Infant mortality in the 20th century, dramatic but uneven progress.

It is quite fitting for a symposium reviewing progress in infant nutrition in the 20th century to start with a review of infant mortality rates during that time period. Indeed, it has been a truism in public health that, within limits, the infant mortality rate of any community, large or small, reflected its general state of health better than any other single indicator. Although no longer valid for the wealthier countries, it is still the norm for most countries in the world, where the diseases that kill most babies, i.e., infections, diarrhea and pneumonia, are all enhanced by inadequate nutrition. Interrelation of infection and nutrition was appreciated early, as documented persuasively in Scrimshaw’s classic 1975 review (1). At the beginning of the 20th century, infant mortality was at such heights that organized attempts to attack it began more or less simultaneously throughout what is now called the developed world. In the forefront was western Europe, a major effort having come from the French, stung by the loss of the Franco-Prussian War in 1870 and the realization that population dynamics favored a newly united Germany. A landmark step in the United States came when more or less isolated efforts in many cities led to organization in 1909 of the American Association for the Study and Prevention of Infant Mortality, instrumental in promoting the White House Conferences on Children and Youth and stimulating the establishment of the Children’s Bureau. Almost 100 years later, decline in infant mortality has occurred worldwide, dramatically in the industrialized nations, less so and unevenly in many population groups in those nations and worldwide.