The United States VS. Singapore: Infant Mortality
The United States cowers behind its status as the most dangerous place to be born out of all of the world’s wealthiest nations. Its appalling infant mortality rate of 0.57% is 356% greater than that of Iceland, the safest nation in which to be born, whose infant mortality rate is a mere 0.16% (OurWorldInData, 2017). In fact, four of the world’s top 10 nations with the lowest infant mortality rate are Scandinavian, where the Nordic Model has proven for decades its superiority over much of the world’s healthcare and economic systems. Japan ranks third, after Slovenia, and Norway and Finland tie for fourth place. However admirable the low infant mortality rates for such countries may be, it is premature to compare their approaches to tackling the issue with the United States.
According to Max Fisher of The Washington Post, the populations of the top 8 nations of the world with the lowest infant mortality rate tend towards being ethnically homogeneous, whereas the United States tends towards being more ethnically diverse (Fisher, 2013). Where the United States’ infant mortality rate has proven to be an issue of racial biases held by medical institutions, it is imperative that the US be juxtaposed against a nation whose ethnic diversity index is comparable. Singapore, whose infant mortality rate of 0.22% ranks at fifth lowest in the world, has comparable ethnic fractionalization to the United States: ~40% (World Population Review, 2021). Even in comparison to the rest of the world’s high-income nations, the United States’ rate plateaus, without improvement, while the rest consistently decline OurWorldInData, 2017).
Even with similar ethnic diversity, though, how is Singapore’s infant mortality rate still almost 260% less than that of the United States?
We are reminded that America’s most oppressed races find themselves with the highest by-race infant mortality rates:
Black Americans have a rate over double that of white Americans, and indigenous peoples similarly have almost double the rate of white Americans (National Center for Health Statistics, 2021). Similarly, Singapore’s indigenous Malay population proves to have a significantly higher infant mortality rate than the Indian or Chinese populations of the country:
Noticeably, though, all of the United States’ data by race still ranks greater than any of Singapore’s data. One can therefore find the difference, and the degree of greater success in reducing the infant mortality rate in Singapore, by exploring the nation’s approach to racism and healthcare.
The United States’ history and continued reality of institutionalized racism, especially in medicine, is no secret. For generations, African American and indigenous communities have been subjected to extraordinarily unethical medical testing and mortality in the hospital due to implicit racial biases held by much of America’s institutions. Where there is a multitude of races in a nation, unfortunately it is almost intuitive that there will be racial tensions to some degree, but Singapore has sought to rid itself of racial tensions on a constitutional level.
According to Walter Sim of The Straits Times, in 2015 Singapore celebrated “50 years of prosperity and relative [racial] peace”, and the government had designated July 21 as “Racial Harmony Day, when young Singaporeans go to school decked in racial garb and are taught the virtues of respecting diversity”. After the nation’s last major racial conflict when the nation was founded in 1965, the then Prime Minister, Lee Kuan Yew “promised to build a multiracial nation [in which] everyone will have his place, equal: language, culture, religion” (Sim, 2015). This is certainly not to say that Singapore is free from racial crimes, tensions, and privileges. Sim reminds readers that many Singaporeans associate themselves primarily with members of their own race, and that there are still a slew of racially-drive riots and crimes annually in the nation. Though members of each population in Singapore may harbour beliefs of racial superiority or inferiority between communities, it appears that Singapore is not inherently institutionally racist — at least, in comparison to the United States. Rather, the government seems to prioritize ameliorating racial tensions until they no longer exist, while the United States still struggles to acknowledge institutional racism exists at all.
According to H. B. Wong of the Singapore Paediatric Society, “the mortality rates are higher among the Malays and Indians than the Chinese, likely due to the reluctance of a Malay mother to use modern medicine [and instead prefer a home delivery].” Wong notes that 9.6% of Malay births, 2.3% of Indian births, and only 0.3% of Chinese births are home deliveries (Wong). It seems that most of the motivation to avoid a hospitalized birth stems from cultural birthing traditions in both the Malay and Indian communities that do not coincide with practices used in a hospital, rather than necessarily an institutionalized fear of medical institutions as is present in America for black and indigenous populations (National Heritage Board, 2021). The United States too finds a large portion of black populations tending towards home births again with licensed black midwifes, but largely due to the absolutely rational fear of being ignored and wrongfully treated by American hospitals when requesting help (Jones, 2020).
Aaron E. Carroll of The New York Times argues that the United States’ Health System has much to learn from that of Singapore. Carroll importantly notes that since the nation’s health system is funded by taxation and is largely universal, “the bottom 20% of Singaporeans in income pay less than 10% of all taxes but receive more than 25% of all benefits. The riches 20% pay more than 50% of taxes and receive 12% of benefits” (Carroll, 2019). Though it is universal, Singapore “stresses personal responsibility and cautions against reliance on either welfare or medical insurance,” and Carroll quotes Dr. Jeremy Lin who reminds readers that “Singaporeans recognize that resources are finite and not every medicine or device can be funded out of the public purse.” Essentially, Singapore provides universal basic healthcare to anyone but anything more than that must be individually funded. Singaporeans also primarily lean towards public hospitals, where quality of healthcare is not sacrificed in comparison to private hospitals. All of Singapore’s work in the healthcare sector yields its hospital infant mortality rate to be just shy of 0.18%.
While the United States and Singapore find themselves comparable by ethnic fractionalization, their approaches to tackling racism and achieving adequate healthcare for all citizens, including ethnic minorities, could not be more different. By using Singapore as a model for the amelioration of the health conditions of historically oppressed ethnic minorities, the United States could improve its abysmal infant mortality rates, but America does not seem to prioritize addressing the race relations or healthcare flaws that are causing the problem. I struggle to see an America in the near future that has infant mortality rates close to those of Singapore or any of the 36 other wealthy nations that precede the States, unless racial medical biases are addressed and debunked and the healthcare system no longer leaves millions of citizens in debt and uncared for.
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