Wednesday, October 21, 2009

A Lean Six Sigma look at the Infant Mortality Rate in the U.S.

In my last post, I analyzed the performance of the U.S. health care system based on a statistical review of the information contained in the World Health Organization’s database. Since that article was published, I have been asked numerous questions regarding health care within each state. In response to those questions, I recently completed a deeper statistical review of the Infant Mortality Rate (IMR) in the U.S.. The facts and conclusions are detailed below.

The U.S. has the highest per capita spend on health care in the world and had an IMR of 6.86 per 1000 live births for period 2002 -2004. In 2006, based on World Health Organization data, the U.S. was tied for 39th for the lowest IMR with countries such as Lithuania, Serbia, Slovakia, and Thailand.

Even more shocking, the 2006 mean IMR for the 30 countries with the highest per capita health care spend, was 3.9 per 1,000 live births. Simply put, if the U.S. simply were to achieve the mean IMR for the 30 total spending countries, there would have been over 12,000 more live births!


Live Births 2004


Mean IMR of 40 highest spending countries


Additional Live Births

United States






Next came the question, does every state in the U.S. have approximately the same IMR? Or do some states actually have higher levels? If so, how high?

To answer these questions, I obtained the report detailing the IMR by state and the District of Columbia and conducted another analysis. The data is from 2002 – 2004.

Armed with the IMR rates on all 50 states plus the District of Columbia, I constructed a histogram to graphically summarize and display all the data. From the graph below, we can see that:

  • The largest number of states has an IMR of between 6.00 and 6.99 per 1000 live births.
  • Four states produced exceptionally good IMR statistics of between 4.00 and 4.99.
  • The poorest performing areas posted IMRs above 9.00 per 1000 live births.

Additionally, the median IMR rate of the 50 states plus the District of Columbia was 6.94. As previous stated the U.S., as a whole, recorded an IMR of 6.86 for this period.

More specifically, the four states with the highest IMR are as follows:

1. District of Columbia 11.42

2. Mississippi 10.32

3. Louisiana 9.95

4. Tennessee 9.05

This data was shocking. Imagine my surprise to learn that an infant born in Bulgaria, Malaysia, or Russia actually has a higher probability of survival than does an infant born in Washington DC!

The four states with the lowest IMR are as follows:

1. Vermont 4.68

2. Massachusetts 4.80

3. Minnesota 4.85

4. New Hampshire 4.93

For a complete look at all 50 states plus the District of Columbia, please refer to the following control chart.

So now that we know which of the 50 states and the District of Columbia have the highest and lowest IMRs, the question yet to be answered is why? To explore that question, I obtained data from the U.S. Census Bureau on income.

After reviewing that data and comparing it to the IMR information, I was able to determine that a high correlation exists between IMR and the percent of the population living at or below 125% of the poverty level. In fact, these two variables have a correlation coefficient of 0.645.

Simply put, all this means is as the percent of individuals living at or below 125% of poverty increases, so does the IMR. This data may be viewed on the following scatter plot.

So why are our government officials not outraged over the IMR in this country? Most likely because it doesn’t happen in their neighborhoods, but that fact may be changing. Based on U.S. Census Bureau data, the 46 million uninsured have an income distribution as follows:·

  • 14,561,000 (24.4%) of those making less than $25,000 annually are uninsured
  • 14,977,000 (20.6%) of those making between $25,000 and $49,999 annually are uninsured
  • 8,300,000 (14.1%) of the making between $50,000 and $74,999 annually are uninsured
  • 8,740.000 (8.5%) of those making $75,000 and more are uninsured.

The following histogram details the number of uninsured by income level based on the U.S. Census Bureau’s report “Income, Poverty, and Health Insurance Coverage in the United States: 2005”.

Clearly some number of individuals opt out of health insurance. But, when considering the income distribution, I believe the high cost of insurance excludes some number of those who are self-employed or covered by employer plans.

Furthermore, the U.S. has long been a champion of human rights. In fact, in 1966, the U.S. signed the United Nations’ International Covenant on Economic, Social and Cultural Rights. This document contains the following provision:

Article 12

1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:

(a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child;

(b) The improvement of all aspects of environmental and industrial hygiene;

(c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases;

(d) The creation of conditions, which would assure to all medical service and medical attention in the event of sickness.

Since that time, our health care system has evolved into the most expensive in the world, costing a staggering 15.3% of the GDP. Yet, this country is tied for 39th in the world on IMR and results in an estimated loss of 12,000 lives annually.

We can do better. As an expert in lean six sigma enterprise and a father of two children who died shortly after birth, I assure you, we can achieve so much more in saving the lives of our future. Unless immediate, corrective action is taken, health care and the right to life will become a privilege reserved only for the wealthy.

Learn more about the author by checking my LinkedIn profile at


Martin, J. A., Kung, H. C., Mathews, T. J., Hoyert, D. L., Strobino, D. M., Guyer, B., & Sutton, S. R., (2008). Annual summary of vital statistics: 2006. Pediatrics, 121(4), Retrieved from doi:10.1542/peds.2007-3753

Post Author: Royce Williard

Copyright 2009, The Williard Group


  1. Wow, I really should not be shocked but I am. The numbers are undeniable.

  2. I guess I'm not surprised at the data and what it means. But I continue to be horrified by the lack of attention this issue receives. I think you should start screaming from the rooftops or run for office which is less dangerous and a better way to reach the press.

  3. Thanks everyone for your comments. I agree the numbers are shocking. More importantly, what they say about the current system is concerning.