U.S. Life Expectancy Is in Decline. Why Aren’t Other Countries Suffering the Same Problem?

Since 2015, the United States has seen a historic decline in life expectancy, in large part driven by the opioid epidemic and then the COVID-19 pandemic. The last two years marked the biggest drop in a century, with expectancy sinking to 76.1 years for Americans born in 2021, according to provisional data [PDF] from the U.S. Centers for Disease Control and Prevention (CDC). This is down from an average of around 79 years in 2019, an enormous difference considering health experts typically measure life expectancy shifts in months, not years.

The decline was more pronounced for some groups. In 2020–21 alone, life expectancy among American Indian and Alaska Native communities was shortened by two years, the largest drop of any demographic group. Their life expectancy is now the same as the total U.S. population’s was in 1944. White Americans saw a sharper drop in 2021 than Black and Hispanic Americans, though the latter groups were hit harder during the first year of the pandemic. The gender gap has also widened, with American women expected to live close to six years longer than men.

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Despite being a top spender on health care, the United States is an outlier among its peers on life expectancy. It sits well in the bottom half of countries in the Organization for Economic Cooperation and Development (OECD), a grouping of several dozen mostly high-income nations.

U.S. life expectancy was slightly above the global average of seventy-three years in 2020. (Japan’s was the highest, at eighty-five years, and the Central African Republic’s the lowest, at fifty-four.) Still, many countries that are poorer than the United States have higher life expectancies.

Moreover, research has found that, unlike the United States, other high-income countries are starting to rebound from life expectancy drops as the world learns how to better manage COVID-19. Places with highly successful vaccination campaigns and public willingness to adopt other preventive measures have generally fared better. Despite developing several leading COVID-19 vaccines and securing an abundant supply of them, the United States ranks toward the bottom of OECD countries for the share of people fully vaccinated against the disease. Vaccine hesitancy and resistance, driven by political polarization and misinformation, has been a particular challenge for U.S. vaccination campaigns.

The U.S. drop-off is mainly due to COVID-19. Increases in deaths due to the coronavirus disease accounted for just over half of the decline, according to the CDC. Since the pandemic’s start, COVID-19 has killed more than a million Americans, by far the highest reported death toll of any country; and in 2021, COVID-19 remained the third leading cause of death among Americans. But the CDC found that also higher was mortality due to unintentional injuries and heart disease, among other causes. The rise in unintentional injuries was driven by drug overdoses, as COVID-19 has exacerbated the country’s opioid epidemic.

However, experts say the pandemic and opioid crisis were not the start of the problem, that rather they upended an already fractured health system. “The broader deterioration in Americans’ health worsened the toll of the pandemic in this country, with higher rates of cardiovascular disease, obesity, and diabetes leading to more COVID-19 deaths than many other peer nations,” CFR’s Thomas J. Bollyky says. In comparisons of public health systems around the globe, the United States ranks at the bottom, lagging behind peers that offer universal health coverage, ensure equitable access to medical services, reduce administrative inefficiencies, and invest in welfare programs. More limited access to health care and increases in poverty amid the pandemic have only compounded the problem, especially for marginalized groups.

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The government is taking some steps to stop the troubling trend, though they are small compared to the comprehensive reforms researchers say would improve life expectancy rates. The Inflation Reduction Act, which was signed by President Joe Biden in August, contains several landmark provisions aimed at reducing health disparities. At the same time, the CDC announced that it will undertake sweeping reforms in response to criticism of its missteps during the pandemic, though it hasn’t released details of the plan. And Biden has continued efforts launched under previous administrations to curb the opioid crisis.

CFR’s Bollyky points to the link between the declining health of Americans and of the country’s political system, and he and other health experts say that there are no quick fixes to the trend. Many argue that alongside changes to the health-care system, improvements to infrastructure, the environment, and education would all help to influence individual behaviors such as diet, exercise, and drug and alcohol use.