In a front-page story April 22, The New York Times reported that infant mortality rates (IMR) in Mississippi and other Southern states are rising. The IMR measures the number of first-year infant deaths per thousand births. It reflects social indicators such as access to care, food availability, family income and education levels.
The Times attributed the rising mortality to decreased Medicaid assistance, health insurance, provider availability and public clinics. Mississippi’s Gov. Haley Barbour, a Republican, has trumpeted tax cuts (for the rich) that have inevitably reduced public services.
Earlier, the proliferation of maternal and child health programs under Lyndon Johnson’s “War on Poverty” had been crucial to a reduction of Mississippi’s IMR for Black infants from 57.8 in 1963 to 29.8 in 1975.
Alluding to obesity among Black women, motivation problems and difficulties in keeping appointments, the Times casts undue blame on victims.
As a pediatrician, I have followed IMR figures in the United States and in Cuba. Cuban babies survive, despite a U.S. economic blockade that cruelly and illegally targets medical supplies and, until 2000, food. Cuba’s IMR continued its decline even after the fall of the Soviet bloc, when Havana lost 85 percent of its overseas trade and 50 percent of its oil imports.
I left New Hampshire in 1975 to teach pediatrics in Mississippi. Touring New Hampshire that year as a presidential candidate, former Oklahoma Sen. Fred Harris heard about these plans and told me, “They need you down there in Mississippi.”
What Mississippi really needed was Peter Boolens. He’d gone to medical school to become a medical missionary, and in 1972 founded a health center in Cary, Miss., in Sharkey County, one of the state’s poorest. When I knew Peter, he was doctoring all comers and helping set up cooperatives.
The Times noted one exception to the bad news from Mississippi. Death rates for mostly Black infants in Sharkey County were low. The Cary Christian Center, where Boolens was a physician for 25 years, got credit for those results. He and I joined other physicians during the 1960s and 1970s in wanting to actually practice public health.
In 2004, Mississippi’s IMR was 9.7-14.7 for Black babies and 6.1 for white infants. In 2005, the state IMR rose to 11.4-17 for Black babies, 6.6 for whites. Since 1991, the IMR for babies in Sharkey County has been 5.0, and most of their mothers attended Dr. Boolens’ health center.
In Cuba, the IMR fell from 41.7 in 1963 to 13.6 in 1986, to 5.3 in 2006. Varying estimates place the U.S. IMR for 2004, the last year for which numbers are available, at more or less 6.8. The death rate for Black infants was 14.0.
What might Cary and Cuba have in common to account for low IMRs? The Cubans attribute advances in education, health care, international solidarity and energy to their “battle of ideas.” According to the Cuban side, there is a better way of living than putting profits first.
Boolens, too, had ideas about the common good, as did many physicians heading for Mississippi at that time, buoyed along by the civil rights movement and initiatives like the War on Poverty.
His ideas were about putting ethics into practice. He wanted Sharkey County families to have health care and jobs. Health workers in Cary, relying upon public health methods that are standard worldwide, encouraged people to participate in their own health care. Boolens’ colleagues trained mothers to visit other mothers, especially during pregnancies. They taught about prevention, provided emotional support, helped out with appointments and talked about food.
Expectant mothers received prenatal care, became aware of early signs of trouble and what to do, and learned about babies. They grew in confidence and awareness.
In parallel fashion, Cuba’s battle of ideas puts the ethics of the Cuban Revolution into practice, some of them articulated by Jose Marti. “Humanity is the homeland,” he said, also “from all for the good of all.” Aspirations like these opened doors to creativity and innovation.
Cuba recently introduced radical changes in education. Ideas are flourishing on energy issues. In health care, the education of physicians from throughout the world and taking medical care to 68 countries, including disaster situations, are built upon sophisticated specialty services, an exemplary primary care system, and biomedical research and manufacturing capabilities.
Stories from Mississippi and Cuba suggest that working for the common good may not, after all, be all that complicated. Creativity and thinking are used to serve higher values. Alternatively, when profiteering, weapons systems and inculcation of fears are pushed as the agenda, likely as not the category of disposable people is resurrected.