We’ve grown accustomed by now to telling our children where not to walk at night, how to stay away from the wrong crowd, how to stay on the right side of the cops, and, lately, how to protect yourself in case of a school shooting. But worldwide, the cold, hard numbers show us the inescapable threats: Measure for measure, America is one of the most dangerous places in the world for a kid to grow up.

According to a multiyear study of mortality data, children in the United States are at higher risk of getting killed than their peers in virtually every other comparably wealthy society. Our country’s number-one child-death ranking centers on two primary factors—teens shot to death, and babies extinguished soon after birth.

The analysis, published in Health Affairs, shows that compared to the other 34 countries in the Organisation for Economic Co-operation and Development (OECD), “From 2001 to 2010 the risk of death in the United States was 76 percent greater for infants and 57 percent greater for children ages 1 to 19.” Over a 50-year period—that is, over a half-century of unprecedented economic growth—American youth saw some 600,000 excess deaths. It’s not a decline in general public prosperity that is killing kids; death rates can be traced to distinct social policies, including laws that value guns over young people’s lives, and a private health-care system that abandons the most vulnerable infants.

There was one finding that stood out from the rest in this study: “children ages 15 to 19 were eighty-two times more likely to die from gun homicide in the US” compared to the other countries over the past decade. Gun murders disproportionately hit young black men, compared to white male or female peers. Gun homicide accounts for about 11 years of cumulative loss of potential life among black youth, compared to six for whites—a figure that eclipses the comparatively minuscule rate in other countries.

Different forms of fatality stalk black mothers: US infant-mortality rates, primarily due to premature births, are shockingly high, with black women’s babies dying at a severely disproportionate rate. Infant-death rates also vary highly depending on where babies are born. CDC data indicate that while infant mortality has declined nationwide by 15 percent between 2005 and 2015, infant-survival rates are divided by state, so a baby in Mississippi is over twice as likely to die before her first birthday compared to her peer in Massachusetts—a pattern that parallels the prevalence of family poverty and racial segregation.

The good news is that childhood mortality has fallen overall since the 1960s. But US progress still worsened in comparison to other OECD countries. And the burden of death fell mostly on young black children.

Though direct links tying race, economic inequality, and public health are not always clear, co-author Ashish Thakrar (a Johns Hopkins resident) says the study reveals how disturbingly arbitrary social factors exert real harm on communities: “From a scientific perspective, ‘race’…is a social construct that reflects our political and cultural history. And so these racial disparities in infant mortality reflect the realities of living in a racialized world plagued by discrimination against people and communities of color.”

The Health Affairs study cites “high poverty rates, poor educational outcomes, and a relatively weak social safety net” as core differences between the United States and other rich countries. According to Sarah Burd-Sharp, co-director of Measure of America, which tracks public-health and social indicators according to international development measures, understanding “the condition in which we are born, grow up, work, and grow old” is vital. To prevent death in the long term, “Policy interventions and public health measures that focus on the conditions of our daily lives can reduce the incidence of low birthweight babies, improve the conditions for mothers and increase child survival.”

Yet Congress has consistently refused to enact policies that could preserve young lives, even basic welfare programs like child tax credits, food stamps, and Medicaid. Medicaid for young children, known as SCHIP, has halved the uninsured rate over the past 20 years by providing chronic and emergency care for poor kids, and has narrowed racial health gaps remarkably: One study in New York City showed that, a year after enrollment in the program, “pre-existing racial/ethnic disparities in access, unmet need, and continuity of care among children were virtually eliminated.” Yet SCHIP funding has been precarious—recently threatened by a months-long budget impasse—and coverage is still not comprehensive for all struggling families.

Research also shows that one’s risk of getting shot is often more closely linked to race than to other social factors. In Philadelphia, for example, researchers found that “gun murders and injuries are much more strongly associated with race than [with] neighborhood income levels,” with blacks facing higher risks than whites even among middle-class households.

“The ‘biology of inequality’ is rooted in the conditions of daily life,” Burd-Sharp observes. “Those who routinely have little autonomy in their work and less control over their living situation experience chronic stress from economic insecurity, and have a nagging sense of exclusion and unfairness…and greater conflict in their personal relationships,” all of which feed into poor health, mental instability, and alienation from the social-service system.

The challenge of resolving child mortality requires improving the overall quality of life—not just improving childhood-survival rates but also helping communities flourish across generations. (Death rates are also rising in many states for younger adults: The risk of dying at a young age increased in 21 states, including West Virginia, where opioid addiction is rife.)

Now we know that the scourge of inequality plagues children from their first breath to their last. Instead of remaining a country rich in guns and poor in welfare, we need to comprehensively address the underlying causes of social violence. Communities need not just gun control but comprehensive social services, focused on prevention rather than punishment. Preventing newborn deaths involves strengthening families before and after birth, expanding access to health insurance, food security, and affordable housing. Addressing the death burden weighing down black youth requires protecting them from fatal social stressors haunting them through deep institutionalized discrimination.

Until we make life more worth living for all children, we’ll keep giving them more reasons to die.