Atlanta Earns Top Health Improvement Grade!


The question arises with every release of the Kid-Friendly Cities Report Card. "How did my city do compared to last time?" The report, which is biennial, changes often because, each time, we add information that may not have been available in past years. The list of cities on the report is growing because we look at every city with a population greater than 100,000–and every two years, there are more of these. Even our system of grading the cities has changed over the years. All of this makes it difficult to compare a city's grade and rank in 1999 to its grade and rank in 2001.

But, tracking progress is important. How are the nation's children faring today compared to a decade ago? Are we moving in the right direction? In order to answer these questions, we decided to look at key health indicators and compare data from 1990 and 1998–the most recent year for which data is available. We chose health indicators for two reasons. First, the healthier a child is, the better her/his chances of having the quality of life we want for all of our children. Second, the data from 1990 and the data from 1998 was collected in exactly the same way for the same populations.

This special section of the Kid-Friendly Cities Report Card takes an in-depth look at the following three indicators: the infant mortality rate, the percent of births to teens, and the percent of low birthweight births. This report presents data for each of the 25 Major Cities (see list of major cities) and 140 Independent Cities (see here for list of independent cities) in the Report Card and grades each city for improvements made in these three areas of health between 1990 and 1998.

While we see substantial improvements in some areas and in some cities, there is much work still to be done. But we are encouraged by the fact that even those cities that scored poorly in our study overall show tremendous improvements in health. Take Atlanta, Washington, and Detroit. Out of 25 Major Cities, these cities finished towards the bottom, receiving low grades and ranking 25, 22, and 24, respectively. But, when it comes to measuring improvements in health, these very same cities are at the top of the list. In fact, Figure 1 (at bottom of page) shows several cities that have a health improvement rank that is higher than their final rank.

Infant Mortality Rate

Infant mortality, defined as the death of an infant before his or her first birthday, reflects the well-being of both mother and child. A variety of factors, such as maternal health care, socioeconomic conditions, and environmental conditions, influence the infant mortality rate.

Nationally, the infant mortality rate declined from 9.2 deaths per 1,000 live births in 1990 to 7.2 deaths per 1,000 live births in 1998–an improvement of 28 percent. Improvements have occurred in every Major City in our report except Baltimore. However, 12 of the 25 Major Cities still have an infant mortality rate that is higher than the national average.

The disparity between cities is also particularly striking. Cleveland, Washington, Chicago, Detroit, Philadelphia, Baltimore, and St. Louis all have double-digit infant mortality rates. In contrast, Portland, San Jose, and Miami have infant mortality rates of less than 5 deaths per 1,000 live births. While infant mortality has declined for all racial and ethnic groups over time, here, again, we see disparities. The infant mortality rate among African Americans is 13.9 deaths per 1,000 live births. Among American Indians and Alaskan Natives, the rate is 9.3 deaths per 1,000 live births. The rates are much lower among white, non-Hispanics (6.0), Hispanics (5.8), and Asian/Pacific Islanders (5.5). The role of poverty in determining infant mortality is complex. The poverty rate among African Americans is about two-and-a-half times greater than the rate among whites. But, Hispanics have the same poverty rate as African Americans and less than half the infant mortality rate.


Percent of Births to Teens

The percent of births to teens is the number of live births to women under 20 years of age divided by the total number of live births. Babies born to teen mothers are at a higher risk of low birthweight and infant mortality compared with babies born to older mothers. They are more likely to grow up in homes that have lower levels of emotional support, and they are less likely to earn high school diplomas. In addition, teen motherhood is often accompanied by poverty and hardships for both mother and child.

The decline in the percent of births to teens in the nation has been marginal– from 12.8 percent in 1990 to 12.5 percent in 1998. Nineteen of the 25 Major Cities in our study show improvement. San Francisco, Seattle, Atlanta, and Detroit all improved by 20 percent or more. Despite some improvement, 17 Major Cities still have greater proportions of teen births than the national average.

Once again, we notice great disparity among cities. San Francisco has the lowest proportion of teen births (6.1 percent), while Baltimore has the highest (22.4 percent). Only five Major Cities have fewer than ten percent of teen births–San Francisco, Seattle, San Jose, San Diego, and New York. In contrast, fewer than five percent of births are to teens in other industrialized countries such as Japan, Denmark, Germany, and France. The U.S. average is even higher than that of the United Kingdom, which has one of the highest proportions of teen births in all of Western Europe. These comparisons make it clear that teen pregnancy prevention initiatives and sexuality education need to be strengthened in the U.S.

Percent of Low Birthweight Births

Low birthweight babies are those born weighing less than 2,500 grams, or about 5.5 pounds. Low birthweight babies are at a higher risk of death or long-term illness and disability than are infants of normal birthweight. They are 20 times more likely to die during the first year of life than normal birthweight infants.

Nationally, the percentage of low birthweight births has risen from 7.0 percent in 1990 to 7.6 percent in 1998– a nine percent increase. This trend of rising proportions of low birthweight births is seen among the Major Cities as well. Thirteen of the 25 cities show no change or increases in the proportions of low birthweight births since 1990. Only Pittsburgh and Washington show substantial improvements and, even with the improvements, they are worse than the national average.

Low birthweight can be caused by many factors, such as poverty, poor maternal health, and lack of prenatal care. However, the National Center for Health Statistics states that the recent rise in low birthweight births is partly due to greater use of fertility treatments which increase the incidence of twins, triplets, and higherorder multiple births. Fifty-five percent of twins and 94 percent of triplets have low birthweight, compared to six percent of singletons. The increase in low birthweight has been greatest among white, non-Hispanics, from 5.6 percent in 1990 to 6.6 percent in 1999.

While low birthweight births among African Americans decreased slightly –from 13.3 percent in 1990 to 13.2 percent in 1999–the proportion remains extremely high, compared to 6.4 percent among Hispanics, 7.1 percent among American Indians and Alaskan Natives, and 7.4 percent among Asian/Pacific Islanders.


Population Connection's Kid-Friendly Cities Report Card is a wealth of information on 239 cities (every municipality in the U.S. with a population of more than 100,000).

Media Review of Report Release

View or download complete Report (PDF, 261KB)

Charts for major Cities(HTML, jpeg)

Chart for Independent Cities (HTML, jpeg)

Chart for United States overall

Kid-Friendly Cities Report Card


Population Connection
1400 16th Street NW, Suite 320
Washington, D.C. 20036

Main: 202-332-2200
Fax: 202-332-2302
Toll Free: 1-800-POP-1956