Steve Utkus is a visiting scholar at the Wharton School of the University of Pennsylvania and Georgetown University. He previously worked in a research capacity at Vanguard.
What does the U.S. have in common with countries like Panama and Estonia? Or Malaysia and Serbia?
It turns out a lot, in terms of life and health outcomes. When it comes to human life expectancy, or the number of years a newborn baby is expected to live, the U.S. ranks 55th in the world, shown in the left panel of the table below, between Panama (54th) and Estonia (56th). That’s right: not #1, not in the top 10, or for that matter not even in the top 50 countries. Number 55.
Life expectancy and healthspan rankings
| Rank | Nation | Life expectancy @birth | Rank | Country | Healthspan |
| #54 | Panama | 79.6 years | #70 | Malaysia | 63.9 years |
| #55 | U.S.A. | 79.3 years | #71 | U.S.A. | 63.9 years |
| #56 | Estonia | 79.2 years | #72 | Serbia | 63.9 years |
Source: U.N. Population Division and World Health Organization.
The U.S. ranks even more poorly when it comes to healthspan, defined as the number of years of healthy life before the onset of the diseases of old age. As shown on the right panel, the US ranks 71st in the world, with our peer countries being Malaysia (#70) and Serbia (#72).
Facts like these are igniting popular and policy interest in improving American health outcomes. My recent paper with co-author Olivia S. Mitchell takes up the challenge these efforts will face. In our paper, we reviewed recent research on both lifespans and healthspans, including how they are defined and measured, what factors influence them, and the science underlying aging and declining health. We also identified actions that families, employers, business innovators, and policymakers might take to help.
Start with the Facts.
But before we can discuss what to do, which we shall take up in future blogs, we must start with a grounding in the numbers. Here the news is not good. While the US is a pre-eminent economic and military power, our life and health outcomes are substantially behind those of our rich-country peers, France, Germany, Spain and Italy in Europe; Japan, Singapore and South Korea in Asia; and other English-speaking countries like Canada, the United Kingdom, and Australia. To put it starkly, Americans get sicker faster, and die earlier, than people in other high-income countries around the globe.
It is true that U.S. outcomes have improved over the decades, so there has been progress. But other countries have improved at a much faster pace, leaving the U.S. to fall behind in the rankings since the end of World War II. It is as if the U.S. has moved from sixth grade to high school over the last 70 years, while our economic peers have made it through college.
Why has the US done so poorly?
There are many explanations for the U.S.’s disappointing relative performance. For one thing, the American healthcare system does a terrible job of keeping babies alive: U.S. infant mortality is #54. America is the home of junk food and the car, leading to poor diets and lack of activity, both of which promote obesity and chronic disease. As a result, we are losing a rising share of middle-aged Americans to heart, metabolic and related disorders, more so than in other rich countries. On top of this, far too many young Americans die due to gun violence, suicide, alcohol, and drugs.
To this long list one could add numerous other factors plausibly associated with life and health outcomes. One is that the US health system is fragmented and expensive, and it has focused on managing disease rather than on healthy living. Social elements play a role, including loneliness and social isolation. The stress of everyday life and work, plus environmental exposures and toxins, also are factors. Yet the research cannot yet definitively quantify exactly which factors are most critical: that is, whether consuming junk food is twice as bad as work stress and lack of vacation time, or whether poor (or no) health insurance is three times worse than environmental toxins.
Wealth in America doesn’t buy health.
If some readers assume that being better off will insulate them from these concerns, they will need to rethink that assumption. One recent study found that the richest quarter of all Americans had a life expectancy that is on par with the poorest quarter of northern and western Europeans. Wealthier Americans do live longer and healthier lives than poor Americans. But they do not necessarily live longer and better lives than peers (or even less wealthy counterparts) in other countries.
The good news is that concerns over US lifespans and healthspans are now receiving a great deal of public attention. The bad news: A considerable effort lies ahead.
Views of our Guest Bloggers are theirs alone, and not of the Pension Research Council, the Wharton School, or the University of Pennsylvania.
