The United States has lower life expectancy than most similarly wealthy nations
nature.com
nature.com
While the lifestyle of many Americans leaves a lot to be desired, I do recognize that many parts of the US have weather/climate that is prohibitive for outdoor activity much of the year and these places tend to be fat. If you look at the life expectancies in parts of the US that are known for having human friendly weather and outdoor activity, they tend to be among the highest in the country with low obesity rates to match, but this is confounded by geography and genetics.
It is complicated. The causes are sufficiently diverse and regional that the solutions need to be local.
The US (330m), Japan (120m), and Italy (60m) are all large countries, and in the US and Italy's case, extremely federalized with social service delivery responsibilities falling onto subnational governments.
And for large developed countries like the US, UK, France, Germany, Italy, Japan, etc their developmental indicators have largely converged at a macro-level (the difference in living standards between countries with a national HDI of 0.900, 0.920, and 0.940 are marginal), but spatial inequality continues to act as a persistent laggard.
Outliers matter. This is like statistics/EDA 101.
P.S. If you do EDA on Japan versus US from an HDI perspective, you find that the Southern Kanto region (ie. Greater Tokyo) tends to skew Japanese statistics - with a subnational HDI comparable to MA - but the rest of the subnational regions of Japan have HDIs comparable to Tennessee (0.890-0.900) or Florida (0.920-0.930).
What this highlights is that public service delivery is stronger in the Greater Tokyo region than the rest of Japan.
And this is unsurprisingly a major topic of discussion in Japanese policymaking as well, as the poorer regions have seen a massive youth flight to Tokyo.
Same with the less developed regions of the US as well.
When you do a similar spatial analysis of the US, you find the Deep South (MS, AL, AR, LA), Appalachia (WV, TN, KY), and MO continuing to lag. You also end up identifying rust belt states like MI and OH starting to lag.
The interest thing is, the Deep South and Appalachia didn't seem to lag in the early 1990s compared to the rest of the states, but remained stuck at 1990s levels while other states improved significantly in the 2000s and 2010s, and it was these states that regressed the most in the COVID years (2020-2022) [0]. My running theory is that these states were the kinds of states where low value single factory/industry towns (eg. Textiles) were most prominent, and were the worst hit by a mixture of NAFTA, China Shock, and the Great Recession.
This would also explain why GA, NC, and SC didn't see the same laggardness despite being comparable with the rest of the south in the 1990s - Atlanta, Charlotte, RTP, Greenville, and Columbia were industrialized enough in high value industries like automotive and power systems and had significant additional industries like Finance and Tech that allowed them to upskill and diversify.
[0] - https://globaldatalab.org/shdi/table/healthindex/USA/?levels...
At a macro-level or even for larger states of the US like California or Texas, not really.
Due to birth records being lost in war time bombing, I just need to find a citation to support this beyond that of a few podcasts.
Værsgo:
https://www.ucl.ac.uk/ioe/news/2024/sep/ucl-demographers-wor...
https://theconversation.com/the-data-on-extreme-human-ageing...
Discussed here 9 months ago:
https://news.ycombinator.com/item?id=41597415
Reddit discussion seems to tackle this research more critically:
https://old.reddit.com/r/longevity/comments/1fhcfvu/the_data...
"Blue zones as health miracle" is overstated. "Blue zones as simple fraud" is overstated.
sounds fairly fraudy.
This is completely untrue. In fact, most of the fattest states are in the south. A number of the fittest states are in the north, including Alaska, as well as Minnesota. https://www.forbes.com/sites/garystoller/2019/11/12/9-states...
The populated parts of Alaska have mild climates similar to the Pacific Northwest, certainly more pleasant than the Midwest and not nearly as cold in winter. The high desert (e.g. Utah, Colorado) similarly has a pleasant low-humidity climate most of the year that is conducive to outdoor activity.
I just have to laugh at this. Have you lived in the Midwest? We have suffocating heat and humidity too, in fact the past several days. In the winter, we have biting cold windchills. And guess what, we also rely on air conditioning!
Two other factors worth noting: exercise does not depend on the outdoors. There are gyms, etc. Moreover, obesity does not depend entirely on lack of exercise; diet is a major factor too. Indeed, many would argue that diet is the more important factor.
I don't know much about the Midwest but I grew up in Massachusetts (one of those northern states with good health & life expectancy but a reputation for bad weather) and my sister lived in Houston for a decade (which has mediocre life expectancy and bad weather). In Massachusetts, the winters were cold and snowy, the summers are hot and humid, and you had about 3 weeks of good weather in the spring and 2 weeks in the fall, but you sucked it up and went outside anyway. The snow wasn't going to shovel itself. In Texas, you stay inside in your nice air conditioned home all the time, unless you're getting into your nice air conditioned car to drive to a nice air conditioned indoor place. Nobody goes outside.
I'm in California now, in a town that is both hilly and walkable, and a lot of the residents here live to 95. When you're climbing the equivalent of 200 stairs each time you drop your kid off at school, you get a lot of background exercise without really trying.
I'm fairly convinced that exercise or the lack thereof and relatedly the rate at which people go outside is a major predictor of health outcomes.
To each their own, I guess, but I immediately thought of Midwest winters.
> borderline uninhabitable without air conditioning
The south was inhabited long before air conditioning was invented.
> In Massachusetts, the winters were cold and snowy, the summers are hot and humid, and you had about 3 weeks of good weather in the spring and 2 weeks in the fall
Minnesota is like that too, except the winters are colder and the summers hotter.
> you sucked it up and went outside anyway
Indeed, it's a choice. People exercise in all types of weather, hot and humid or cold and bitter.
> unless you're getting into your nice air conditioned car to drive to a nice air conditioned indoor place
Like the gym, for example?
> Nobody goes outside.
That's false, but in any case it's a choice.
> I'm fairly convinced that exercise or the lack thereof... is a major predictor of health outcomes.
Of course it is. But you completely ignored my statements about diet.
> and relatedly the rate at which people go outside
This is a different matter. Speaking personally, I almost always exercise indoors nowadays.
Also the gym fucking sucks so I don't know why we are pretending it's a viable replacement for liveable climate. I don't go to the gym, but I ride my bike. I even ride it in extreme heat, like yesterday the heat index was over 100. Still won't catch me wasting my life doing boring exercise I hate in a gym.
And it's miserable in the Midwest without AC too.
> 90+ on the other hand is not manageable, even in low humidity
Ridiculous. I have a lot of family in Arizona, where it's 90+ with low humity all the time. It's very manageable.
Also, let's not pretend it's 90+ all day all year in the south. It's not. Not even close:
http://www.worldclimate.com/climate/us/mississippi
> Also the gym fucking sucks so I don't know why we are pretending it's a viable replacement for liveable climate.
Ok, that's your opinion, but millions of people go to gyms, and millions more use indoor exercise equipment in their homes.
For me personally, it's a 100% viable replacement.
It's "very manageable" as in, safe to sprint and exercise rigorously for people who aren't already heat conditioned athletes?
Yes people use gyms. Vastly many more don't.
No, and no. Because both would be gross exaggerations.
My point is that both Minnesota and Mississippi, for example, have many days a year that are good for outdoor activites and many days a year that are not good for outdoor activities. The climate of Minnesota is no less hostile than the climate of Mississippi. Thus, differences in climate do not explain why Minnesota is one of the fittest states and Mississippi one of the fattest.
Needless to say, these are only relative differences. There are many fit people in both states, and many fat people in both states. When commenters say crap like, "Nobody goes outside", it's an absurd hyperbole, and it undermines the argument.
Can a worker who does not earn six figures and who does not have large savings afford treatment for diabetes, cancer, heart disease, or proper time to heal after an accident?
Go to the dentist when they have a toothache, or to the general physician when they have a flu or even a severe cold?
There is no paid sick leave, right?
I'm asking this in earnest, because it is not clear to me what the minimum public healthcare currently covers in the US?
Being sick or even chronically ill when you are not wealthy is already likely to make you poor even in places with broad public healthcare in Europe, if you are in bad luck.
But if you aren't given a minimum life support when sick (1-room flat, money for food) and no treatment in such a situation, you'll likely to end up homeless or die from your disease while grinding in your low-paid job until the end, no?
That jumped out at me, because, unfortunately, it seems it's become unpopular, or even offensive, to claim there's a link between obesity and poor health/lower life expectancy. I've heard of doctors refusing to recommend weight loss to their patients for fear of being accused of "body shaming".
My guess is that doctors typically understand that the patient already knows they’re obese, and therefore tries to get them to do something, anything, that’ll help.
Wild story, either way. I expect professionals to be better.
That being said, I'm gonna file "doctors are afraid to tell patients they're obese because they'll be accused of body shaming" next to "they're putting litter boxes in the classrooms so the furries can poop in front of everyone" and "strangers are putting LSD in halloween candy to get kids hooked". It's 100% made up rage bait and the people who believe it believe it because they hear it all the time from their propaganda echo chambers.
The reality is that patients do not listen and do not have the tools to make changes. A lot of these people are barely living life, they're just on autopilot.
Riddle me this: were you trying to lose weight as a course of treatment for some other thing that was happening or were you trying to lose weight for its own sake? I'm wondering if the doctor actually thinks that being overweight is fine or if they were just saying you don't have any particular condition that being overweight would treat or relieve. I don't mean to call you out in particular, it's just that your experience is directly opposite to anything I've experienced or been told about as someone who was overweight and went to doctors about it and as someone whose entirely family has always been in healthcare in some way or another (a couple doctors, several nurses, I'm in med tech alongside a couple cousins and my dad runs a power plant but even he runs a power plant owned by a hospital system).
But no, I had no active medical conditions and this was the first time I saw this doctor. So, he didn't really know my medical history anyways.
The weight loss was really the entire reason I went in. But over my medical history I've had a lot of experiences like this where doctors really aren't very helpful. Or at least, they don't have enough time to actually think beyond the 10 most common things that happen to people.
This was in 2018, before GLP-1's, and I wasn't looking for medication.
It’s true that in Japan people walk a lot more, but I think good nutrition and eating habits from a young age are a key factor in why people don’t get fat here. Also, if you want “fast food”, ramen or teishoku is faster than McDonalds.
I'm a healthy weight and every single time I speak to my GP they talk about diet and exercise and the importance of maintaining a healthy weight. I can think of no health advice I have received more than "control your weight." Not even "don't smoke."
I've literally never heard of this, in fact I've heard hundreds of stories about doctors refusing to put any effort into giving people a real diagnosis if they're even the slightest bit overweight.
* https://jamanetwork.com/journals/jamainternalmedicine/fullar...
* https://www.sciencedirect.com/science/article/pii/S259022962...
I wonder how much of this is because of America's embrace of liberty. If you give people choices, some of them will inevitably make stupid choices.
But yes, US poverty is much worse than poverty in other countries. But the flip side is also true - it's generally better being rich in America than in Canada, for example.
You must be restricting your thinking to other Western countries, because there are a lot of areas on Earth that look like hell. At least no part of the US is in a constant state of war.
We spend $1.3 trillion dollars per year on medicaid, HUD, Food Stamps, and refundable "tax credits" like the earned income credit and child tax credit. That's $32,500 of spending for each of the 40 million Americans who live "in poverty" (before including state-run programs and private charities like churches and food banks), meaning our welfare spending per "poor indvidual is higher than the median income for an EU household.
America's poor are doing just fine.
I'm not sure how many pockets of, say, the Netherlands, look like Gary, Indiana.
My understanding is that the amount of money spent on people in poverty isn't the problem. The problem is that it's spent so inefficiently due to an insistence from certain parts of the electorate on not making things "too easy" for such people. It would probably actually be cheaper to have european-style welfare state, provide housing for the homeless, etc.
See also: the US spending many times what other countries spend on healthcare without actually getting better care.
https://www.brown.edu/news/2025-04-02/wealth-mortality-gap
The US also have less healthy years.
> Just as in other countries, chronic conditions like heart disease are major factors in how many years Americans remain alive but in poor health. But, the authors add, a high burden of mental health and behavioral conditions — which the WHO groups together, and include depression, anxiety and addictions to alcohol and drugs — are also weighing heavily on our health span, as well as curtailing life expectancy in the U.S.
> Underpinning both chronic diseases and what are sometimes called deaths or diseases of “despair,” such as addiction, is the prevalence of loneliness, stress and inequality in the U.S., Gurven says. “It’s hard to avoid that living in a highly unequal society is stressful and that takes a toll on our health in so many ways,” he says. That inequality affects not only access to health care, but can also be seen in how little opportunity there is for Americans in many parts of the country to get physical activity or healthy meals in their busy days, helping to fuel the obesity epidemic, which, in turn, curtails health span.
https://www.yahoo.com/lifestyle/the-us-has-the-biggest-lifes...
> Five times more people died as a result of substance misuse in the United States in 2021 than the comparable country average.
No, that's not a fact.
https://en.wikipedia.org/wiki/Demographics_of_the_United_Sta...
https://en.wikipedia.org/wiki/Demographics_of_Canada?#Visibl...
I think I've heard this argument before in the context of gun violence in the US - as in, the US wouldn't have a gun violence problem if we excluded cities like Chicago and Baltimore from gun violence research. Is this the same basic argument?
Talking about behavior patterns of US people like they're all part of a single nation stopped making sense long ago if it ever did.
One, you're a public health official or maybe even just a voter trying to weigh various policy options or assess the success of what has already been done. In this case, sure, you have to care about national averages and other measures of central tendency and ways to characterize distributions.
Two, you're an individual American trying to figure out how much you should worry about an early death. In this case, national averages or even per-culture averages seemingly mean next to nothing for you. I can't speak for all Americans, but I expect to outlive the average by quite a bit.
For gun violence, it's often travelers and visitors worried they're going to get shot if they come to the US, and we're trying to tell them that whether they really need to worry heavily depends on where they're visiting. Even if they're actually visiting Chicago or Baltimore, gunshot deaths in tourist districts are damn near unheard of, and besides which, the vast majority of people ever killed by guns at all are either killed by themselves or someone who knows them. There aren't a whole lot of random stranger attacks happening anywhere.
Facts have a clear racist bias.
Alternatively, if Canadian Whites and Blacks live proportionally longer than American Whites and Blacks respectively, you would know that demographics could not explain the difference.
Hence the need for the disaggregated data.
That's still an abysmal thing, as the US would have something like 30% of their population getting clearly worse health and not caring or doing anything about it?
If the difference is down to demographics, surely that's really bad?
If you want to get anything done, then hell yes! If life expectancy is low in Concord because of too many Doritos, but it's low in Phoenix because of a bad medical system, and it's mysteriously high in Fresno, you very much want to disaggregate. And you definitely don't want to ask "What is going so well in 'the U.S.'(Fresno)?" and then look at Concord.
Ok, but it is a lagging indicator. Hopefully there are faster ways to measure it.
https://hdpulse.nimhd.nih.gov/data-portal/mortality/map?cod=...
> The biggest difference in death rates has been in people aged 15–49 (see ‘Early deaths’). Among these younger people, the death rate has been falling much more slowly in the United States than in peer countries — and it spiked drastically owing to COVID-19. “More people die younger,” says Lynne Cotter, a senior health-policy researcher at KFF. And because young deaths erase more years of life than do older ones, they drag down overall life expectancy.
> Overall, chronic conditions — heart disease, cancer, stroke and respiratory disease — take up four out of five spots on the country’s list of biggest killers.
> As of 2022, about 42% of adults were considered obese in the United States, compared with 27% in the United Kingdom and 5.5% in Japan. Obesity increases the risks of developing diabetes, heart disease, cancer and many other conditions.
> Research supports Kennedy’s argument that ultra-processed foods might be partly to blame for poor health. Their consumption has been linked to increased risks of obesity and some other chronic diseases, and is relatively high in the United States. Such foods comprise an estimated 58% of US daily energy intake — similar to that in the United Kingdom, but greater than the 48% in Canada and 31% in France3.
> Deaths from substance misuse are explained mainly by overdoses of synthetic opioids such as fentanyl — part of the US opioid crisis. Many Americans are killed in traffic accidents, partly because they tend to spend proportionately more time driving, and in bigger cars, than people in many other nations.
It looks like obesity promotes chronic disease and the younger demographic is dragging the life expectancy down.
Where?
https://hdpulse.nimhd.nih.gov/data-portal/mortality/map?cod=...
A higher concentration occurs in the south eastern quadrant of the US. This as I recall coincides with obesity rates.
What can I do personally? I guess eat less processed food, cook more at home, walk more, or engage in fun phisically active time. Even cleaning the house, yard care, home gardening, simple hikes, or walking while shopping can help. Chosing stairs over elevators, that kind of thing.
What can the government do to help? Maybe regulating sugar additives and plastic use in food containers? Limiting the use of seed oils in convenience foods, in favor of healthier options? Build back a strong middle class would go a long way towards preventing the other causes too. Drugs and gun deaths are linked to poverty. The closer the middle class is pushed to the poverty line the more those things increase. I suppose there's some merit to preventing the illegal import (smuggling?) of drugs like fentanyl, which in that case requires a harder stance on import from China. I dunno guys. I'm throwing darts at a wall here...
If you want to eat junk then fine but there's something going wrong if it's the cheapest, most convenient option available
- Poor diet
- Low levels of exercise due to car dependence
- Difficulty accessing healthcare
- General lack of safety net for the poor
I once had a doctor order a test at a hospital that he assured me was in network. The hospital got pre-authorization from my insurance company for me to have the test done. I had the test done. My insurance company then denied me any benefit because they said afterward that I went out of network … and there are millions of stories like mine.
Not to mention that even if you manage to stay in network, lots of people cannot afford even the max out of pocket that creeps up faster than inflation every year.
I have had some family members decide that they will just accept that they are going to die in an emergency situation because “if it’s my time, it’s my time” and they don’t want their life savings to get vacuumed up by some hospital administrators. This is not merely theoretical… one person in my life is dead now who probably would have lived if he had felt comfortable seeking medical care.
So I just wanted to highlight that even if those problems don’t exist, you still have the scary unknown cost question that might be the largest impediment of all.
1: https://www.cia.gov/the-world-factbook/field/alcohol-consump...
https://en.m.wikipedia.org/wiki/List_of_countries_by_alcohol...
And anecdotally, any corporate event I’ve attended in the US is dry or 1 drink. Which is a pretty stark difference from when I’ve visited European colleagues.