Guest Essay by Kip Hansen – 18 October 2020
I grew up in a medical household. My father was one of the leading pediatricians of the Greater Los Angeles, California area. Every single day I was greeted with pragmatic, practical news on the advances being made in medicine, public health, and especially in the treatment and care of children and their diseases. And every day, it was plain, when my father came home, if he had lost a patient that day – he was stoic and realistic, but every baby lost, every child that died, crushed part of him. That was in 1950. There was a vaccine for smallpox but almost nothing else. Children were expected to suffer through measles, mumps, chicken pox and German Measles (Rubella). We almost all did. The worst was the dreaded risk of polio.
Most kids in the United States got through the raft of childhood diseases just fine. But the death toll of the 1950s would be considered terrifying in the world of 2020.
Dr. Perri Klass tells in a recent article in the New York Times, which promotes her upcoming new book “A Good Time to Be Born”:
“Despite the crises of 2020, parents can realistically expect that children born today will outlive them. That wasn’t always the case. “
Before 1950?
1800: Demographic research suggests that through to at least the year 1800 more than one-third of children failed to reach the age of five. Despite estimates in 1800 coming with substantial uncertainty, it’s expected that in some countries rates could have been as high as every 2nd child. Let’s think about what this meant for parents of this period. The average woman in 1800 had between 5 to 7 children.1
Parents probably lost 2 or 3 of their children in the first few years of life. Such loss was not a rare occurrence but the norm for most people across the world.
— “From commonplace to rarer tragedy – declining child mortality across the world” by Hannah Ritchie
In the North America of the 1950s, 4% of children died before their 5th birthday – that seems awful today, but in Europe it was over twice that. In many parts of the world, one-in-five or even one-in-four was common – and in Africa, one out of three died before they were five years old.
What a difference one generation makes.
Today, less than 1% (0.68%) of U.S. children fail to reach their 5th birthday – and two thirds of those failures are neonatal deaths (newborns aged 0–27 days). That means if a baby lives through her first month, she will most likely be one of the 998 out of 1000 to make it to elementary school age.
The majority of those neonatal (newborn) deaths are from two causes. Low Birthweight and Congenital Malformations. Sadly, often here is little to be done about congenital malformations; something has gone wrong in the genetic material or in fetal growth – some of these are repairable, some not. For example, there has been substantial progress in surgical correction of heart problems in neonates saving many infants that would have died in the past. Premature babies get support in life-saving Neonatal Intensive Care Units (NICUs). There has been success with prevention of low birthweight and premature birth through better and more intense prenatal care for mothers and this has been especially important for very young mothers (under 20), older mothers (40 and above), poor and socially disadvantaged mothers and those mothers with mental and/or emotional problems, such as depression, alcoholism and other substance abuse.
Postneonatally, the most common causes of death are: Congenital Malformations (like heart valve problems, internal organs that don’t function right, etc), Sudden Infant Death Syndrome (SIDS) and Unintentional Injuries (accidents). There are continuing advances dealing with postneonatal congentital malformations with surgical and other interventions. The American Academy of Pediatrics issued a policy statement making recommendations about prevention of SIDS reinforced the Back-to-Sleep Campaign and SIDS deaths have been reduced by about 40%. Aggressive action on safety issues affecting children have reduced accidental deaths – such things as safer crib designs, high chair design, car seats and age-appropriate toys.
As Dr. Klass summaries it:
“Collectively, as human beings, we changed the game. It took science, medicine and public health, it took sanitation and engineering and safety legislation, and it took many different kinds of education and parent advocacy. And it took vaccines and antibiotics, those 20th century game-changers.”
Vaccines and Antibiotics
Many readers here are of the “pre-vaccines” generation. We attended elementary schools (kindergarten through 6th grade) in the early 1950s – we are the post-World War II Baby Boomers. The oldest of us got only small pox vaccinations and then received polio vaccines as they were developed. We gained our immunity against the five common childhood disease from having them — but our children benefited from the new protective vaccines.
In 1950, the only effective antibiotics were sulfa drugs and penicillin – and both were “miracle drugs” saving untold numbers of lives. Most of today’s antibiotics, or their precursors, were developed from 1940-1962. These drugs keep our children alive when their bodies are attacked by infections against which they have not yet developed adequate defenses. Where these antibiotics are not readily and affordably available, child mortality is unacceptably high.
The role of Public Sanitation in preventing child mortality is seldom understood by the general public in modern Western societies, such as Europe, Japan, ANZO and the United States. One needs to have experienced the conditions found in the poorer areas of Third World countries to really “get it.” My local water department issued a “boil water order” last week because some water pipe had broken lowering general pressure in the mains, which “might have” allowed some tiny amount of ground water to enter the water system. Compare this to: No clean safe drinking water (unless purchased in a plastic bottle), no flushing toilets, no running water (cold or hot) for hand washing, dish washing, or bathing. Privies and animal waste washed into the local drinking water supply with every rain. Rampant childhood under- or mal-nutrition and homes with no windows or window screens thus open to mosquitoes and all the diseases they spread, worsen the situation. These factors coupled with no or few local health clinics – or a health clinic with no medicines available – lead to the still sadly high child mortality in less developed areas, despite improvements over the last 70 years.
Those interested in humanitarian efforts to “save the children” should concentrate their giving to organizations that work specifically on these issues: safe drinking water, local health clinics and childhood vaccination, public sanitation and anti-mosquito-borne disease programs.
But for the vast majority of those reading here, those living in North America, Europe, Japan and Australia/New Zealand and the more developed parts of other nations:
“Because, believe it or not, even in 2020, parents in the United States and in many other countries, and not just the very richest, are among the luckiest parents in history. We can, for the most part, hope and even expect to see our children live to grow up, and we live in a society shaped and colored by that expectation. And for all of the anxieties and terrors of this present moment, as parents, we are actually on the lucky side of a divide that separates us from the parents who came before.” — Dr. Perri Klass
It is, indeed, a Good Time to Be Born
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Author’s Comment:
I welcome each and every newborn child I meet with the salutation: “Welcome Aboard!” with the knowledge that the ship-of-life they’ve boarded is far safer and kinder and fairer than the one I climbed aboard so many years ago. It’s not a perfect world, but with faith and hard work, almost all of them will make a go of it and have a good life.
The madness of the moment will eventually pass, probably soon after the upcoming U.S. Presidential election, and things will return to their pre-pandemic boom conditions.
My father, the pediatrician, told every new mother with a new baby in her arms, “That’s a fine baby!” I do the same, in his honor, because it is true – every baby is a “fine baby”.
Yes, there are other worthy projects that help children: Poverty Vitamins, Deworming Medications and Vitamin A programs, supporting basic educational programs with school kits and program materials and childhood vision programs. I have been involved in all of these and witnessed a great deal of success.
If your comment is meant for me, please start it with “Kip – “ so I don’t miss it. Thanks.
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How dare you not steal my childhood!
MatthewSykes ==> We abase ourselves in apology for failing to steal your childhood.
Kip, as always, great article. But I’m inclined to think that the great era has passed and we have entered an age of nonsense.
We can see it happening and if we don’t fix it we’ll be going astray for a while.
To Mr. MatthewSykes above, LOL, priceless.
Tim Spence ==> The madness of the moment — we hope. The “moment” may last longer than we’d like, but the ideas put forward by the Madness Movements are eventually self-extinguishing.
I remember in the 50s when one child in the neighborhood got mumps, measles or chicken pox, all the kids were herded to their house so we all got sick at once, and were done with it.
Steve Keohane ==> Yes, today’s mothers do not believe this when they hear it — the idea of intentionally letting their kids get sick. But it was a common practice: Mumps Parties or Measles Parties. All the kids on the block would be sick at the same time, and then all well and back in school together!
This article is an excellent reminder of how lucky we are now, how progress is in the right direction, and how the gains we have made in health are for the most part due to wealth, nutrition, infrastructure (sanitary sewer, water and food systems), public health measures (vaccinations, food and water quality management) and only a very small amount due to modern health care within hospital facilities and clinics. I work in the latter but I despair that the largest part of our health care resources are devoted to repairing health injuries at high cost which could be prevented with much more attention and investment in the traditional public health processes noted above.
Nutrition, physical activity, trauma (mostly related to transportation accidents) and substance use explain much of what we spend trillions of dollars on in health care such that many people can’t afford the care. The nutrition problem now is one of too many rather than too few calories, and the wrong mix of sources (largely due to bad advice from the healthcare system), leading to a tsunami of obesity, diabetes and multi-organ dysfunction. The physical activity deficit began following WW2 with wealth, automation and spreading suburban living. Because of modern automated transportation, one of the largest explanations of years of disability-free life lost is traffic accidents.
The substance use issues of tobacco, alcohol and other drugs should be self-evident, and so too should be the strong link to social determinants such as poverty, marginalization, early life traumas, education deficits etc.
All of that said, if we think we can do better, and I believe we can, it should be obvious that just building more hospitals, buying newer and more expensive drugs and training more people like me is not the solution. These are social and public health problems not medical/surgical problems.
Andy Pattullo ==> Public Health is not easy. Read my essays on the Salt Wars or the Obesity Epidemic.
A huge part of the problem is Nutritional Epidemiology — which repeatedly gives wacky wrong advice which gets written into Public Health Policies.
In 1944, I was treated, as a newborn, with sulfa for a dangerous kidney infection, and then, in 1954, with penicillin for mastoiditis (also a dangerous infection if not stopped). I also had the Asian flu in 1957, which kept me out of school for two weeks, but at least school was there when I was ready to return. Like other commenters, I am willing to take my chances at almost 76 if it means children can go back to school and if it means life, for the most part, can return to normal. I will be cautious, but I would rather take responsibility for my health than have the government assume that role when it comes to day-to-day decisions on exposure.
Pam M ==> Right there with you on all that, Pam.
Clean water and sanitation are wonders and investments like electric grids. Let’s not lose those gains or call them something else.
Indeed, thankyou Kip.
I expect mortality rate of birthing mothers was also high. Todays surgical techniques and disinfection (which practice in serious form is only 150 years old) improved life.
Though perhaps warping the gene pool.
Keith Sketchley ==> All human lives have nearly infinite value. Even those of the less genetically blessed. In our modern world, we need intelligent, good hearted, morally strong people. I’m not too worried about the “gene pool” — I’ll leave that for the pedigree dog breeders and cattle ranchers.
When you see someone making $10 000 a day being a social media influencer, you know capitalism works. That might be offensive to those who really work but it’s the result of excess resiurces for the many.
Kip,
In 1981 our middle child of three was born with Pulmonary Atresia. Thanks to fast action by the medical staff and a life-flight to Children’s Hospital in Seattle, he survived three surgeries and is doing well today. The surgical sequence had just been developed at that time – we were told that the oldest survivor was only age 6.
Farmer Ch E retired ==> Glad to hear it and a good example of the advances in pediatric medicine.