Infant mortality and the uncritical celebration of progress

(Hello! I'm back. I'm working on working on another project and figured I'd start the process of stretching my fingers. It's nice to see you again. Tenderly and piously yours forever, T-Bone)

                March 27, 2023

            Infant mortality and the uncritical celebration of progress

(Hello! I'm back. I'm working on working on another project and figured I'd start the process of stretching my fingers. It's nice to see you again. Tenderly and piously yours forever, T-Bone)

Every now and again someone tactically annoying will come along and argue that life in 2023 is so much better than life in, say, 1923, and that dissenters (typically 'the left'), who passionately complain about the country's various shortcomings, ignore the progress that has been made. This uncritical celebration has always bothered me, and not because I'm a spoilsport.

It's true that, say, infant mortality rates have plummeted—from ~70 per 1k births in 1935 to around ~6 in 2020. That's obviously good (if still nearly double the rate of peer countries). But these gains are not evenly shared. Today, 4.5 out of 1,000 white children die before their first birthday; but for Black children, it's 10.6. This difference has grown over time: black natal mortality was 1.5x white natal mortality in the early 1920s, and now it's 2.3x—a 50% increase.

We are offered a benchmark: if it is possible for white natal mortality to hit 4.5, it must be possible for Black natal mortality to hit 4.5 in parallel. It has not.

There is no inherent propensity toward dying during infancy which explains the discrepancy between Black and white natal mortality. We are two centuries beyond the 1790s; it is no longer fashionable to believe that some people are just predestined to early death (or in "miasma"). There is no natural reason that Black babies need to die at twice the rate of white babies, and there is no medical reason we can't protect the Black child with the same structural love and concern with which we protect white children—we have merely been unwilling to do so. We understand the thrust of the mechanics in play—racism, as expressed through modes like segregation, environmental risk factors, segregation, and access to healthcare. 

And still! The relative gap between Black infant death and white infant death has increased. There is a countervailing destructive force which acts alongside this great wave of progress which must be explicitly considered in any assessment of the delights of modernism.

The left dissenter argues that this failure does not condemn the progress of the past century, but asterisks it, and prohibits an uncritical assessment of "things are better than ever!". If last week you and I both were beaten in the street, and this week you were beaten with only one hand and I was spared, is outrage unreasonable?

It is possible to hold at once two thoughts: one, that a century of technological, medical, and social developments have been tremendously good for millions and millions of people and should be celebrated; and two, that these benefits have not fallen upon all God's children alike, and that this gap constitutes a hideous moral failure: that there was the potential to do more, and that we in this great and celebrated wave of progress refused to do it.

~~

Here are some things I've been reading about and might try to put to paper:

Private equity in healthcare: private equity is one of the most dangerous threats to American healthcare, and the threat private equity represents is not intrinsic to private equity. It is a consequence of the financialization of healthcare. This one's been fun to research: PE is en vogue right now as the dumbest guys in the world start getting in on the game (the whole sector is getting crowded in the same way VC has been over the past decade), and they're getting much more loose-lipped about the whole deal. There are healthcare PE podcasts!

Medical debt: How on earth did we come to accept the existence of medical debt? How does it relate to notions of "deservingness" that underlay (underlied? underlined?) the development of benefit programs?

The transition from poverty laws to workhouses to the liberal welfare state: the tension between the ideas that "people deserve to live comfortably" and "on the other hand, fuck 'em."

Extractive abandonment: my friends Artie Vierkant and Beatrice Adler-Bolton wrote a book that I read the entirety of standing up in my kitchen in one sitting (in one standing) that introduced to me the idea of "extractive abandonment;" that a function of the state is to turn "unproductive" people, who on their own wouldn't make anyone any money and whom capital would generally prefer to liquidate were it socially acceptable, into sources of private profit. Think, for example, of the prison telecom industry.

Animal rights, pork farming, and the central role it plays in some local economies: frankly I can't get very far into this one without crying.

Wong Kar-Wai's In The Mood For Love. I started watching movies recently, after a year spent mostly alone on the road (I left New York to work for a mobile abortion clinic), and this might be the best one I've ever seen? It's as perfect a technical execution of the concept of a "movie" as I think might be possible. I was blown away.

I also might move this listserv to another platform (substack? yuck!) not because I hope to monetize it but because tinyletter was always barely held together (I had to edit this page's CSS in the webdev console just to be able to post links) and I fear it may fall apart entirely.

LYLAS

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