Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2014:35:307-25.
doi: 10.1146/annurev-publhealth-032013-182411. Epub 2014 Jan 9.

Why do Americans have shorter life expectancy and worse health than do people in other high-income countries?

Mauricio Avendano  1 , Ichiro Kawachi
Affiliations
Review

Why do Americans have shorter life expectancy and worse health than do people in other high-income countries?

Mauricio Avendano et al. Annu Rev Public Health. 2014.

Abstract

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Life expectancy at birth in the US and 16 other OECD countries, 1960–2010 Source: OECD Health Data, OECD Health Statistics (Database)(70)
Figure 2
Figure 2
Mortality from external causes, maternal conditions and infections in the US and other high-income countries, 1960–2010, women Source: OECD Health Data, OECD Health Statistics (Database)(70)
Figure 3
Figure 3
Mortality from non-communicable diseases in the US and other high income countries, 1960–2010, women Source: OECD Health Data, OECD Health Statistics (Database)(70)
Figure 4
Figure 4
Prevalence of chronic disease and disability among men and women aged 50 years and older in the United States, England, and Europe: HRS, United States, 2004; ELSA, England, 2004; and SHARE, Europe, 2004 AT is Austria, DE is Germany, SE is Sweden, NL is the Netherlands, ES is Spain, IT is Italy, FR is France, DK is Denmark, GR is Greece, CH is Switzerland, US is United States, and EN is England
See this image and copyright information in PMC

References

    1. Alesina A, Glaeser E, Sacerdote B. Why Doesn't the United States Have a European-Style Welfare State? Brookings Papers on Economic Activity. 2001;2:187–277.
    1. Alley DE, LLoyd A, Shardell M. Can Obesity Account for Cross-National Differences in Life-Expectancy Trends? In: Crimmins E, Preston S, Cohen B, editors. International Differences in Mortality at Older Ages: Dimensions and Sources. Washington, D.C.: The National Academies Press; 2010. pp. 313–332. - PubMed
    1. Almond D, Hoynes HW, Schanzenbach DW. Inside the War on Poverty: The Impact of Food Stamps on Birth Outcomes. Review of Economics and Statistics. 2011;93:387–403.
    1. Avendano M, Glymour M. Obesity doesn't explain U.S.-Europe disparities. Health Aff (Millwood) 2008;27:298. - PubMed
    1. Avendano M, Glymour MM, Banks J, Mackenbach JP. Health disadvantage in US adults aged 50 to 74 years: a comparison of the health of rich and poor Americans with that of Europeans. Am J Public Health. 2009;99:540–548. - PMC - PubMed

Publication types

LinkOut - more resources