"The country which first recognizes its responsibilities to the child," S. W. Newmayer² wrote in 1911, "will receive the recognition of the world as being the foremost civilized nation." Newmayer had just been asked to guide Philadelphia's child health and welfare efforts, and as he surveyed indicators of child health from around the world, he found that the United States lagged behind. The most telling sign was a list of the infant mortality rate (IMR) in 30 countriesthe United States ranked 18th with an IMR of 135 deaths per 1000 live births. Newmayer then noted that some American cities had recently initiated a variety of programs to improve child health. "The United States," he concluded hopefully, "is awakening to such realization."²

Newmayer's optimism seemed well-placed. The first third of the 20th century marked an era of significant growth in child health and welfare efforts. Building on the European example, US public health leaders launched a national campaign to reduce infant mortality. As part of this effort, the US Children's Bureau (USCB) was founded in 1912, and both local and state public health departments began focusing many of their resources on mothers and children. Pediatricians and children's hospitals also emerged in this period as the most common source of health care for children. The results of these efforts during the last century have been impressive. Along with improved nutrition and public health, advances in medical therapy have reduced the IMR from more than 100 to fewer than 10 deaths per 1000 live births.^3-5

Nevertheless, the IMR continues to be a focus of attention and still appears problematic to many observers in the United States. Although we claim the most advanced and best endowed health care system in the world, we now rank 23rd among industrialized nations.⁶ Deaths among African-American infants have remained double the national average for more than a . . . [Full Text of this Article]