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UNIVERSITY PARK, Pa. — In a race nobody wants to lose, the United States has found itself in last place. A recent study in BMJ Open reveals that Americans have the shortest life expectancy among six high-income English-speaking countries. This startling finding raises urgent questions about the state of health and healthcare in the world’s largest economy.
The research, led by Jessica Ho, an associate professor at Penn State, examined life expectancy trends from 1990 to 2019 in the United States, Canada, Ireland, the United Kingdom, Australia, and New Zealand. The findings are stark: Americans consistently lag behind their Anglophone counterparts, with U.S. women living an average of 81.5 years and men just 76.5 years as of 2019. In contrast, Australians are living up to four years longer for women and five years longer for men.
“One of the main drivers of why American longevity is so much shorter than in other high-income countries is our younger people die at higher rates from largely preventable causes of death, like drug overdose, car accidents and homicide,” Ho explains in a media release.
This trend doesn’t improve with age, as Americans in their mid-life years continue to face higher death rates from drug and alcohol-related causes, as well as cardiovascular disease.
The researchers utilized data from the Human Mortality Database and the World Health Organization Mortality Database. They analyzed life expectancy at birth and at age 65, breaking down the data by sex, age groups, and 18 comprehensive cause-of-death categories. These categories included various types of cancers, drug- and alcohol-related deaths, firearms, motor vehicle collisions, and more.
To understand health disparities within each country, the researchers examined life expectancy variations across different regions or states using a measure called the “index of dissimilarity.” This approach revealed striking internal inequalities, particularly in the United States.
While the U.S. consistently ranked at the bottom, the performance of the other countries offers valuable insights. Canada generally held the second-highest life expectancy until recent years when Ireland and New Zealand began to catch up. The United Kingdom, while performing better than the U.S., often had the second-lowest life expectancy among the six countries in recent years.
Ireland’s story is particularly noteworthy. The country experienced remarkable gains over the study period, with Irish men adding 8.29 years to their life expectancy and women gaining 6.66 years. This dramatic improvement moved Ireland from having one of the lowest life expectancies among the six countries in 1990 to ranking second for men and third for women by 2019.
New Zealand, while not reaching Australia’s heights, also showed consistent improvements. Interestingly, New Zealand performs relatively better in life expectancy at age 65 compared to life expectancy at birth, suggesting particular strengths in supporting health in older age.
The United Kingdom has seen a slowdown in life expectancy gains since 2010. Some researchers have linked this trend to austerity measures, highlighting the potential impact of broader economic policies on public health outcomes.
What separates Americans from their longer-lived Australian cousins? The study points to several key factors:
- Gun violence: Australia’s strict gun laws have resulted in significantly lower rates of firearm-related deaths.
- Drug and alcohol use: The U.S. continues to grapple with a severe opioid epidemic, while Australia has managed to keep drug-related mortality relatively low.
- Traffic safety: Australia has implemented measures like more roundabouts and stricter driving regulations, resulting in fewer road fatalities.
- Healthcare system: Australia’s healthcare system outperforms the U.S. in several key areas, including accessibility and preventive care.
- Lifestyle factors: Higher rates of obesity, sedentary lifestyles, and unhealthy diets contribute to America’s higher cardiovascular disease mortality.
The vast disparity in life expectancy within the United States itself is alarming. While states like California and Hawaii boast life expectancies comparable to other developed nations, southeastern states fall dramatically behind, with some regions seeing life expectancies as low as 72.6 years for women and 69.3 years for men.
This internal inequality is not unique to the U.S., but it is particularly pronounced. Canada also shows significant regional variations, with the territories of Nunavut and the Northwest Territories having much lower life expectancies than the rest of the country. These disparities are largely driven by health inequalities among indigenous populations, a factor that also affects Australia, particularly in the Northern Territory.
Australia, despite its overall strong performance, is not immune to internal disparities. However, its geographic inequality in life expectancy was still the lowest among the countries studied, suggesting more success in distributing health benefits across its population.
The study shed light on how different age groups contribute to the overall life expectancy gaps between countries. For the U.S., the 25-44 and 45-64 age groups account for a substantial portion of its life expectancy shortfall compared to Australia. This highlights the particular challenges facing Americans in young and middle adulthood.
At older ages, the picture becomes more complex. The 65-84 age group typically makes the largest contribution to life expectancy gaps between countries. Australia’s advantage in this age group points to strengths in its approach to elderly care and management of age-related health issues.
“Australia is a model for how Americans can do better and achieve not only a higher life expectancy but also lower geographic inequality in life expectancy,” Ho suggests.
The study author proposes several policy changes, including investing in public transit infrastructure, implementing more effective drug prevention and treatment programs, and focusing on community interventions to encourage healthier lifestyles. The study also points to Australia’s success in implementing effective public health measures. For example, Australia’s response to its own opioid crisis in the late 1990s, which included harm reduction strategies and increased access to treatment, offers valuable lessons for countries still grappling with this issue.
Moreover, Australia’s approach to mental health, including the implementation of a national network for youth mental healthcare (headspace) in 2006, may contribute to its lower rates of suicide and substance abuse-related deaths.
The study’s findings serve as a wake-up call for all countries facing health challenges. It underscores the importance of comprehensive public health strategies, effective healthcare systems, and policies that address the social determinants of health. As populations around the world continue to age, the lessons from this research become increasingly crucial for ensuring not just longer lives, but healthier and more equitable ones for all citizens.
Paper Summary
Methodology
The researchers analyzed life expectancy data from national databases and the World Health Organization for the six countries from 1990 to 2019. They examined 18 cause-of-death categories and calculated geographic inequalities within each country using a measure called the index of dissimilarity. The study used decomposition methods to determine how different age groups and causes of death contributed to life expectancy differences between countries.
Key Results
The U.S. consistently ranked last in life expectancy throughout the study period. By 2019, American women lived an average of 81.5 years and men 76.5 years, compared to Australian women living up to 85.5 years and men up to 81.4 years. The U.S. also showed the largest geographic inequalities in life expectancy among the countries studied. Ireland showed the most significant gains over the study period, while Australia maintained the top position throughout.
Study Limitations
The study relied on existing data, which may have inconsistencies in cause-of-death reporting across countries. The geographic units used for within-country comparisons varied, potentially affecting inequality measurements. The study didn’t exhaustively investigate all the reasons for the U.S.’s poor performance or Australia’s success, leaving room for further research into the specific policies and cultural factors that might explain these differences.
Discussion & Takeaways
The study highlights the urgent need for the U.S. to address its life expectancy crisis. Key areas for improvement include reducing gun violence, addressing the opioid epidemic, improving traffic safety, enhancing healthcare accessibility, and promoting healthier lifestyles. Australia’s success provides a model for potential improvements in the U.S. and other countries. The research also underscores the importance of addressing within-country inequalities in health outcomes, as these can significantly impact overall national life expectancy.
Funding & Disclosures
The research was supported by the National Institute on Aging of the National Institutes of Health.
What would you expect when the US emphasis is on profit and in other western countries the emphasis is on actual healthcare. With all our resources and natural advantages, we have no excuses and should all be ashamed!
We also spend the most on health-care of any industrial Nation . Problem is most of our money goes to CEOs and middlemen along with insurers. It s not designed to save a life only cost more money. But healthcare isn’t the only one. Education, housing, pretty much anything you can finance is off the charts expensive.
In mean what do you expect, America has spent the last half century waging war on its young, accelerating to absurd levels the past two decades. We should never have built a society based on enriching the rich at the expense of the young. But that’s what we did. I’m middle aged, watched many friends and family already die younger than me. I’m sure I’ll go sooner rather than later too. Good riddance to this rubbish world when it happens. If there’s a next life, I hope the people that made this world miserable suffer in it.
Stuff and nonsense. The reason for the decline is OBVIOUS to those of us who actually live in the USA .. the overall rate has declined due to the influx of folks from around the world, and due to the percentage of the population with multi-generational roots in the USA proper. For a fair comparison, once should, for example, compare the life expectancy (and health and wealth) of say, Norwegians with Americans of Norwegian descent. On those fronts the USA is still ahead – even further for Finns (maybe due to the fact that American Finns and Suomi have evolved a culture not centered around the consumption of alcohol (not judging, sober people are not more fun to hang with – everything’s a trade-off).