Infant mortality rates are declining. But gun violence is overtaking that progress. l Expert Opinion

There is a disturbing trend in Philadelphia that everyone should be aware of. Even as hard-won progress is being made in reducing our infant mortality rate, the toll of gun violence among the city’s children and youth could erase those gains.

Last year, 130 Philadelphia babies died before their first birthday, half the number of just a decade earlier. Yet also in 2020, the city lost 127 lives, all under age 21, to homicide. That toll has been rising just as infant deaths have declined.

One of the best predictors of a society’s overall health is how many babies celebrate their first birthday. Infant mortality rates correlate closely with levels of poverty, racism, environmental factors, and community health as a whole, and have been carefully calculated in this country since 1912.

The COVID-19 pandemic laid bare so many health disparities, but this is one that has long been widely recognized. Black infants in the U.S. die at more than twice the rate of white infants, and the disparities are even worse in Philadelphia.

Many of these deaths are preventable with improved prenatal care and access, safe sleep messaging, and safe home environments. In fact, over the last 15 years, Philadelphia has shown astonishing improvements in infant mortality from close to 300 deaths a year in 2005 to 130 in 2020. That said, the infant mortality rate in Philadelphia is 8.4 per 100,000 births, towering over the national rate of 5.8. In North Philadelphia, where I practice at St. Christopher’s Hospital for Children, the rate is more than 11, double the national average.

Total deaths in children under 21 have remained steady from 2014 until 2020 at fewer than 70 a year. As a city, we haven’t moved this needle in six years. What has changed is that, increasingly, the cause of death is not babies being born too early, but teens dying too young.

Both kinds of death are unspeakably tragic. Especially because both usually are entirely preventable.

From 2005 to 2019, there was about one homicide of a young person for every three or four infant deaths. Then, in 2020 and continuing into 2021, this ratio shifted abruptly to the point that it is approaching one homicide to one infant death.

Since 2005 almost 1,440 Philadelphia children under 21 have been killed, almost all by guns. Of those deaths, 95% were Black or Brown children. (These data do not count non-Philly residents who died in Philly.)

The root causes of infant deaths are well-documented and targeted interventions are in place, and saving lives. For homicides of children under 21, the causes are more complex, nuanced, regional, and even with more than $155 million in this year’s city budget for anti-violence initiatives, it doesn’t seem to be community driven and innovative enough to move the needle.

This is why, working with more than a dozen community-based organizations, St. Christopher’s Hospital for Children is hosting “Moving the Needle: Gun Violence Prevention Conference” on Oct. 1, a free and virtual event, to listen to the voices of those affected by gun violence. To listen to those who are working to make our city safer for our youth. To listen to U.S. leaders discuss their innovative methods and observations that have helped fight gun violence from Washington, D.C., to Massachusetts, to California.

As a pediatrician working in the epicenter of infant mortality and homicides in Philadelphia for more than two decades, this trend feels personal and terribly concerning. Saving lives in one category cannot lessen the crisis of deaths in another category.

We must continue to battle for the life and dignity of all children, of all ages, of all races in Philadelphia. It is our moral obligation to infants living in Hunting Park, to those about to graduate high school in Elmwood, and all in between, that they thrive. That they stay alive.

Daniel R. Taylor is medical director of the outpatient center at St. Christopher’s Hospital for Children.