America is not the unhealthiest country in the world, but it consistently ranks last or near last among wealthy nations on nearly every major health measure. That gap is striking because the U.S. spends more on healthcare than any other country by a wide margin. Among the 30+ large, high-income nations it’s typically compared to, the U.S. has the lowest life expectancy, the highest rates of chronic disease, and some of the worst outcomes for mothers and infants.
Life Expectancy: Last Among Peers
Life expectancy at birth in the U.S. reached 78.4 years in 2023, rebounding from pandemic lows but still trailing every comparable wealthy nation. Countries like Japan, Switzerland, Australia, and most of Western Europe routinely clear 80 to 84 years. The U.S. ranks lowest in life expectancy for both men and women among countries with high GDP per capita, a position it has held for years.
To put this in perspective, the gap between the U.S. and the top-performing countries is roughly four to six years of life. That difference isn’t explained by genetics or geography. It reflects the cumulative toll of chronic disease, limited access to preventive care, and lifestyle factors that play out across an entire population.
Obesity and Diabetes Rates Dwarf Other Nations
About 40.3% of American adults have obesity, a figure that has remained stubbornly above the national public health target of 36%. While obesity is rising in most wealthy countries, no peer nation comes close to the U.S. rate. The United Kingdom and Australia, often cited as the next-closest, hover in the upper 20s to low 30s.
Diabetes tells a similar story. The age-adjusted diabetes prevalence among U.S. adults aged 20 to 79 is 13.7%, according to the International Diabetes Federation’s 2024 data. Compare that to the rest of the G7: Canada sits at 7.7%, Germany at 7.8%, Japan at 8.1%, the U.K. at 7.4%, Italy at 7.7%, and France at 6.5%. The U.S. rate is nearly double that of most peer nations and more than double France’s.
More Preventable Deaths, Not Fewer
One of the most damning comparisons involves “avoidable mortality,” deaths that could have been prevented through public health measures or timely medical treatment. Between 2009 and 2019, avoidable mortality increased across all U.S. states, rising by a median of 29 deaths per 100,000 people. During that same decade, most EU and OECD countries saw their avoidable death rates drop by about 14 per 100,000.
By 2019, the median avoidable mortality rate across U.S. states had climbed to roughly 283 per 100,000, while comparable countries had fallen to about 187 per 100,000. The COVID-19 pandemic widened the gap further. From 2019 to 2021, avoidable mortality jumped by a median of 101.5 per 100,000 across U.S. states, compared to 25.8 in peer countries. A 2025 study published on PubMed concluded that “broad, systemic factors” are driving worsening U.S. population health, not isolated problems in specific states or demographics.
Maternal and Infant Health Lag Behind
The U.S. infant mortality rate is approximately 5.6 deaths per 1,000 live births in recent years, but historical data shows it has long exceeded European averages. In comparable studies, the U.S. rate runs about 1.5 to 2.5 deaths per 1,000 higher than peer European nations, even after adjusting for differences in how countries register extremely premature births. The U.S. rate in broader international rankings has placed it alongside countries like Croatia, despite having nearly three times the GDP per capita.
Maternal mortality follows the same pattern. High-income countries average about 10 maternal deaths per 100,000 live births. The U.S. rate has been roughly two to three times that figure in recent years, making it the most dangerous wealthy country in which to give birth. Black women in the U.S. face maternal death rates several times higher still, a disparity that no other high-income nation matches.
Spending the Most, Getting the Least
What makes these numbers especially difficult to explain away is the money involved. The U.S. spent over $14,880 per person on healthcare in 2024, according to OECD estimates. The average across wealthy nations was about $6,000. That means the U.S. spends 2.5 times what its peers spend per person and gets worse results on virtually every population health metric.
That spending doesn’t translate into better access, either. More than one in four Americans report skipping doctor’s visits, tests, treatments, or follow-up care because of cost. Twenty-one percent report skipping prescribed medication. Even though only about 9.2% of the population is formally uninsured, cost remains a barrier for millions who technically have coverage. In countries with universal healthcare systems, these cost-related access problems are far less common.
Diet Plays a Bigger Role Than Most Realize
About 60% of calories consumed by Americans come from ultra-processed foods: items like packaged snacks, sugary drinks, ready-to-eat meals, and processed meats. In European countries, ultra-processed food consumption ranges from 14% to 44% of total energy intake, with many nations falling well below the U.S. figure. The U.S. leads the world in ultra-processed food consumption, and research has consistently linked these foods to higher rates of obesity, type 2 diabetes, heart disease, and certain cancers.
This isn’t purely a matter of personal choice. A 2024 analysis found that ultra-processed foods dominate mainstream U.S. supermarkets, often forcing consumers to choose between health and cost. Healthier whole foods tend to be more expensive per calorie, and food deserts in lower-income areas limit access further. European countries, by contrast, have stricter regulations on food additives and marketing, and their food environments tend to make minimally processed options more accessible.
So Is America the Unhealthiest Country?
Globally, no. Dozens of low-income countries in sub-Saharan Africa and South Asia have far lower life expectancies, higher rates of infectious disease, and fewer healthcare resources. By those absolute measures, the U.S. is nowhere near the bottom.
But among the 30 to 40 nations it should be compared to, countries with similar wealth, education levels, and medical infrastructure, the U.S. performs worst or near worst on life expectancy, obesity, diabetes, infant mortality, maternal mortality, and preventable deaths. It does this while spending more than any of them. The problem isn’t a lack of medical technology or talent. It’s a combination of how care is financed and accessed, what people eat, and how public health infrastructure has eroded relative to peer nations over the past two decades.