Heaton et al. 2007 + Chen et al. 2016

Heaton et al. 2007

Historical Context

• Conquest by Spaniards
    * Massive and expanding political and social disruption
    * Serious diseases
    * Massacres and enslavement
• Culture of resistance: conscious efforts to preserve their own traditions, language, and culture
• Colonial period: cultural hybridization and domination
• Independence movements of the 1820s
    * Resistance to integration and assimilation
    * Living conditions and political power of the indigenous people remained low
• Indigenous people: seen as barbarian and inferior, leading to isolation and poverty
• Indigenous culture: seen as primitive, simple, backward technology, and belief in the magical
• Indigenous people are seen as incapable of self-governing, an instrument to be used, and their territory is for exploration
• Decline in infant mortality in Mexico
• Mortality rates are much higher among indigenous people
    * Infectious diseases
    * Causes: high fertility, young age at initiation of sexual activity, short birth intervals, low maternal education, unsanitary household conditions, and lack of access to health care

Results

• Indigenous speakers score much lower on the socioeconomic index, have less sanitary toilet facilities, and have less education
• Indigenous speakers are more likely to have medical service
• Indigenous groups are more likely to participate in governmental programs designed to improve living conditions of the disadvantaged

Child Mortality Rates

• Rate of child mortality is higher among indigenous groups compared to Mexicans
    * Socioeconomic status
    * Household conditions
    * Important factors:
      * Standard of living
      * Maternal education
      * Number of children

Chen et al. 2016

• US infant mortality rate disadvantage compared to European countries

Results: United States versus Europe

Reporting Differences

• Possible reporting differences for infants born near the threshold of viability
• Many countries have reporting requirements related to birth weight and may not report infants under 500 g as live births
• The presence of assisted reproductive technologies has increased the frequency of multiple births, which have higher mortality rates

Conditions at Birth

• Birth weight in the US is worse than in Finland but close to other countries considered
• Birth weight matters for the US infant mortality disadvantage but previous research may have overstated the importance of this explanation

Timing of the US IMR Disadvantage: Neonatal and Postneonatal Mortality

• The US IMR disadvantage arises in the postneonatal period
• Postneonatal period: from 1 month to 1 year
• Cause: delay of deaths in the US

Causes of Death

• No clear difference in the causes of death

Results: Within-US Evidence

• Tremendous variation in infant mortality rates across the United States

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• United States: has a mortality advantage during the neonatal period
• Policy attention: should focus on either preventing preterm births or on reducing postneonatal mortality
• Policies should be able to focus on individuals of lower socioeconomic status
• Home nurse visits: help to reduce mortality

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