The United States spends more on healthcare than any other country in the world, yet its people live shorter lives. In 2024, U.S. life expectancy reached a record high of 79 years, but that still falls 3.7 years short of the average among comparable high-income nations, which sits at 82.7 years. The gap isn’t explained by a single cause. It’s the result of several overlapping crises, from drug overdoses and gun violence to chronic disease and uneven access to care, all compounding in ways unique to the U.S.
A Gap That Has Been Growing for Decades
The U.S. hasn’t always been this far behind. Working-age Americans have had higher mortality rates than their peers in other wealthy countries since the 1960s, but the gap was relatively modest for years. Starting around 2000, it widened dramatically. The number of excess deaths among Americans under 65, compared to what would be expected in peer nations, doubled between 2000 and 2018. Then, between 2019 and 2021, it grew by an additional two-thirds, fueled by COVID-19 and the ongoing overdose epidemic.
That trajectory matters because it shows the problem isn’t static. It’s accelerating. While other wealthy countries saw their life expectancy climb steadily over the past two decades, the U.S. stalled and then fell backward during the pandemic. Life expectancy has rebounded somewhat since 2021, but data from California (one of the few states with complete 2024 vital statistics) suggests the country still hasn’t fully recovered to pre-pandemic levels.
The Drug Overdose Crisis
No single factor drags down U.S. life expectancy more visibly than drug overdoses. In 2022, opioid-related deaths alone reduced national life expectancy by 0.67 years, up from 0.52 years in 2019. That translates to roughly 3.1 million years of life lost collectively, with the average overdose death stealing about 38 years from a person’s life. These are overwhelmingly young and middle-aged people dying, which has an outsized effect on overall averages.
The impact falls unevenly. American Indian and Alaska Native men lost an estimated 1.5 years of life expectancy to opioid deaths in 2022, more than double the figure just three years earlier. Black men lost 1.1 years. Every racial and ethnic group saw the toll worsen between 2019 and 2022, driven by the spread of synthetic opioids like fentanyl and the increasing overlap between opioids and stimulants like methamphetamine. No peer country faces anything close to this scale of drug-related mortality.
Gun Violence
Firearms are the leading cause of death for children in the United States. Globally, the U.S. ranks at the 93rd percentile for overall firearm mortality, meaning it has a higher gun death rate than 93 percent of countries worldwide. For women, it’s the 96th percentile. In a recent year, more than 43,000 Americans died from firearms, and there were over 650 mass shootings.
These deaths contribute meaningfully to the life expectancy gap because they disproportionately kill young people. A 20-year-old killed by a gun loses far more potential life years than an 80-year-old dying of heart disease, so gun violence pulls down the national average more than raw death counts alone would suggest. Other high-income countries simply don’t experience firearm deaths at anywhere near this rate.
Chronic Disease Starts Earlier and Kills Faster
The U.S. has higher rates of obesity, diabetes, heart disease, and lung disease than comparable nations, and these conditions are hitting Americans at younger ages. From 2000 to 2019, increases in cardiometabolic diseases (conditions involving blood sugar, blood pressure, and cholesterol that damage the heart and blood vessels) were a major contributor to rising mortality among Americans under 65.
This connects directly to the healthcare spending paradox. The U.S. spent an average of $14,775 per person on health care in 2024, nearly double the $7,860 average among peer countries and almost $5,000 more per person than Switzerland, the next highest spender. Yet much of that spending goes toward treating advanced disease rather than preventing it. Americans are less likely to have a regular primary care doctor, more likely to skip care because of cost, and more likely to manage chronic conditions poorly due to fragmented insurance coverage. The money is there. It’s just not buying longer lives.
Maternal Deaths and Early Life
The U.S. is also an outlier in maternal health. In 2022, there were approximately 22 maternal deaths for every 100,000 live births, more than double and sometimes triple the rate in most other high-income countries. In half of the nations studied for comparison, the rate was below five per 100,000. American mothers die from pregnancy-related complications at rates that look more like a middle-income country than the wealthiest nation on earth.
High maternal mortality reflects broader problems: gaps in prenatal care, racial disparities in how pregnant patients are treated, and the patchwork nature of health insurance, where coverage can change or disappear in the months surrounding a birth. While maternal deaths alone don’t move the national life expectancy number by a large amount, they signal a healthcare system that underperforms at one of the most basic measures of population health.
Stark Differences Within the U.S.
National averages obscure enormous variation between states. A Yale School of Public Health study tracking a century of data found that for women born in some Southern states, life expectancy increased by fewer than three years across the entire 20th century. In New York and California, it rose by more than 20 years over the same period. That’s not a small gap. It means that where you live in the U.S. can matter as much for your longevity as which country you live in.
These geographic disparities track closely with poverty rates, access to healthcare, state-level policy differences, and the availability of healthy food and safe environments. A resident of a wealthy suburb of San Francisco and a resident of a rural county in Mississippi technically share a national life expectancy of 79 years, but their individual prospects may differ by a decade or more.
Why Spending More Hasn’t Helped
The most counterintuitive part of the U.S. life expectancy story is the price tag. At nearly $15,000 per person annually, Americans spend roughly twice what citizens of peer countries spend on health, yet they die younger. The disconnect comes down to how the money is spent and what it doesn’t cover.
A large share of U.S. healthcare dollars goes toward high-cost interventions, specialty care, and administrative overhead rather than the primary care, public health infrastructure, and social services that keep people healthy in the first place. Other wealthy countries invest more heavily in prevention: universal access to primary care, paid parental leave, robust addiction treatment systems, and safety net programs that reduce the stress and instability associated with poverty. The U.S. has chosen a system that excels at treating illness in those who can access it but does comparatively little to prevent illness across the entire population.
The result is a country where cutting-edge medical technology coexists with overdose epidemics, where world-class hospitals operate miles from neighborhoods with no primary care clinic, and where the average person lives nearly four fewer years than someone in Japan, Switzerland, or Australia.