country’s great wealth, some children are not surviving past childhood. Even with recent improvements in child mortality, approximately 7 out of 1,000 children die before the age of 1 (Federal Interagency Forum on Child and Family Statistics, 2003), and 44 percent of deaths of children between the ages of 1 and 19 are caused by unintentional injuries (Anderson and Smith, 2003).

Children, particularly poor and minority children, are not faring as well as the public might think. The current and future prospects of these children, and the prospects of the nation as a whole, are reduced as a result. The nation needs to consider the significance of statistics such as these and adopt prudent policies to improve children’s health if it is to successfully maximize the potential of all its children and ensure the future health of the nation.

Even more distressing than the absolute numbers are the sustained and marked disparities between white children and racial and ethnic minority children, and between children in poorer families and wealthier families. For example, blacks have higher infant mortality (Centers for Disease Control and Prevention, 2002d) and adolescent mortality rates, with the death rate for adolescent males increasing from 1985 to 2000 (125 to 130), while the rate for white adolescents males decreased (105 to 86) (Federal Interagency Forum on Child and Family Statistics, 2003). Teenage pregnancy rates have fallen but blacks still have higher rates than other population groups (Ventura et al., 2003). Hispanic children are more likely than both black children and white children to lack health insurance (Institute of Medicine and National Research Council, 1998) and twice as likely to drop out of school (Martinez and Day, 1999). These and other substantial disadvantages for some groups of children during childhood have major effects both on child health and on adult health outcomes and subsequent health care costs and productivity. These discrepancies are particularly disturbing given projected population changes over the next several decades. While the proportion of children is projected to stay relatively constant (24 percent), the non-Hispanic white child population is projected to decrease from 64 to 55 percent by 2020, while the percentage of Hispanic children is projected to increase from 16 to 22 percent (U.S. Department of Health and Human Services, 2001b).

The health of the U.S. population generally, and children’s health in particular, lags behind that of many Western industrialized countries (Shi and Starfield, 2000). For example, while the infant mortality rate has decreased by more than 50 percent in the past two decades, the United States still has an infant mortality rate that is higher than all but 5 other Organisation for Economic Co-operation and Development (OECD) nations (Hungary, Mexico, Poland, the Slavic Republic, and Turkey) (Organisation for Economic Co-operation and Development, 2002). While this might be partly attributable to the more inclusive definition of live birth used in the United States, data suggest that this is not the only factor. An indepth comparison involving 13 industrialized nations in the mid-1990s showed that the United States ranked worst (13th) in rates of low birthweight. Similar poor rankings for postneonatal mortality (11th) indicate that the poor infant



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