Why Do Americans Have Shorter Life Expectancy and Worse Health Than Do People in Other High-Income Countries?
Open accessAbstract
Americans lead shorter and less healthy lives than do people in other high-income countries. We review the evidence and explanations for these variations in longevity and health. Our overview suggests that the US health disadvantage applies to multiple mortality and morbidity outcomes. The American health disadvantage begins at birth and extends across the life course, and it is particularly marked for American women and for regions in the US South and Midwest. Proposed explanations include differences in health care, individual behaviors, socioeconomic inequalities, and the built physical environment. Although these factors may contribute to poorer health in America, a focus on proximal causes fails to adequately account for the ubiquity of the US health disadvantage across the life course. We discuss the role of specific public policies and conclude that while multiple causes are implicated, crucial differences in social policy might underlie an important part of the US health disadvantage.
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The USA has higher co-morbidities in working-age groups compared with European populations, with greater vulnerability to COVID-19.
“Despite having a younger population, the USA also has higher co-morbidities in these age groups compared with European populations with greater vulnerability to COVID-19.42,43”
From Quantifying impacts of the COVID-19 pandemic through life-expectancy losses: a population-level study of 29 countries (2022) · cites this paper as [42]
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References 107 · Cited by 195
Research works printed but not linked: 2
- [64]National Academy of Science Panel Explaining Divergent Levels of Longevity in High-Income Countries 2010 Washington, D.C. 21977544
- [65]National Academy of Science Panel International Differences in Mortality at Older Ages: Dimensions and Sources 2011 Washington, D.C. 21977541
- Authors
- Avendano, M., & Kawachi, I.
- Affiliations
- Department of Social Policy, LSE Health and Social Care, London School of Economics and Political Science, London, WC2A 2AE, United Kingdom;,
- Harvard University (US)
- ORCID
- Kawachi, Ichiro
- Venue
- Annual Review of Public Health
- Publisher
- Annual Reviews
- Published
- 2014-03-18
- Volume
- 35
- Issue
- 1
- Pages
- 307-325
- ISSN
- 0163-7525 (ISSN-L)
- 1545-2093
- PMC
- PMC4112220
- OpenAlex
- W2145125061
- Cited by
- 195
- References
- 107
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 22 · 2023: 19 · 2022: 23 · 2021: 28 · 2020: 15 · 2019: 17 · 2018: 18 · 2017: 24 · 2016: 7 · 2015: 8 · 2014: 3
- FWCI
- 2.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Annual Review of Public Health (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- London School of Economics and Political Science Research Online (London School of Economics and Political Science) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- National Institutes of Health (5p30ag012815-25)
- National Institute on Aging (R01AG037398, U01 AG09740‐13S2, P30AG12815, P01AG08291, P01AG008291, 2R01AG7644-01A1, P30AG012815, R01AG040248, R21AG025169, R01AG017644, P01AG005842, U01AG009740, Y1-AG-4553–01)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
- Keywords
- life expectancy, health disparities, mortality, morbidity, life course, women's health, health care, health behavior, socioeconomic disparities, built environment, social policy, high-income countries comparison
- MeSH terms
- Age Factors, Cause of Death, Delivery of Health Care, Environment, Female, Health Status, Humans, Life Expectancy, Life Style, Male, Public Health, Residence Characteristics, Sex Factors, Socioeconomic Factors, United States, Global Health, Health Behavior, Developed Countries, Policy
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