Americans die earlier – and have been doing so for much longer than originally thought – according to findings published in the American Journal of Public Health.
Americans experience more illness, have less access to health care and pay more for health services than citizens in other high-income countries.
The findings show that dozens of countries across six continents have outranked the United States in life expectancy over the past 70 years.
“The new study challenges two assumptions that have influenced previous research on the U.S. life expectancy disadvantage,” said Steven Woolf, M.D., director emeritus of the Center on Society and Health at Virginia Commonwealth University and author of the study. “First, past studies have usually only compared the United States with a select group of 15-20 ‘peer countries,’ largely Anglo-Saxon or Western European countries with high incomes. Second, experts typically consider the 1980s or 1990s as the inflection point when growth in U.S. life expectancy began underperforming compared with other countries. However, this analysis shows that premature deaths among Americans are a much larger and older public health issue than previously believed.”
By 2020, the U.S. life expectancy ranked 46th among populous countries.
“We may be one of the richest countries in the world, and we certainly outspend every country on health care, but Americans are sicker and die earlier than people in dozens of countries. We’ll keep falling behind unless we get serious about policy solutions,” said Woolf, a professor in the Department of Family Medicine and Population Health at the VCU School of Medicine.
Woolf’s analysis revealed that between 1933 and 2021, 56 countries from around the world had at one point achieved a higher life expectancy than the United States, including 17 countries that outranked the United States for more than 50 years.
Countries with less affluence and less elaborate health care systems have previously been considered a poor benchmark for measuring the U.S. health disadvantage, based on the assumption that only wealthy countries could outperform the United States.
“If you only compare the United States with 15 high-income countries, you can guarantee that it will never rank worse than 15th,” Woolf said. “However, we found that countries with different cultures, forms of governance, societies and economies have all found a way to outperform the United States in terms of health outcomes and life expectancy. Even former Soviet countries in Eastern Europe managed to surpass the United States.”
Woolf additionally examined how life expectancy trends varied among U.S. states, revealing significant disparities that widened over 60 years. Growth rates in life expectancy were generally highest in the Northeast and West and lowest in South Central and Midwestern states.
“State governments play a large role in promoting the health and well-being of their constituents, and over time we’ve seen widening disparities in health trends at the state level,” Woolf said. “This is encouraging, as it shows that states are capable of adopting policies that improve health, but it is also discouraging, because many other states that fared poorly in this study are now actively weakening or rolling back such policies.”
While more research is needed to understand the complex reasons behind these trends, the pervasiveness of the U.S. health disadvantage over the past few decades suggests that the problem is larger and more enduring than a single health issue, according to Woolf.
“At the root of it, the health disadvantages experienced in the United States are likely the product of social values and policy decisions capable of producing widespread effects on health,” he said.
Woolf suggests that health declines may be due in part to policies that have relaxed regulations that protect public health and safety, redistributed wealth from the middle to the upper class, and curbed access to education, health care and human services.
“The upside is that many countries have found a way to consistently ensure that their populations live longer, healthier lives. That’s hopeful, because it means that there are policy solutions that could help Americans live longer,” Woolf said. “This issue is not a lack of solutions, but rather a lack of political will.”
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Crystal Graham
