Why Has U.S. Life Expectancy Fallen Below Other Countries?

Life expectancy at age 65 in the United States and other high-income countries has increased dra­matically over the last 50 years. But progress in the United States on this key health indicator has been slower than its peers during this period, and the U.S. ranking has dropped from near the top of the group to the bottom. How long people live has significant implications not only for their well-being but also for the finances of the Social Security program. Thus, understanding the reasons for the relatively slow pace of improvement is necessary to provide some basis for future projections. This brief compares U.S. life expectancy, separately for men and women, to nine other countries in the Organization for Economic Cooperation and Devel­opment (OECD). It focuses on two factors that may have contributed to the U.S.’s relatively poor perfor­mance: smoking and obesity. This brief is the second of two on mortality; the first explored trends within the United States. The discussion proceeds as follows. The first section looks at trends in life expectancy at age 65 across countries and finds that the major source of the U.S. shortfall rests with women. The second sec­tion explores whether the shortfall could be explained by the unique aspects of the U.S. health care system and concludes that these differences probably have had little impact. The third section reports cause-of-death statistics that suggest diseases associated with smoking and obesity are the major sources of the U.S. shortfall. The fourth section compares U.S. smoking and obesity patterns to those of other countries. The fifth section isolates the impact of smoking and obe­sity on life expectancy using regression analysis. The results show that, if U.S. patterns had matched those of its peer countries, U.S. life expectancy would have exceeded the average until very recently. The final section concludes that the relative performance of U.S. life expectancy in the future depends on control­ling obesity.