Domestic health-care issues to test Obama


The election of Barack Hussein Obama as U.S. president represents hope for the kind of transformational politics that can lead to a better, more secure world. It also suggests an end to the politics of divisiveness and a turn toward a political system more attuned to the needs of what both candidates persistently called “the middle class.”

But, as Ralph Nader points out, that message doesn’t take into account the much bigger needs of the poor in America. It is on success in confronting these needs that we will need to judge this new president.

In 2006, the poverty rate for minors in the United States was the highest in the industrialized world, with 30 percent of African-American minors living below the poverty threshold. Moreover, the standard of living for those in the bottom 10 percent was lower than most other developed nations. Approximately one in eight Americans (36.5 million people) were living below the poverty threshold in 2006, compared to 31.1 million in 2000, according to official figures.

By several measures, the U.S. has among the most inequitable health system in the world. Despite widespread declines in infant mortality during the 20th century, the U.S. infant mortality rate — seven deaths for every 1,000 live births — ranks 29th worldwide, on a par with Slovakia and Poland and lagging behind Cuba. Compare that with Singapore, Hong Kong and Japan, where the rates are two deaths for every 1,000 live births, 2.5 and 2.8, respectively. The U.S. infant mortality rate, which did not decline significantly between 2000 and 2005, is now higher than in most other developed countries.

This is one of the most important indicators of the health status of a nation, since it is associated with factors such as maternal health, quality and access to medical care, general socio-economic conditions and public health practices. The gap between the U.S. infant mortality rate and the rates of the countries with the lowest infant mortality is widening, which indicates that those countries are making better progress than the U.S.

The U.S. health-care system is the most expensive in the world but comes in last in almost any measure of performance, according to a 2007 study by the Commonwealth Fund in New York.

In addition, the U.S. lags behind all industrialized nations in terms of health coverage. Up to 46.6 million Americans had no health insurance coverage in 2005, according to data from the U.S. Census Bureau. Nine million children in the U.S. are uninsured, while 23.7 million — nearly 30 percent of the nation’s children — lack regular access to health care.

While employment, access to jobs and health care are key issues at the national level, the application of diplomatic measures to ensure a safer, more peaceful world will become crucial at the international level. That means, for the U.S., a return to a policy of respect for international law and treaties.

Preventive wars, a serious violation of international law, should become a thing of the past. At the same time, the U.S. should become a signatory of a treaty aimed at eliminating land mines. By 2007, the treaty, known as the Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-Personnel Mines and on Their Destruction, had been signed by 158 countries. But the U.S. is not a party to that convention.

The U.S. should also ratify the U.N. Convention on the Rights of the Child (CRC). Participating governments are to report their progress in advancing that convention and the status of child rights in their country. All U.N. member nations — except the U.S. and Somalia — have ratified the CRC.

I recently asked an American friend who has been living in Spain the past two years how Europeans see the situation in the U.S. “Europeans,” he told me, “are desperate to find reasons to love America again.” If Obama effectively addresses the challenges facing him, he can help fulfill their wish.

Cesar Chelala, a physician who writes on human rights issues, is a cowinner of an Overseas Press Club of America award.