Let's try it the French way

March 17, 1996|By Sara Engram

A HOST OF experts will gather tomorrow in College Park to consider what we Americans can learn from the French. Not about haute cuisine or even haute couture, this conference will focus on a subject much closer to home.

The French-American Foundation, a private group committed to enhancing ties between the two countries, took a look at our problems with infant and maternal health and at the French success in this area and decided that this was an issue ripe for exploration.

Given this country's affluence, it puzzles other nations why we tolerate stigmas more common to the Third World high infant mortality, lack of consistent prenatal care for every pregnant woman and, as one result, lots of babies born so small their survival depends on advanced and expensive neo-natal intensive care.

Consider a few comparisons:

In France, 96 percent of pregnant women receive prenatal care beginning in the first trimester of their pregnancy; in this country only 76 percent of women receive care that early.

In France, the percentage of babies born at very low birth weights (less than 1,500 grams) is 0.5 percent. In this country, the rate is 1.3 percent, almost three times as high.

France spends $1,650 per capita on health-care expenses, or some 9.1 percent of the country's Gross Domestic Product. By contrast, health care expenditures in the United States gobble up 13.4 percent of the GDP, at a per-capita cost of $2,867.

Clearly, the French are getting more for their money, at least for women and infants. Is there a lesson here for us, as we enter an era of managed care for virtually everyone and shrinking federal dollars for medical services for the poor?

The organizers of tomorrow's meeting think we have a lot to learn from the French and that those lessons could alleviate other social problems.

They're right, the French have created a society which doesn't just proclaim itself ''pro-family,'' but one which puts in place the policies that clearly demonstrate its pro-family colors.

Soon after World War II, the country decided that its policy of targeting medical services to poor families was less cost-effective than simply providing universal benefits.

Middle-class support

As a result, there is solid political support from the middle class for the subsidies and services offered to expectant mothers and to all families with children younger than 6. Even with recent budgetary woes and efforts to cut back on health-care costs, there is a consensus that maternal and child health programs are a cost-effective investment.

It doesn't stop with babies. The French system of pre-schools is so good with bright, cheery surroundings and highly trained teachers that no private system can compete. Because virtually every French child is enrolled in those schools, they provide a convenient way to monitor immunizations and other basic health precautions.

In contrast, our system of early-childhood education is hardly a system at all. Child-care subsidies for children younger than 4 create conflicts between the working poor and welfare mothers who have been told to find a job. And even in Maryland, a leader in pushing for better child-care policies, the state's system of subsidies for poor families is now under assault.

Unlike the French, Americans failed to recognize that targeting aid for children and families to the needy was less cost-effective in the long run and put these expenditures at political risk for lack of a wide constituency. So we are left with a system that, from pregnancy on, treats children and mothers on a catch-as-catch-can basis.

Meanwhile, the French are investing in children who will grow up as healthier, smarter, more productive and less embittered citizens. For one thing, they avoid the agonizing, expensive problems we face when the biggest drops in infant mortality are attributable not to better prenatal care or persuading pregnant women not to smoke, but rather to medical advances that allow ever younger and tinier babies to survive often with debilitating problems that will require life-long medical care.

Will the French system work here? Given the vast gap between infant and maternal health in impoverished inner cities and among middle class families, it's clear that this country faces challenges unknown in France. So the better question might be, will the French system work in inner-city Baltimore, or inner-city Washington?

That's the real test for the conferees at tomorrow's meeting.

Sara Engram is deputy editorial-page editor of The Sun.

Pub Date: 3/17/96

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