lancet.
In the United States, “there are an awful lot of people who think we have the best medical system in the world,” said Dr. Christopher Murray, who directs the institute and is an author of the report. The data, he said, are “so contrary to that.”
Singapore, the country with the lowest child mortality rate in the world, at 2.5 deaths per 1,000 children, cut its rate by two-thirds between 1990 and 2010. Serbia and Malaysia, which were ranked behind the United States in 1990, cut their rates by nearly 70 percent and now are ranked higher.
The United States, which is projected to have 6.7 deaths per 1,000 children this year, saw a 42 percent decline in child mortality — a pace that is on par with Kazakhstan, Sierra Leone and Angola.
Meanwhile, even many countries that already had low child mortality rates, such as Sweden and France, were able to cut their rates more rapidly than the United States over the past two decades.
“It’s really just hard to fathom,” said Laura Beavers, national Kids Count coordinator for the Annie E. Casey Foundation, one of the nation’s leading advocates for children’s health.
The U.S. mortality rates defy traditional explanations, such as a nation’s diversity, high number of immigrants and persistent pockets of poverty, Murray said.
Australia — another diverse country with a large immigrant population — cut its child mortality rate over the past two decades more than the United States, for example. Australia now ranks 26th in the world.
Murray said high child mortality rates are not limited to black and Latino populations in the United States. In fact, researchers have found high rates among higher-income whites, a group that traditionally has better access to medical care.
The data instead suggest broader problems with the nation’s fragmented, poorly planned health care system, Murray and other experts said.
Although the United States spends nearly twice as much per capita on health care as most other industrialized countries, researchers are finding substantially higher levels of preventable deaths from diseases such as diabetes and pneumonia.
Another recent study by the Institute for Health Metrics and Evaluation found that the rate of deaths among women giving birth has actually increased in the United States over the past two decades.
“We certainly have outstanding medical science and centers of excellence that rival the best in the world,” said Cathy Schoen, an expert on global health systems at the nonpartisan Commonwealth Fund. “But many other countries have been putting many more resources into thinking about how they can improve. … They have been far more strategic.”
That is one of the main reasons the recently enacted health care law is so important, many health care experts say. The bill not only expands insurance coverage but gives providers incentives to improve quality and better coordinate care and makes it easier for Americans to get preventive medical care, they say.
There is more encouraging data about progress elsewhere in the world.
Although child mortality remains extremely high in several regions — including sub-Saharan Africa, where in some countries one in seven children dies before the age of 5 — mortality rates are falling at an accelerating rate, according to the institute’s research.
That in part reflects efforts to expand vaccinations for diseases such as measles and to give anti-retroviral drugs to pregnant women infected with HIV, said Dr. Mickey Chopra, chief of health and associate director of programs at UNICEF.
Chopra and others said initiatives to distribute mosquito netting to reduce malaria infections, provide Vitamin A supplements to children, and encourage more breast-feeding are also probably having an effect.
Global public health advocates hope to be able to make more progress as new efforts get under way to distribute antibiotics to combat pneumonia and dysentery in the developing world.
“I am even more excited about the next five years,” Chopra said, adding that such progress was almost inconceivable a few years ago.
Researchers found the fastest rates of decline over the past two decades in many countries in Latin America and North Africa.
Other countries with slow rates of decline include Great Britain, New Zealand and South Korea, which have all fallen in the international rankings since 1990. All three are still ahead of the United States.