[peterbonney]

> Complicating this further is the fact that outcomes differ significantly across the U.S., with some leading hospitals able to keep twice as many 22-week-old babies alive as the national average, and occasionally able to keep babies born as early as 21 weeks alive.

The hard truth that many don’t want to face about prematurity is that the odds of survival at 24 or even 23 weeks are actually quite high, IF the baby is lucky enough to be born in the right facility. The odds at 22 weeks and even 21 weeks are not a lock but actually much better than you’d think.

We don’t actually need new science to radically improve prematurity outcomes. We just need to invest money in equipping and training more NICUs.

My son was born at 26 weeks, luckily in New York City where the standard of care is excellent (level 3 on a scale of 1-4) at even the second-tier NICUs, and where the highest possible standard of care is never more than a short ambulance ride away.

To put it bluntly: in NYC, a 26-weeker is 90% likely to survive to term. In some areas of the country a 26-weeker is 90% likely to die. The averages cited here flatten out this reality and make the problem seem more scientific and less social than it actually is.

[shiroiushi]

>To put it bluntly: in NYC, a 26-weeker is 90% likely to survive to term. In some areas of the country a 26-weeker is 90% likely to die

This is probably because of a shortage of highly competent medical personnel, especially in rural areas where no top medical school graduate in her right mind would want to work, just like they probably wouldn't want to live and work in someplace like Iran.

I don't really see any way to fix this. Getting excellent medical care means having excellent medical professionals living and working in proximity to you, and since they're humans with free choice, they tend to move to places that are nice for them to live in, which not surprisingly usually doesn't include economic backwaters.

[oofabz]

A lot of people, including myself, prefer living in rural areas. They have more natural beauty, more solitude, tighter knit communities, cultures that prioritize family. Not everyone shares your own personal preferences.

It is true that there are fewer economic opportunities in the country. Cities are a labor market, after all. But there are hospitals everywhere, so if you work in medicine, you have the opportunity to work in the country and still earn good pay.

[shiroiushi]

In the US, rural areas have cultures that prioritize guns, meth, and eschewing advanced education. It should be no surprise that doctors (i.e., people with advanced education) wouldn't want to live among such people, and the only way they can get doctors to work in rural hospitals is to offer huge financial incentives such as medical school loan forgiveness.

[GJim]

So do some urban areas.

[shiroiushi]

They do, and those particular urban areas also tend to be "healthcare deserts" for similar reasons. However, many times the bad urban areas aren't geographically very far from more economically prosperous areas, so it's not that hard to transport patients with more acute needs from the bad parts to hospitals and doctors that can treat them well. This isn't true for rural areas: the distances are just too great.