Why the life-expectancy rate in the United States is falling behind that in other rich countries
By Kelli María Korducki
Compared with its wealthy peer nations, the United States is failing the most basic test of a civilization: keeping its denizens alive. As my colleague Derek Thompson wrote last week, U.S. life spans are shorter on average than in much of Europe, Japan, South Korea, and Australia. I called Derek to discuss why the nation’s life-expectancy rate is falling behind, and what can be done about it.
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The Mortality Tax
Kelli María Korducki: In your latest article, you repeat a turn of phrase that you used in a previous story, calling the U.S. a “rich death trap.” The rich part is pretty self-explanatory, but unpack the rest of it.
Derek Thompson: The appropriate context is that, over the past 30 years or so, U.S. life spans have increased a little bit, but way behind the pace of similarly rich countries like Western Europe, Japan, South Korea, and Australia. This is a pretty shocking development because throughout economic history, people living in richer countries have generally lived longer. And yet in the U.S.—which is the richest country in the world—we’re not getting the long lives that we would expect. So you could say that there is a mortality tax on being an American as opposed to being French or Japanese, for example.
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Kelli: When does this mortality tax emerge in the data?
Derek: You start to see it in the 1980s, but it really picks up in the 1990s. That’s where we really start to see this life-expectancy divergence.
Kelli: What might have happened in the 1980s and ’90s to stagnate life-expectancy increases here in the States but not abroad?
Derek: You could look at guns. Clearly, we have more gun deaths here than in other countries. And you can look at car deaths, which we also have more of than in similarly rich countries. But gun deaths per capita and car deaths per capita haven’t clearly increased a lot in the past 30 years. So that leaves things like drug overdoses, obesity, and health inequalities. But the truth is that health-care access has actually probably gotten more equal in the past 30 years; we passed Obamacare, which has extended Medicaid and all sorts of health care to low-income individuals. My bet, then, is that the growing gap between American longevity and that of other rich countries, at least in the past 30 years, is being driven by our poor health, specifically, more drug addiction, more drug-overdose deaths, and a higher risk of obesity.
Kelli: And despite Obamacare and broadly expanded health-care access, there’s also still a pretty significant health-care gap in the U.S.
Derek: That’s absolutely the case, and health outcomes are much more unequal in the U.S. than in countries with universal health care, where you tend to see that life spans in poor areas and rich areas are pretty similar; in the U.S. they’re much more different. Where you’re born in the U.S., and how much income your parents have, is much more determinative of how long you’ll live.
Kelli: What would it take to make America less of a death trap?
Derek: It’s a really big question. I would say that this conversation needs to be about all of these things that are driving our mortality: thinking more about ways to reduce obesity in America and talking more about the importance of exercise for metabolic health. And we have to reduce synthetic opioid overdoses (primarily fentanyl), which kill more than 70,000 people in the U.S. every year.
This is sort of an aside, but there are almost two separate opioid crises happening in the country right now. One is the opioid-prescription-addiction crisis with the Sackler family and Purdue Pharma at its center, and then there’s the fentanyl crisis. Nearly 17,000 people a year are dying of opioid-prescription addiction—that is, from the abuse of opioids that were prescribed by a doctor—and about 70,000 people died of fentanyl overdoses in 2021. So the fentanyl crisis is four times deadlier than the opioid crisis that we’re used to talking about, but it doesn’t really occupy that much attention from lawmakers. I think we could use some really hard thinking about how to bend the curve of fentanyl abuse.
Kelli: What about the other American death drivers you mention in your article? Cars, guns?
Derek: So far, it seems that a little bit more working from home is probably good for reducing car use and related deaths. More housing in downtown areas that would reduce the need for driving commutes would probably also be good. And when it comes to guns, I can think of some pretty clear policy ideas for reducing gun deaths but, man, I’m not particularly optimistic about their ability to be passed at the federal level.
Kelli María Korducki is a senior editor at The Atlantic.
