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Americans like to think that we have the world's best health care. Sometimes that's true.

But in one of the most fundamental measures of health - infant mortality, the percentage of babies who die before their first birthday - we come up short. By a lot.

Roughly seven of every 1,000 babies born in the United States die before their first birthday. That puts America on a par with the rates in Serbia and Lithuania. In a ranking of countries' infant mortality rates, with number one being the best, the United States is tied with Thailand in 29th place.

We rank slightly lower than Poland, Hungary, Croatia and South Korea. Our rate is more than twice as bad as the rates in Japan, Sweden, Cyprus and Italy, and three times worse than Iceland's.

There is some good news: Recently released national numbers show that the infant mortality rate improved slightly here during 2006, the latest year for which complete statistics are available. That marked the first statistically significant change since rates stalled in 2000.

The U.S. Centers for Disease Control and Prevention and most health experts regard infant mortality as among the most important indicators of a nation's health. That's because it is associated with and affected by a wide variety of factors: maternal health, access to health care, socioeconomic conditions and public health practices. The United States falls short in many of these measures.

Because many factors influence the infant mortality rate, it can take a long time to see improvement. But widening disparities in access to health care and rapid increases in the number of people without health insurance make it even more difficult.

For example, about a third of U.S. infant deaths occur in premature babies.

Babies who arrive too early and, thus, are very small receive heroic care at specialized hospitals at great cost. It's not unusual for the care of such infants to cost hundreds of thousands of dollars. Yet many die before their first birthdays.

That care might not be needed if more money were spent to provide prenatal and preventive care to scores of mothers and infants. That makes premature births and infant mortality a problem for all of society, not just the mothers of these unfortunate infants.

In 1960, our country had the world's 12th-lowest infant mortality rate. Since then, other nations have surpassed us at lowering their rates. And infant mortality isn't the only international measure of health by which the United States does poorly.

Americans have a "healthy life expectancy" of 69 years. That's a measure of the number of years a citizen can expect to live in full health. That's about the same as residents of Slovenia and Portugal, two fewer years than the British, three fewer years than the French and six fewer years than the Japanese.

Americans have fewer doctors, CT scanners and MRI machines per capita than residents of many other Western nations. We see doctors less often and are less satisfied with the care we receive.

Yet we spend about twice as much on that care as the British, French or Japanese. At least $1,000 of our health care spending per person, on average, pays for paperwork - administrative expenses. Unlike Americans, every citizen in Britain, France, Japan and every other developed country has government-paid health care.

Health care reform clearly will be a major political issue over the next four years, although it's too soon to say exactly what kinds of changes could occur. But it's not too soon to ask if Americans want a fairer, more efficient health care system - or if they think that being tied with Thailand in infant mortality is good enough for the United States.