Poverty, health services, and gun violence are all reasons the United States has experienced difficulties in significantly lowering its child mortality rate.

Childhood mortality rates in the United States are down, but that single statistic doesn’t tell the entire story.

The child death rate is decreasing at a much slower rate in the United States than it is in 19 other economically similar countries.

In fact, infants in the United States are 76 percent more likely to die than those born in those other nations.

And American children ages 1 to 19 are 57 percent more likely to die.

Those are the conclusions presented in a new study reported in the journal HealthAffairs

This isn’t the first study to yield similar results. UNICEF completed a comparative overview of childhood well-being in rich countries in 2013.

The U.S. ranked 26th out of 29 countries studied at that time, beating only Lithuania, Latvia, and Romania in an overall ranking comparing material well-being, health and safety, education, behaviors and risks, and housing and environment.

In short: For a rich, developed nation, the United States is dramatically failing its children.

This is despite the fact that the United States is also outspending other nations on children.

This all begs the question: Are we throwing money at these problems without truly addressing them?

Healthline spoke to Dr. Dipesh Navsaria, a member of the executive committee of the Council on Early Childhood for the American Academy of Pediatrics (AAP), about the latest research.

He explained that, “We did a great job as a country of really helping to figure out the single cause of issues that are simple. Polio, for instance. We studied the virus, came up with the vaccine, and then tackled the hard part — getting the vaccine to the entire world. But what we’re seeing now, a lot of the issues contributing to higher childhood mortality rates are problems that are multifactorial. Things that have a lot of moving parts having to do with behavior, built-in environments, and socioeconomic contributors. Those issues are harder to change. And other countries have found better ways to make those changes.”

So what kind of changes are we talking about?

The latest research identified specific areas where the United States is falling behind.

For example, death as a result of premature birth is 3 times higher in the United States than in the other 19 developed countries.

American babies are also more than twice as likely to die of SIDS.

Teens between the ages of 15 and 24 are 82 times more likely to die by firearm homicide in the United States than in the other nations.

The United States did reduce road fatalities by 23 percent between 2000 and 2011. However, the other countries studied managed to reduce those rates by 26 to 64 percent over the same time period.

According to Navsaria, much of the problem has to do with childhood poverty rates.

“Childhood poverty is not viewed as a significant issue in the U.S.,” he explained. “[Between] 42 and 48 percent of children are living in poverty in America. Nearly half of U.S. children live below 200 percent of the federal poverty level. That’s a shocking number in a country that’s considered to be so wealthy.”

In 2014, the Washington Post reported on this very issue.

Citing a UNICEF report, they wrote, “Nearly one third of U.S. children live in households with an income below 60 percent of the national median income. In the richest nation in the world, one in three kids live in poverty. Let that sink in.”

Navsaria notes that the United Kingdom had a child poverty rate in the 1990s that was higher than the United States.

“Their government committed to changing that, declaring war on child poverty,” he said.

The U.K. extended paid parental leave, which was already three months, to nine months. The United States still doesn’t have guaranteed paid parental leave.

The U.K. also extended the child tax credit, and they implemented home visiting. Not just to people who fell below the poverty line, but to a wide swath of the population.

“Rather than just do a little here and there, they did a lot of things together and put real money behind the initiative,” said Navsaria. “And they saw the rates of childhood poverty plummet as a result — well below that of the U.S. today. So when people say we’re never going to be able to fix childhood poverty, well, this is a great real-world example of how it can be accomplished. We’re just not following that example.”

Childhood poverty is not the only area where the United States is failing to follow the example of more successful countries.

Shannon Watts, founder of Moms Demand Action, told Healthline that gun control is also a factor.

“Our lax gun laws, combined with the NRA’s ‘guns everywhere’ agenda, means that every American is at risk of experiencing gun violence,” Watts said. “On an average day, 96 Americans are shot and killed, including 7 children and teens. What’s more, gun homicide rates are more than 25 times the average of other developed nations. There’s so much more work to be done to keep us safe.”

BBC News reported on Australia’s solution in October 2017.

On April 28, 1996, 35 people were killed in Australia during a mass shooting that ultimately became known as the Port Arthur Massacre.

The country immediately banded together, committing to a change in gun laws that included 28-day waiting periods, thorough background checks, and the need to have a “justifiable reason” for owning a gun.

They’ve had zero mass shootings since. The homicide and suicide rates also dropped drastically.

“As much as we talk about the U.S. as being advanced and the envy of the world, it’s really important to recognize that we do absolutely terrible on basic things like childhood mortality and fetal mortality.” Navsaria concluded. “And we’re behind developing nations in some of these areas as well, not just nations economically similar to us. We’re not investing enough in prevention, supporting families, and public health. What we’re doing isn’t working. And that’s what policy makers should be looking at.”