For decades, the health of U.S. citizens has been getting progressively worse than the health of citizens in other high-income countries, and the United States’ health disparities have widened. As of 2018, the United States ranked 46th in life expectancy worldwide.1 Its infant mortality rate—the probability that a newborn will not survive to its first birthday—was 65 percent higher than the average infant mortality rate in the European Union.2 In 71 other countries, female infants are more likely to reach age 65 than those born in the United States.3
This is a paradox, as the United States has the highest gross domestic product in the world4 and is home to some of the greatest scientists and medical centers. But it is not a new problem. These disparities have existed for decades and have worsened year after year.5 And within the United States, the divide has widened between those who have opportunities for good health and access to high-quality health care and those who face systematic barriers.
The world saw the U.S. “health disadvantage” firsthand during the COVID-19 pandemic, when more people died from the virus in the United States than in any other country and when U.S. death rates were starkly higher among people of color.6 The decline in U.S. health status, however, began decades ago in the 1980s.7
Now, the health of Americans is in a precarious place. This matters not only because Americans live with more sickness and die sooner than their peers in other rich nations, but also because a decline in the nation’s health has ripple effects—on the economy, workforce productivity, health care costs, the fitness of military recruits, and national security.8 These ripple effects extend over time; the traumas faced by today’s children and the adverse conditions they inherit from their parents shape their future and the health trajectory of the nation.
This report explains the reasons for the U.S. health disadvantage and suggests policy solutions. It explains that health outcomes in the United States are shaped less by health care than by living conditions such as education, income, food security, housing, neighborhoods, and the environment. These conditions are less favorable in the United States than in other high-income countries.
Meaningful change to restore the health of Americans and reduce inequities requires a concerted effort by the nation to close the gap with other countries—an effort that must include investments in schools, jobs, economic opportunity, and community infrastructure.
The world saw the U.S. “health disadvantage” firsthand during the COVID-19 pandemic, when more people died from the virus in the United States than in any other country and when U.S. death rates were starkly higher among people of color.6 The decline in U.S. health status, however, began decades ago in the 1980s.7
Now, the health of Americans is in a precarious place. This matters not only because Americans live with more sickness and die sooner than their peers in other rich nations, but also because a decline in the nation’s health has ripple effects—on the economy, workforce productivity, health care costs, the fitness of military recruits, and national security.8 These ripple effects extend over time; the traumas faced by today’s children and the adverse conditions they inherit from their parents shape their future and the health trajectory of the nation.
This report explains the reasons for the U.S. health disadvantage and suggests policy solutions. It explains that health outcomes in the United States are shaped less by health care than by living conditions such as education, income, food security, housing, neighborhoods, and the environment. These conditions are less favorable in the United States than in other high-income countries.
Meaningful change to restore the health of Americans and reduce inequities requires a concerted effort by the nation to close the gap with other countries—an effort that must include investments in schools, jobs, economic opportunity, and community infrastructure.
The decline in U.S. health
Life expectancy has increased over the past century in industrialized countries, including the United States.9 But in the 1990s, the pace of the U.S. increase began to slow, and by 1999, the nation’s life expectancy had fallen below the Organization for Economic Cooperation and Development (OECD) average.10 (see Figure 1) In the ensuing years, life expectancy in other countries continued to outpace life expectancy in the United States, widening the gap between it and other countries. In 1980, U.S. life expectancy was 1 1/2 years higher than the OECD average;11 by 2018, it was 1 1/2 years below the OECD average.12
The United States has also experienced widening inequities since the 1970s—not only the growing wealth gap13 but also deeper health disparities.14 Indeed, differences in health based on income are larger in the United States than in other developed countries.15 For example, a study that compared adults ages 55–64 in the United States and in England found that the health gap between the bottom 20 percent and top 20 percent of the income distribution was greater in the United States on 13 of 16 health measures.16
