By most major health metrics, the United States performs significantly worse than other wealthy nations, despite spending far more on healthcare. Americans live shorter lives, have higher rates of chronic disease, and are more likely to die from conditions that are preventable or treatable elsewhere. The gap is not small, and in several areas it has been widening.
Americans Die Younger Than Their Peers
Life expectancy in the US falls between 75 and 80 years, placing it in the bottom tier of the 38 OECD member countries. The OECD average was 81.1 years in 2023, and 27 member nations exceeded 80 years, led by Spain, Japan, and Switzerland. The US sits in a smaller group that falls short of that threshold.
This gap didn’t appear overnight. Life expectancy gains in the US slowed compared to historical trends even before the pandemic, partly driven by opioid-related deaths among working-age adults. While other wealthy countries experienced a similar slowdown, the US started from a lower baseline and lost more ground.
Chronic Disease Rates Dwarf Other Countries
The US has dramatically higher rates of the diseases that drive disability and early death. Compared to the average of peer nations, the US has 2.4 times the rate of obesity, twice the rate of diabetes, 1.7 times the rate of asthma, and 1.3 times the rate of depression. These aren’t marginal differences.
Diabetes is a clear example. In 2022, 12.5% of American adults had diabetes, compared to an average of 6.1% in comparable countries. Hypertension affects about 32% of US adults, a number that has held steady for three decades while peer nations have seen their average decline to around 28.6%. Uncontrolled high blood pressure is a direct pathway to heart attack, stroke, and kidney failure, so that persistent gap translates into real consequences downstream.
What Americans Eat Plays a Major Role
One reason chronic disease rates are so high: the American diet leans heavily on ultra-processed foods. Roughly 60% of the calories Americans consume come from ultra-processed products like packaged snacks, sugary drinks, frozen meals, and fast food. Across Europe, that figure averages about 27%. That’s more than double the exposure to foods linked to obesity, type 2 diabetes, heart disease, and certain cancers.
This isn’t just about individual choices. The US food environment is structured around cheap, calorie-dense processed products. They’re the most affordable, most available, and most heavily marketed options in many communities, particularly lower-income ones.
The US Spends More and Gets Less
Perhaps the most striking comparison involves money. In 2018, the US spent $11,172 per person on healthcare. The median OECD country, Finland, spent $4,338. Even Switzerland, one of the most expensive healthcare systems in the world, spent $7,702 per person, roughly 69% of the US figure. The US outspends every other nation by a wide margin, yet its population is sicker and dies younger.
Where does that money go? Not primarily to better outcomes. Administrative costs, drug pricing, and high procedure fees consume a large share. Meanwhile, 8.5% of Americans reported delaying or skipping needed medical care due to cost in 2019. Among working-age adults (18 to 64), that number was 12.1%. In countries with universal coverage, cost is rarely a reason people avoid the doctor.
More Deaths That Didn’t Have to Happen
Avoidable mortality captures deaths that could have been prevented through public health measures or treated with timely medical care. It’s one of the clearest indicators of how well a health system actually protects its population. In 2019, the median avoidable mortality rate across US states was 282.8 per 100,000 people. In comparable high-income countries, it was 187.1 per 100,000.
That means roughly 50% more Americans die from conditions that other wealthy countries successfully prevent or treat. And the trend is moving in the wrong direction. Between 2009 and 2019, the variation in avoidable death rates across US states widened, while it narrowed among peer countries. Some states improved, but others fell further behind, and the national picture grew more unequal. Other countries were converging on better outcomes while the US was diverging.
Maternal Health Tells a Similar Story
The US is an outlier among wealthy nations for maternal deaths. Between 2007 and 2016, the pregnancy-related death rate was 16.7 per 100,000 live births for all US women. Most Western European countries and Japan report rates between 2 and 10 per 100,000. The racial disparity within the US makes the picture even starker: Black women died at a rate of 40.8 per 100,000 live births during that same period, more than three times the rate for white women (12.7 per 100,000).
These numbers reflect gaps in prenatal care access, insurance coverage, chronic disease burden going into pregnancy, and the quality of postpartum follow-up. In countries with universal healthcare and stronger social safety nets, many of these deaths simply don’t occur.
Why the Gap Exists
No single factor explains the US health disadvantage. It’s a combination of overlapping problems that reinforce each other. Higher chronic disease rates drive up healthcare costs. High costs make care less accessible. Less accessible care means chronic diseases go unmanaged. Meanwhile, the food environment fuels obesity and diabetes at rates no other wealthy country experiences.
The US also lacks several structural features that healthier countries share: universal health coverage, stronger regulation of food and tobacco industries, more robust paid leave and social support programs, and public health systems with consistent funding. Health in the US is also more unequal than in peer countries. Where you live, how much you earn, and your race all predict your health outcomes to a degree that is unusual among wealthy nations. The result is a country that spends more per person on healthcare than anywhere else in the world, yet falls behind on nearly every measure that counts.