Life and Death in the United States: A Costly Anomaly

By Joseph Chamie
PORTLAND, USA, May 6 2025 – On the crucial matters of life and death, the United States is a costly anomaly. Simply stated, women and men in the US pay more​ for health but get less​ life.

Although the United States has the highest healthcare costs per capita among developed countries, it does poorly compared to other developed countries on the vital issues of life and death.

The US spends close to twice the amount on healthcare per capita as other developed nations. In 2023, for example, the United States spent approximately $13,400 per person on healthcare, while the comparable average for other OECD countries was about $7,400 (Figure 1).

Source: OECD.

Even with its high healthcare expenditures, the US continues to lag behind other developed countries on virtually every measure of the chances of dying and living, including preventable and treatable deaths.

Despite the US paying high​er healthcare costs per capita​ than other developed countries, men and women in the United States are ending up with higher death rates and shorter lives than their peers abroad
The poor standing of the United States on measures of life and death persists despite the US having: (1) the world’s largest economy; (2) the most powerful military; (3) the third largest land area, population and workforce; (4) enormous amounts of resources; (5) a highly educated population; (5) a top migration destination; and (6) higher expenditures on health care per capita than other developed countries.

Starting at birth, the comparatively poor standing of the United States on matters of life and death is strikingly evident. The US has a higher infant mortality rate than the majority of other developed countries.

In 2023, the US ranked 33rd out of 38 OECD countries in terms of infant mortality. The US infant mortality rate of 5.6 deaths per 1,000 live births, which in 2023 resulted in 20,162 infant deaths, is more than three times the infant mortality rates of Japan, Norway and Sweden, which were about 1.7 deaths per 1,000 live births.

If the US had experienced an infant mortality rate of any of those three countries in 2023, the number of infant deaths would have been about 6,113, or 30% of the actual number of infant deaths.

Regarding maternal deaths, the United States also has one of the highest maternal mortality rates among wealthy nations. Its standing on maternal mortality is well below other developed countries, ranking 30th among OECD countries. In 2021, the US maternal mortality rate was three times the OECD average, i.e., 33 deaths per 100,000 versus 11 deaths per 100,000.

Furthermore, the life expectancy at birth of the United States ranks at about 32nd among OECD countries. In 2023, the US had a life expectancy of about 78 years, compared to an average of about 83 years among peer countries. The US life expectancy at birth is well behind countries such as Canada, France, Japan, Sweden and Switzerland (Figure 2).

Source: OECD.

It is the case that life expectancy at birth varies considerably across the large territory of the United States. Nevertheless, the life expectancies of all 50 US states fall below the average for comparable developed countries.

With respect to premature death before age 70 years, the US level is substantially higher than those of other developed countries. In 2021, the premature death rate before age 70 years of the United States was approximately twice the average for similar wealthy countries, i.e., 408 versus 228 per 100,000 people below age 70 years.

In the ages 25 to 29 years, men and women in the US experience death rates nearly three times higher than their counterparts in other developed countries. In particular, men and women in the United States are almost twice as likely as those in peer countries to die of cardiovascular diseases before age 70.

Also, US death rates from chronic diseases of the liver, kidneys and respiratory system as well as diabetes are increasing, especially among young people. In contrast, the death rates from those diseases in other developed countries have generally not changed or decreased during the recent past.

The reasons for the increase in chronic diseases among young people in the US are believed to be related to health behavior. For example, the prevalence of diabetes is strongly influenced by diet, respiratory diseases are linked to smoking and chronic liver conditions often result from heavy alcohol consumption.

The poor standing of the United States on the chances of survival continues well into old age. With respect to life expectancy at age 65 years, for example, the US is ranked 30th among OECD countries. Again, the US level is well below the life expectancies at age 65 years of other developed countries, including Australia, Canada, France, Japan, Sweden and Switzerland.

Many societal, communal, institutional and cultural factors influence life and death outcomes across the United States. Income, inequalities, access to healthcare, delays for care, lack of health insurance coverage, costs, affordability, shortages of healthcare professionals, administrative complexities and related shortcomings within the healthcare system are certainly critical determinants of survival outcomes and longevity in the US.

Moreover, the United States continues to be in a class by itself in the underperformance of its healthcare sector.

That underperformance is expected to worsen in the near future with the US administration’s proposed tax reduction legislation disproportionally going to the rich that is to be partially offset by huge cuts in Medicaid healthcare coverage, food assistance and related programs aimed at people with limited income, resources and security.

In contrast to the underperformance of the US healthcare, many high-income developed countries have found ways to meet most of the basic healthcare needs of its citizens, including universal coverage.

In addition to the shortcomings of the US healthcare sector, health behavior, including cigarette smoking, alcohol misuse, illicit drug use, motor vehicle crashes, firearms deaths, violence including homicides, obesity and the lack of exercise, also affect preventable deaths and average lifespans.

With respect to health behavior, men and women in the United States are doing relatively poorly in comparison to their peers in other developed countries. In terms of obesity, for example, the US level of approximately 42% is the highest among OECD countries with the percentages of many countries being a fraction of the US level, including Italy, Japan and South Korea, all at less than 10 percent.

In terms of daily food consumption, the United States consumes more calories and sugar per capita than any other OECD country. The US also has the highest level of ultra processed food consumption in the world, estimated to account for approximately half of the calorie intake of the average person in the United States.

Regarding motor vehicle crashes, the United States has one of the highest motor vehicle death rates among OECD countries. Among the reasons believed to account for the higher vehicle fatality rate of the US are distracted driving, speeding and impaired driving.

In 2022, for example, the US fatality rate from registered motor vehicles was one of the highest among OECD countries. The motor vehicle fatality rates of some OECD countries, such as Canada, Denmark, Italy, Japan, Sweden and the UK, were less than half of the US rate (Figure 3).

Source: OECD.

In sum, despite the US paying high​er healthcare costs per capita​ than other developed countries, men and women in the United States are ending up with higher death rates and shorter lives than their peers abroad. Moreover, considering the recent actions and proposed legislation of the US government, the existing healthcare system and the health behavior of the country’s population, the anomaly of healthcare costs and length of life in the United States is not likely to improve any time soon.

Joseph Chamie is a consulting demographer, a former director of the United Nations Population Division and author of numerous publications on population issues, including his recent book, “Population Levels, Trends, and Differentials”.