Opinion, Berkeley Blogs

We’re # last!

By Claude Fischer

emergency room

If you ask young Americans how good their health is, they’ll tell you it’s great. The U.S. ranks #1 among 17 affluent, western countries in that regard, in the percentage of people aged 5 to 34 who rate their health as good. Unfortunately, when doctors look at people’s actual health, at indicators such as obesity, diabetes, and simply the chance that someone will die before his or her next birthday, the U.S. ranks last: young Americans are #17 out of 17 in real health.

emergency room

The National Research Council and the National Institute of Medicine – the nation’s go-to sources for the best scientific assessments we have – recently issued a report entitled U.S. Health in International Perspective: Shorter Lives, Poorer Health. Although the press conveyed the punch line – “Younger Americans die earlier and live in poorer health than their counterparts in other developed countries” – your humble correspondent has looked through much of the 350+ pages and is here to report: It’s even worse than that.

The study’s findings signal how much the U.S. has slipped behind the rest of the advanced world in the last 40 years. And it exposes the disconnection between Americans’ pride and Americans’ reality.

The facts

As of the latest international data, a newborn’s life expectancy in the United States is 75.6 years for boys, 17th out of 17 countries [p. 39]. (Swiss, Australian, and Japanese boys live longest.) Life expectancy for newborn girls here is 80.8 years — 16th of out 17. (We are just above the Danes, while Japanese, French and Swiss girls live longest.) Since 1980, the U.S. dropped from the middle of the western pack in life expectancy to the bottom [pp. 42-43]. Moreover, America’s infant mortality rate, once better than the western average, is now notably worse than average [p. 68].

Most striking, the U.S. has been falling behind specifically in the life expectancy of those aged 50 and under [pp. 44ff]. Our seniors, especially those older than 80, are actually doing pretty well. They live as long, on average, as the elderly in comparable countries; and Americans 95 or older are #1 in the chances of getting to 100 [p. 48]. But it is our kids and young adults who have really fallen behind other westerners. Estimates of how many years of life, on average, people under 50 lose shows how exceptional we are. See the figure below for males; the absolute number of years lost for females is less, but the American women are also at the bottom [p. 50].


Young Americans are at greater risk of dying than young people in these other nations no matter what the specific cause of death is, although deaths by violence, accidents, and drugs stand out [pp. 48ff].

The health of those Americans who do survive also tends to rank at the bottom [pp. 62ff]. Rates of obesity, rates of diabetes, and glucose levels are way worse here (blood pressure rates, however, are pretty good). Americans are unusually likely to be the victims of transportation accidents and violence [pp. 75-76]. There is some evidence, although not as clear, that Americans suffer from higher rates of mental illness than people in comparable nations [pp. 85ff].

Nonetheless, as I noted above, young Americans are #1 in rating their health as good or better [pp. 61-2]. USA! USA!

There are a few areas in which Americans really do do better than the western average: we have lower rates of suicide and cancer, for example. But, overall, we are doing miserably. And, while poorer Americans are particularly worse off than poorer people elsewhere, “several studies have found that even the most advantaged Americans may be faring worse than their counterparts in other countries” [p. 89].

We are # Last.


Take note: The U.S. numbers are not bad because of our minorities. When the researchers looked just at non-Hispanic whites, the U.S. rankings “hardly changed” [pp. 43, 49].

Many aspects of nations, from how they provide health services to their general values, may explain variations in their people’s health. No definitive answer explains why younger Americans are doing so badly, but the following issues rise to special attention in the report:

  • getting health care depends more on the market and on each person’s financial resources in the U.S. than elsewhere [pp. 113ff];
  • while the U.S. has many specialist physicians, we have “fewer practicing physicians per capita,” and “less access to primary care” [p. 134];
  • Americans’ eating habits account for much of the longevity gap [p. 146];
  • our road habits contribute a lot to the gap: we use seatbelts and motorcycle helmets less, drive drunk more [p. 155], and are more lenient with speeders [pp. 226ff];
  • gun ownership: Americans are probably not more violent on average than other westerners are, but, with so much more widespread arms ownership, violence here is more traumatic and lethal [pp. 156ff];
  • the U.S.’s exceptionally high rate of poverty, especially child poverty, is part of the story [pp. 171ff];
  • as may be our high rates of single-parent households [p. 184ff].
  • Clearly, there are many explanations and probably several are true. The NRC-NIM researchers wondered whether there was a common denominator to them. Plausibly, the U.S. insistence on individual self-reliance, free-market solutions, resistance to centralized authority, and suspicion of the state – that is, American voluntarism – underlies much of this. Even our poor eating habits might be the result of our refusal to allow government (the “nanny state”) to guide our food practices [Ch. 8].

    In any event, Americans’ health is falling further and further behind those of other western nations – an historically new development of the last few decades. These findings are consistent with other findings, noted in an earlier blog post, that Americans are falling behind Europeans in physical stature, too.


    The well-known, liberal-turned-neoconservative intellectual, Norman Podhoretz,wrote in 2009 that the “complex of traditions, principles and institutions” of the United States “has afforded . . . more prosperity to more of its citizens than in any society in human history.”

    Had he written that line in 1909, or in 1959, or maybe even in 1979, the statement would probably be uncontested. By 2009, it was false bravado. If Podhoretz meant by “prosperity” simply material wealth like owning cars and large homes, he may still be right. But if we mean prosperity more broadly as the good life, he is not.

    Whereas Americans used to live longer and stronger lives than our European counterparts, we have been lapped by the Old World. Maybe we need to think again about our “complex of traditions, principles and institutions.”

    Cross-posted from Claude Fischer's blog, Made in America (tag line: "Notes on American life from American history").