Are Europeans Healthier Than Americans?

By most major health measures, Europeans live longer and get sick less often than Americans. A fifty-year-old American in 1975 could expect to outlive most Western European peers; by 2005, that advantage had flipped, and the gap has widened since. The divergence shows up not just in life expectancy but in rates of chronic disease, infant mortality, avoidable deaths, and disability. The reasons behind it are tangled up in how Americans eat, move, pay for care, and structure their communities compared to Europeans, and the picture gets more complicated once you recognize that “Europe” itself contains enormous health variation.

A Longevity Gap That Keeps Growing

The United States began falling behind peer nations on life expectancy in the 1950s, and the disadvantage has steadily worsened over the past four decades. Dozens of globally diverse countries now outperform the U.S., with the gap concentrated in the Midwest and South.¹ Research comparing the U.S. with Western Europe specifically found that by 2005, American life expectancy at age 50 had fallen behind most Western European countries, driven primarily by real declines in the health of near-elderly Americans relative to their European peers.²

This is not a small or ambiguous difference. The U.S. life expectancy disadvantage is now measured in years, not months, and it persists even when researchers control for factors like race, immigration, and measurement differences across countries. The trend is also moving in the wrong direction: between 2009 and 2019, total avoidable mortality increased across all U.S. states while it decreased in most high-income comparison countries.³ Americans are not just behind; they are falling further behind.

Chronic Disease Tells Much of the Story

One of the clearest differences between the two populations is how much chronic illness Americans carry. Compared to Europeans of the same age, Americans are roughly twice as likely to have hypertension, twice as likely to be obese, and twice as likely to have diabetes.² These are not marginal differences or artifacts of how doctors diagnose disease in different countries; researchers have found that the gaps persist even after adjusting for reporting and diagnostic differences.

A study using harmonized data from the Health and Retirement Study and its European equivalents found that close to a fifth of Americans in the older adult age range had heart disease, compared with about a tenth of Europeans. For most conditions examined, prevalence was 40 to 100 percent higher in the U.S. than in Europe.⁴ Across the board, disease prevalence and rates of medication treatment are substantially higher in the United States than in comparable European countries.⁵

The chronic disease burden matters beyond the immediate suffering it causes. It drives healthcare costs, reduces disability-free years, and contributes directly to the life expectancy gap. Americans are not just diagnosed more often; they live with these conditions longer and accumulate more of them simultaneously.

What Americans Eat and What They Can Buy

Diet is one of the most commonly cited explanations for the health gap, and the evidence supports it, though the story is more about the food environment than individual willpower. A comparison of staple products at major supermarkets in the U.S. and Europe found that about 58 percent of products at Walmart and Target were ultra-processed, compared with 41 percent at comparable stores in France and Spain. American supermarkets carried roughly 41 percent more ultra-processed products overall, and the ultra-processed items in the U.S. contained 41 percent more markers of ultra-processing, such as artificial colors, emulsifiers, and flavor enhancers. About 60 percent of ultra-processed products in the U.S. had three or more such markers, compared with 38 percent in Europe.⁶

This does not mean Europeans avoid ultra-processed food entirely. European consumption varies widely by country, and surveys across the continent have found that countries with higher sugar intake also tend to have a higher energy share from ultra-processed foods.⁷ But the baseline availability of highly processed food in the U.S. is higher, the products tend to be more aggressively formulated, and for many American consumers, the ultra-processed option is often the cheapest one on the shelf. The framing of the research puts it plainly: Americans are more often forced to choose between health and cost.

Regulation plays a role too. The EU and the U.S. take broadly similar approaches to food safety, both relying on risk assessment and management. But the details differ. Some additives, particularly certain synthetic food colorings, are approved in one jurisdiction but not the other, which means producers selling across both markets have to reformulate their products.⁸ The practical upshot is that the same brand-name product can contain different ingredients depending on which side of the Atlantic it is sold. Whether those specific regulatory differences translate into meaningful population-level health effects is debated, but they contribute to a food environment in the U.S. that is more permissive toward additives and ultra-processing.

How People Move Through Their Days

One of the starkest and least discussed differences between Americans and Europeans is how much daily physical activity people get just by going about their lives. Europeans walked nearly three times as far as Americans per year and cycled roughly five times as far, according to transportation data from 2000.⁹ That gap is not driven by Europeans being unusually athletic. It reflects the fact that European cities and towns are built in ways that make walking and cycling practical for everyday errands.

A direct comparison of Germany and the U.S. found that about 42 percent of Germans reported any walking as part of their daily travel by the late 2000s, compared with about 19 percent of Americans. For cycling, the numbers were roughly 14 percent in Germany versus under 2 percent in the U.S. Critically, there was much less variation by income, gender, and age in Germany: German women, children, and seniors walked and cycled far more than their American counterparts.¹⁰ In the U.S., active transportation is more concentrated among younger urban men with higher incomes, while in Germany it functions more as a default across the population.

The built environment drives much of this difference. American communities are frequently designed around automobile use, with little infrastructure for pedestrians or cyclists. Research has found that places built this way tend to have higher rates of physical inactivity, obesity, diabetes, heart disease, and stroke, while communities designed to encourage active transportation see a large segment of the population meeting physical activity guidelines through daily tasks alone.¹¹ This is not about gym memberships or deliberate exercise programs. It is about whether your daily routine involves moving your body or sitting in a car.

More Spending, Worse Results

Perhaps the most counterintuitive part of the US-European health comparison is the money. As of 2007, the U.S. was spending more than $7,200 per person on healthcare, more than twice what France, Germany, or the United Kingdom spent. Yet the improvement in deaths that could have been prevented through timely healthcare was about half as good in some American populations as in those European countries.¹² Americans under 65 had particularly high rates of amenable mortality, meaning deaths from conditions that good healthcare should be able to treat or prevent.

Between 2009 and 2019, this problem got worse. Avoidable mortality rose in every U.S. state, with a median increase of about 29 deaths per 100,000 people, while it fell in most high-income comparison countries by about 14 per 100,000. The variation across U.S. states also widened during this period, even as variation among comparison countries narrowed.³ This pattern suggests that the U.S. problem is not just about spending levels but about how the money translates into actual care and who has access to it.

Financial barriers are part of the explanation. Americans face a much higher risk of catastrophic medical expenses than people in countries with universal coverage. A comparison with Canada found that Americans were 1.5 to 4 times more likely to face large medical expenses depending on the demographic group, with the worst burden falling on the non-elderly poor, who had about a 27 percent chance of medical expenses exceeding 5 percent of their income compared to 11 percent for their Canadian counterparts.¹³ When healthcare costs act as a barrier, people delay treatment and preventive care, and treatable conditions become deadly ones.

Deaths of Despair

A category of mortality that has received growing attention is what researchers call “deaths of despair,” encompassing drug overdoses, alcohol-related deaths, and suicides. The United States ranks among the top ten countries globally for these deaths for both sexes. Between 2000 and 2019, five-year mortality rates from these causes increased by about 35 percent for American women and 21 percent for American men, driven overwhelmingly by rising drug-use mortality even as suicide rates declined slightly.¹⁴

Most Western European countries do not appear anywhere near the top of this ranking. While some Eastern European nations, particularly those with histories of high alcohol consumption, share some of these patterns, the crisis of drug-use mortality that has swept the United States has no real parallel in Western Europe. The opioid epidemic alone has shaved measurable time off American life expectancy, contributing to the unprecedented phenomenon of life expectancy actually declining in a wealthy country during a period of medical advancement.

Babies and New Mothers

The health gap starts at birth. The U.S. has higher infant mortality than most European countries, and the reasons are revealing. Research comparing the U.S. with European nations found that neonatal mortality, deaths in the first month, was similar across countries. The American disadvantage showed up in postneonatal mortality, deaths between one and twelve months, and it was driven by poor birth outcomes among lower socioeconomic status individuals.¹⁵ In other words, American hospitals are not worse at delivering babies or handling the immediate emergencies of the first weeks of life. The gap opens when families go home and face the realities of their economic circumstances and available support systems.

Paid family leave is one tangible policy difference that appears to matter. Research across OECD countries found that the adoption of paid maternity leave was associated with decreases of roughly 2 to 5 percent in infant, neonatal, and under-five mortality rates.¹⁶ The United States is the only wealthy nation without a national paid maternity leave policy, and while individual states and employers may offer their own programs, coverage is patchy and often does not reach the populations that would benefit most.

The Inequality Dimension

One consistent finding across the research is that health gaps between the U.S. and Europe are largest among the worst-off and smallest among the best-off. Wealthy, well-educated Americans can and do achieve health outcomes comparable to wealthy Europeans. The divergence shows up in the middle and bottom of the income distribution. A study of wealth-related health inequalities across the U.S. and 14 high-income countries found that while self-reported health varied with wealth in all countries, the U.S. demonstrated higher levels of inequality than its European counterparts, and those inequalities remained unchanged over the study period.¹⁷

This matters for understanding the comparison correctly. When someone asks whether Europeans are healthier than Americans, the honest answer depends partly on which Americans and which Europeans you are comparing. A high-income Chicagoan with good insurance and a walkable neighborhood may have health outcomes on par with a Parisian. A low-income resident of rural Mississippi faces a health landscape that looks more like a developing country. The American average is dragged down not because every American is unhealthy but because the floor is so much lower than in countries with stronger safety nets.

Europe Is Not One Country

It is worth pausing on the fact that “Europe” contains enormous health variation of its own. The comparison that dominates the research literature is between the U.S. and Western Europe, but Eastern and Central European countries tell a different story. During the communist era, Central and Eastern European countries developed a large life expectancy gap compared to Western Europe, with differences ranging from about 1 to 6 years for men and 1 to 3 years for women. A significant portion of that gap, between 11 and 50 percent for men and 24 to 59 percent for women, was attributable to deaths from conditions amenable to medical intervention.¹⁸

After the fall of communism, health trajectories diverged. Central European countries like the Czech Republic and Poland saw relatively immediate improvements, while the Baltic states initially stagnated or worsened. More recent data suggests a delayed positive impact of EU enlargement, with the Baltic countries making rapid progress after 2007, though the convergence process has been uneven. Estonia, Poland, and the Czech Republic stand out as health leaders in the region.¹⁹

Countries like Bulgaria, Romania, and parts of the former Soviet Union still have life expectancies below or comparable to the United States. When researchers compare the U.S. to “Europe,” they typically mean Western Europe or a curated list of high-income European countries. This is a legitimate comparison since those countries are America’s economic peers, but it is worth knowing that the European health advantage is a Western and Northern European story, not a continent-wide one.

The Mediterranean Factor

Within Europe, some of the best health outcomes cluster around the Mediterranean. A large study of elderly Europeans found that adhering to a Mediterranean diet was associated with more than 50 percent lower rates of all-cause and cause-specific mortality, including deaths from heart disease and cancer. This held after controlling for age, sex, education, body weight, and other lifestyle factors.²⁰

Countries like Spain, Italy, and France consistently rank among the longest-lived in the world, and their dietary traditions, rich in olive oil, vegetables, legumes, fish, and moderate wine, are a commonly cited reason. But the Mediterranean advantage is not purely about food. These countries also tend to have strong social networks, walkable towns, universal healthcare, and cultural norms around eating that discourage the kind of isolated, rapid, convenience-food consumption that characterizes much of American eating. Teasing apart the contribution of diet from other lifestyle and structural factors is difficult, but the dietary component alone appears to be substantial.

Medicating Youth

One area where the US-European divergence is particularly striking, and where the implications remain contested, is the use of psychotropic medications in children and adolescents. A comparison across the U.S., the Netherlands, and Germany found that the annual prevalence of any psychotropic medication use in youth was about 6.7 percent in the U.S., compared to 2.9 percent in the Netherlands and 2.0 percent in Germany. American children were three or more times as likely to be on antidepressants or stimulants and about 1.5 to 2 times as likely to be on antipsychotics.²¹

Whether this reflects over-diagnosis and over-medication in the U.S., under-diagnosis in Europe, or some combination of the two is genuinely unresolved. American clinical culture tends to lean more heavily on pharmaceutical intervention, while many European systems emphasize psychotherapy and behavioral approaches as first-line treatment for conditions like ADHD and childhood depression. The question of which approach produces better long-term outcomes has no clean answer yet, but the scale of the difference is hard to ignore and speaks to fundamentally different philosophies about how to manage health, even in childhood.

Disability-Free Years

Living longer is only part of the picture. How many of those years are spent in good health matters just as much to the people living them. Research comparing England and the United States using harmonized data found that in both countries, sensory impairments like poor vision and hearing were associated with substantially shorter disability-free life expectancy. At age 50, men and women with both vision and hearing impairments could expect to live up to 12 fewer disability-free years compared to those without impairments, and the pattern was similar in both countries.²²

The finding that some specific health relationships look similar on both sides of the Atlantic is itself informative. It suggests the American disadvantage is not about some unique biological vulnerability or an across-the-board difference in every health pathway. Rather, the gap is concentrated in the areas where policy, environment, and social structures diverge most sharply: chronic disease management, access to care, the built environment, food systems, and the social safety net. Where those structural factors are comparable, health outcomes tend to converge. Where they differ, which is often, Americans come out worse.

1
PubMed Central. Falling Behind: The Growing Gap in Life Expectancy Between the United States and Other Countries, 1933-2021
2
PubMed Central. Differences in Health between Americans and Western Europeans: Effects on Longevity and Public Finance
3
JAMA Internal Medicine. Avoidable Mortality Across US States and High-Income Countries
4
PubMed Central. Disease Incidence and Mortality Among Older Americans and Europeans
5
PubMed. Differences in disease prevalence as a source of the U.S.-European health care spending gap
6
medRxiv. Ultra-processed food staples dominate mainstream U.S. supermarkets. Americans more than Europeans forced to choose between health and cost
7
PubMed Central. Ultra-processed food consumption in adults across Europe
8
Food Additives & Contaminants: Part A. Comparison of food colour regulations in the EU and the US: a review of current provisions
9
PubMed. Walking, cycling, and obesity rates in Europe, North America, and Australia
10
American Journal of Preventive Medicine. Active Travel in Germany and the U.S.: Contributions of Daily Walking and Cycling to Physical Activity
11
Kinesiology Review. Encouraging Physical Activity and Health Through Active Transportation
12
PubMed Central. Commentary on “In Amenable Mortality – Deaths Avoidable Through Health Care – Progress in the US Lags That of Three European Countries”
13
PubMed Central. The financial burden of out-of-pocket expenses in the United States and Canada: How different is the United States?
14
Public Health. Deaths of despair-associated mortality rates globally: a 2000-2019 sex-specific disparities analysis
15
PubMed Central. Why Is Infant Mortality Higher in the United States Than in Europe?
16
PubMed Central. Paid family leave and children health outcomes in OECD countries
17
PubMed Central. Wealth-related inequalities in self-reported health status in the United States and 14 high-income countries
18
PubMed. The East-West life expectancy gap: differences in mortality from conditions amenable to medical intervention
19
Comparative Population Studies. Is East-West Life Expectancy Gap Narrowing in the Enlarged European Union?
20
JAMA: The Journal of the American Medical Association. Mediterranean Diet, Lifestyle Factors, and 10-year Mortality in Elderly European Men and Women. The HALE Project
21
PubMed Central. A three-country comparison of psychotropic medication prevalence in youth
22
Innovation in Aging. Vision and Hearing Impairments in Relation to Disability-Free Life Expectancy in People From England and the United States