Population-Based Study of Child Mortality (0-4) and Income Inequality in Japan and the Developed world 1989-91 v 2012-14: Any Excess Deaths Between the Most Unequal Countries?

Introduction: Parental child `neglect’ is usually linked to parents but can apply to nations using the criteria explicit in UNICEF statement “in the last analysis Child-Mortality-Rates (CMR) indicates how well a nation meets the needs of its children”. Hence under-five (0-4) CMR rates of Japan and twenty Other Developed Countries (ODC) are compared within the context of relative poverty. Method: WHO data yields CMR rates per million (pm), analysed between 1989-91 and 2012-14 to compare Japan against ODC. World Bank Income Inequality data used as a measure of relative poverty. Excess deaths calculated by matching the most unequal Income Inequality country’s CMR with the most equal nation. Results: All countries reduced CMR substantially. The highest CMR was in USA 1383pm, followed by three English-speaking countries. Japan at 597pm was 19th of 21. USA and New Zealand were double Japan’s CMR, whilst twelve ODC had rates 25% higher than Japan. Most unequal Income Inequality USA at 15.9 times, Japan the most equal at 4.5 times. Income Inequality and CMR were strongly correlated (+0.6188 p<0.005). The countries with the lowest Income Inequality, had lowest CMR namely Finland Japan, Norway and Sweden. America not matching Japan’s CMR, meant an average excess of 16,838 US children’s deaths annually. Discussion: The strong statistical association between higher CMR and Income Inequality, suggests that one factor in Japan’s results is the lower social inequality, unlike Canada, New Zealand, the UK and USA. Does Japan’s results indicate cultural factors suggesting Japan is more child orientated than English-speaking countries

Reduced Cardiovascular Disease Deaths in 21 Western Countries 1989-91 V 2013-154: What is the UK doing Right or What is the USA doing Wrong?

Objectives: To compare UK Cardiovascular Disease Deaths (CDD) with twenty Other Western Countries (OWC). Design: Population-controlled-based study using WHO data on CDD people aged 55-74 and Age-Standardised-Death-Rates (ASDR) rates per million (pm) contrasts UK and OWC outcomes between 1989-2015 and World Bank % GDP Expenditure-on-Health (%GDPEH) data. Setting: Twenty-one Western Countries. Participants: National populations. Outcome measures: Reduced CDD for people aged 55-74 and ASDR confidence intervals determines statistical differences between UK and OWC over the period. Result: All countries substantially reduced CDD 55-74, highest current rates America at 3440pm, Finland 3197pm, Greece 3173 to lowest, France 1522pm, Australia 1634pm and Japan 1866pm. Previously UK was 4th highest but fell to 8th at 2524pm, significantly reducing CDD more than 15 OWC, though three had greater falls than Britain. ASDR fell substantially everywhere but the UK had second biggest reduction, significantly reducing total CDD deaths more than 15 OWC. Highest 1980-2015 average %GDPEH was USA at 12.7%, UK’s 7.6% was lowest suggesting British cardiac services achieved more with proportionately less. Conclusion: Improvements in primary and secondary prevention of cardiovascular disease occurred in every country, we speculate whether the UK success might be attributable to the Pan UK public health innovations, the National Service Framework (2000) to reduce myocardial infarction, and, National Framework for long term conditions (2005) but further research is required to identify the effective mechanisms. These results should be a morale boost for patients and their families and or all in the cardiac services, especially in the UK

Mortality in the USA, the UK and Other Western Countries, 1989-2015: What Is Wrong With the US?

This population-based study compares U.S. effectiveness with 20 Other Western Countries (OWC) in reducing mortality 1989-1991 and 2013-2015 and, responding to criticisms of Britain's National Health Service, directly compares U.S. with U.K. child (0-4), adult (55-74), and 24 global mortality categories. World Health Organization Age-Standardized Death Rates (ASDR) data are used to compare American and OWC mortality over the period, juxtaposed against national average percentages of Gross Domestic Product (GDP) Expenditure on Health (%GDPEH) drawn from World Bank data. America's average %GDPEH was highest at 13.53% and Britain's the lowest at 7.68%. Every OWC had significantly greater ASDR reductions than America. Current U.S. child and adult mortality rates are 46% and 19% higher than Britain's. Of 24 global diagnostic mortalities, America had 16 higher rates than Britain, notably for Circulatory Disease (24%), Endocrine Disorders (70%), External Deaths (53%), Genitourinary (44%), Infectious Disease (65%), and Perinatal Deaths (34%). Conversely, U.S. rates were lower than Britain's for Neoplasms (11%), Respiratory (12%), and Digestive Disorder Deaths (11%). However, had America matched the United Kingdom's ASDR, there would have been 488,453 fewer U.S. deaths. In view of American %GDPHE and their mortality rates, which were significantly higher than those of the OWC, these results suggests that the U.S. health care system is the least efficient in the Western world