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

Annu Rev Public Health. 2014:35:307-25. doi: 10.1146/annurev-publhealth-032013-182411. Epub 2014 Jan 9.


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Age Factors
  • Cause of Death
  • Delivery of Health Care / organization & administration
  • Developed Countries / statistics & numerical data*
  • Environment
  • Female
  • Global Health / statistics & numerical data*
  • Health Behavior
  • Health Status*
  • Humans
  • Life Expectancy*
  • Life Style
  • Male
  • Policy
  • Public Health*
  • Residence Characteristics / statistics & numerical data
  • Sex Factors
  • Socioeconomic Factors
  • United States