In 2016, US life expectancy was 78.6 years, compared to an average of 82.2 years for comparable high-income countries. Most of the difference is due to “excess” American deaths before the age of 40. By the age of 65, the disparity in life expectancy between the US and the other rich countries is just 1.6 years for women and 1 year for men. The disparity in life expectancy actually begins at birth: the infant mortality rate is higher in the US than in most European countries, even after excluding births at less than 24 weeks of gestation (because some countries count those as “miscarriages”, which make their infant survival rates look better), Clearly, lack of universal healthcare plays a role in the shorter lifespans of Americans - but less than is commonly thought. For instance, both insured and uninsured Americans experience poorer health than their European counterparts.

Without further ado, here are nine reasons why Americans don't live as long as people in other developed countries:

  1. Drug Overdoses: the main reason US life expectancy has recently declined, with the age-adjusted rate of drug overdose deaths in 2016 being 36% higher than the rate in 2014.

  2. Homicide Rates: homicide mortality contributes the most to excess mortality among US men under 50. Consider: life expectancy for black males living in high-risk urban environments is 21 years lower than life expectancy for female Asian Americans.

  3. Traffic Accidents: among men under 50, transport injuries follow homicides as the leading cause of death. Note that Americans lead the world in traffic deaths.

  4. Earlier Smoking: while we smoke much less these days, Americans smoked like chimneys in the 1950s-70s, which is considered “the most important factor explaining the lag in US life expectancy at older age”.

  5. Infant Mortality: even full-term babies die more in the US than in other developed countries. Maternal stress may play a role: countries with generous parental leave programs have much lower infant mortality.

  6. Life-Style and Behaviors: Between eating too much of the wrong things, not exercising enough, and comparatively low medication adherence (not taking all doses as directed), Americans suffer more from chronic conditions such as diabetes and hypertension.

  7. Non-Communicable Diseases: for adults under 50, diseases such as diabetes and heart disease are largely matters of lifestyle, socioeconomic conditions, and public health policies. Non-communicable diseases explain 29% of years of life lost below age 50 in the US compared to other OECD countries among women, and 18% among men.. However, survival rates for these diseases (including cancer) might even be better in the US than in other developed countries, which suggests that US medical care is not the problem.

  8. Social Welfare System: some programs may reduce mortality risk factors. For instance, an expansion of the Earned Income Tax Credit may reduce maternal smoking and increase infant birth weight and the Food Stamps program appears to improve infant health, especially with African American mothers.

  9. Health Insurance: while health insurance appears to have limited effect on the mortality of American adults under 50, there is conclusive evidence that health insurance improves the health of vulnerable subpopulations such as infants, children, individuals with AIDS and low income individuals with high blood pressure.

Bottom line: All Americans should have access to decent healthcare one way or another, but universal healthcare by itself will not increase US life expectancy to that seen in other developed countries.


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Levy, H. and D. Meltzer (2008). "The Impact of Health Insurance on Health." Annual Review of Public Health 29(1): 399-409.

MacDorman, M. F., T. J. Matthews, et al. (2014). "International comparisons of infant mortality and related factors: United States and Europe, 2010." National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 63(5): 1-7.

Mills KT, Bundy JD, Kelly TN, et al. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation. 2016;134(6):441–450. doi: 10.1161/CIRCULATIONAHA.115.018912

How does U.S. life expectancy compare to other countries? Selena Gonzales, Marco Ramirez and Bradley Sawyer   Kaiser Family Foundation April 4, 2019

"Mortality Under Age 50 Accounts For Much Of The Fact That US Life Expectancy Lags That Of Other High-Income Countries." (2013) Health Affairs 32(3): 459-467.